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Cancer Deaths Continue Downward Trend in NC, US


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By Rose Hoban

An IV chemotherapy bag hangs in the chemo wards at the North Carolina Cancer Hospital in Chapel Hill.

An IV chemotherapy bag hangs in the treatment ward at the North Carolina Cancer Hospital in Chapel Hill. Photo credit: Rose Hoban

New numbers compiled by the Centers for Disease Control and Prevention show deaths from cancer are dropping around the South, along with the rest of the United States.

For decades, cancer death rates climbed slowly until about 1990, when the trend started to turn around. Since that time, deaths from cancer have steadily decreased.

Ruth Petersen, who leads cancer prevention efforts for the Department of Health and Human Services said the decrease is the result of a complicated group effort.

“I think the public health and environmental experts who are working on reducing risk are winning, the medical community is winning and the primary care and oncology teams at the cancer hospitals are winning,” she said.

Petersen said reductions in tobacco use and reductions in exposure to second-hand smoke are starting to bear fruit.

There’s also reduced risk as a result of environmental radon in houses, she said.

Geography of deaths from all cancers in North Carolina, 2008-2013.

Geography of deaths from all cancers in North Carolina, 2008-2013. Map courtesy: NC Center for Health Statistics.

“In areas in North Carolina where we know we have radon, the environmental folks are making headway on changing building codes so you don’t get radon exposure in your house,” Petersen said.

Radon exposure is the second leading cause of lung cancer in the United States, behind smoking. Researchers at the National Cancer Institute estimate 15,000 to 22,000 lung cancer deaths in the U.S. each year are related to radon.

Electronic medical records help out

“It’s wonderful that doctors are working hard to get screening and diagnostic exams done for their patients,” she said, noting that the ways that medical practice has changed supports reminding doctors to remind patients to get patients screened.

Like what you read on NC Health News? Help make it possible. Make a donation today. As little as $5/ month will help keep us going!For example, if a patient who is 50, or 60 comes into a doctor’s office who has never had a colonoscopy, the electronic medical records give the doctors an alert.

“The burden is on the computer system to remember, not the individual providers,” she said, noting that more providers are following evidence-based guidelines created by the U.S. Preventive Services Task Force.

Cancer care has also improved across the state, made easier by patients who screened sooner to get treated sooner before cancers are too advanced.

“The cancer hospitals are the ones doing the last ditch efforts for saving those people and getting those people back into the community,” she said.

Age-Adjusted Death Rates* from Cancer by U.S. Census Region and Year, Data and image courtesy: CDC

Age-Adjusted Death Rates* from Cancer by U.S. Census Region and Year, Data and image courtesy: CDC

Far to go

But the CDC data also show that Southern states also lag behind states in the West and Northeast in cancer mortality. At the beginning of the 1970s, rates were highest in the Northeast, but since the late 1990s, rates in the South and Midwest have been higher.

“In our statistics we show that 140 people a day are newly diagnosed with cancer in North Carolina, and 50 people lose their lives,” Petersen said.

She said part of that persistent lagging behind other states is due to some “hot spots” of disease in the state, which tend to also happen to be in areas of high poverty: in the east, in border counties, and in the far west.

She said one of the goals of the recent North Carolina Cancer Plan is to get into counties where there are pockets of cancer and get more people screened earlier.

“That will require boots on the ground with people who know those populations and areas,” including local health departments, community activists and local health providers, Petersen said. “It has to be concerted effort, with a commitment made to find those individuals who are at risk.”

She said the American Cancer Society has made a pledge to get 80 percent of the people who need screening for colorectal cancer screened for the disease by 2018.

Cancer screening, prevention, treatment and support resources in N.C.

American Cancer Society – Need information about cancer prevention, screening or cancer treatment?
Shop Tobacco Free – Want to support stores and companies that have gone tobacco free? The Campaign for Tobacco Free Kids has a new tool to help you do it.
http://shoptobaccofree.org/

NC Quitline – Want help quitting smoking?
http://www.quitlineNC.com

ClinicalTrials.Gov Research Information – Have cancer? You can participate in a clinical trial.

Celebrating 25 Years of the Americans With Disabilities Act


Aside from movement on the ABLE Act (see today’s other story), advocates for people with disabilities have another reason to celebrate this week: July 26 is the 25th birthday of the Americans with Disabilities Act, which was signed into law by President George H..W. Bush in 1990.

There wasn’t a cake, but there were balloons and refreshments at a “birthday party” held at the N.C. Museum of Natural Sciences, where advocates presented the Triangle Access Awards, which honor people who have made strides in helping people with disabilities.

“This is the signature event for the Alliance of Disability Advocates,” said Chris Evans, head of the N.C. Council on Developmental Disabilities, another group that collaborated on the event and is coordinating events around the state.

“It really recognizes strides made in this area, with local businesses and individuals promoting the ADA,” Evans said.

DHHS Secretary Aldona Wos praised winners of the   Photo credit: Rose Hoban

DHHS Sec. Aldona Wos praised winners of the annual advocacy awards. Photo credit: Rose Hoban

The categories for the awards include honoring efforts to improve communication for people with disabilities, remove architectural barriers, advance technologies that help people with disabilities and create opportunities for people with disabilities. Most significantly, the awards honor efforts to change attitudes about disability.

“Each of you helped to uphold the principles of the ADA by working to create an inclusive environment,” said state Health and Human Services Sec. Aldona Wos, who attended the event and read a declaration from Gov. Pat McCrory naming Tuesday “ADA Day.”

Wos noted that while there’s been a lot of progress, there is still stigma that keeps people with disabilities from achieving what they want to in life.

In particular, employment remains a big issue for people with disabilities.

“Depending on what statistics you look at, at least 80 percent of people with developmental and other disabilities remain unemployed or underemployed,” Evans said. “So while we made a lot of progress when it comes to awareness, access and opportunities for people, there are still areas where we have plenty to do.”

President George HW Bush signed the Americans with Disabilities Act into law on July 26, 1990

President George H.W. Bush signed the Americans with Disabilities Act into law on July 26, 1990.

Two of the award recipients were Sen. Tamara Barringer (R-Cary) and Rep. Marilyn Avila (R-Raleigh), who both have worked this legislative session to pass the ABLE Act along with other pieces of legislation that benefit people with disabilities.

Along with other individuals, awardees included the N.C. Coastal Pines chapter of the Girl Scouts; NCSU Housing Conference Services; the Goodwill Community Foundation’s Learn Free, which teaches computer and web skills online; the Contemporary Art Museum; the Durham Bulls Athletic Park; and Creativity in Motion, a program that provides individualized academic and dance instruction to kids with disabilities.

Bill Would Allow for Peewee ATV Operators


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Legislators are considering a provision that would allow 6-year-olds to operate certain all-terrain vehicles.

By Rachel Herzog

In North Carolina, a child must be 8 years old and have parental supervision to operate a small all-terrain vehicle. If a provision of House Bill 765 passes, they could be first-graders when they start driving.

A provision in the Senate regulatory reform bill would allow children as young as 6 years old to operate ATVs.

A provision in the Senate regulatory reform bill would allow children as young as 6 years old to operate ATVs. Photo credit: Frankie Leon, flickr creative commons

Currently, a North Carolina law passed in 2005 prohibits children under 8 years old from operating ATVs.

“The current standards were established after an 18-month study and a quite rigorous debate in both houses in the General Assembly,” said Tom Vitaglione, a senior fellow at child-advocacy group NC Child.

Between the law’s passage in 2005 and 2011, child ATV rider deaths fell by 59 percent, dropping from an average of eight deaths per year to five deaths, according to a report the North Carolina Child Fatality Prevention Team released in 2013.

“We felt that all of that process was really worth it, and the industry was part of that process,” Vitaglione said. “We think part of the reason why we dropped that by 59 percent was we got kids ages 6 and 7 off the machines.”

Vitaglione said the 8-year-old age restriction is a compromise between child health advocates and the specialty-vehicle industry.

“These machines are not easy to operate,” he said, explaining that engineers also recommend a more stringent age restriction. “They feel that younger people are not developmentally ready for the judgments that have to be made on these vehicles.”

Age appropriate?

The new proposed legislation is based on the national standard established by the U.S. Consumer Product Safety Commission, which limits use of ATVs with larger engine sizes (a 70-cubic-centimeter displacement or higher) to children 12 and over, but considers those with smaller engine sizes acceptable for children ages 6 to 11.

In 2006, more than 4,400 kids under 18 were admitted to the hospital with injuries from using ATVs.

According to research, in 2006 more than 4,400 kids under 18 were admitted to the hospital with injuries from riding ATVs. Photo credit: David Fulmer, flickr creative commons

“Our standards were different, which made it tough for the retailers to sell their equipment,” Sen. Andrew Brock (R-Mocksville) said. “In North Carolina, we’re just kind of tweaking what’s allowed to be sold and what the manufacturers are able to send here.”

Brock added that the ATVs 6- and 7-year olds would be allowed to operate would be small bikes that run slower than a two-wheeled bicycle or a 12-volt Barbie Jeep. The bikes manufactured for young children contain a restrictor plate that prevents them from going faster than 10 miles per hour and can be modified to increase the speed to 15 miles per hour.

“I can see parents getting more powerful equipment for younger bikers, which is more damaging, so this one’s kind of lining it up with the national standard,” Brock said, adding that he would be willing to drop the provision.

Vitaglione said the smaller bikes are still dangerous for young children.

“It also kind of loosens the way people think about things,” he said.

The new legislation would still require that children operating the ATVs be supervised, but Child Fatality Task Force Chair Karen McLeod said that’s not enough.

“While you may be able to watch the child or even ride with them, that risk is still in place,” McLeod said.

Vitaglione said he thinks a comprehensive study should be done before the legislation is passed, as was done before the current restriction was passed.

“It sounds dramatic, but we’re sort of betting on children’s lives here,” he said. “Why take any risk when all we have to do is slow down a few months and study this?”

The provision passed in the Senate and is waiting to be considered by the House.

Few North Carolinians Get Enough Fruits and Veggies


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By Rose Hoban

New data from federal public health authorities show that only about one 10 people in North Carolina eat a healthy amount of fruits and vegetables.

Surveys done by the Centers for Disease Control and Prevention between 2007 and 2010 show that, on average, North Carolinians ate only one serving of fruit and 1.7 servings of vegetables every day.

The corner store at North Roxboro and Geer Streets in Old North Durham has embraced selling healthy food alongside beer and lottery tickets.

The corner store at North Roxboro and Geer streets in Old North Durham has embraced selling healthy food alongside beer and lottery tickets. If HB 250 passes the Senate, more corner stores around the state would have the opportunity to do the same. Nutrition experts recommend that people eat a total of about five servings of fruits and vegetables combined each day. The CDC recommends adults who do less than 30 minutes of moderate activity daily should eat between 1.5–2 cups of fruit and 2–3 cups of vegetables. Photo credit: Rose Hoban

 

The surveys also show that only about 10 percent of people in North Carolina ate the recommended amounts of fruits, and about 7 percent ate the recommended about of vegetables.

Tar Heels’ intake of fruits and vegetables means North Carolina is stuck in the bottom quarter of states when it comes to eating healthy foods. The state with the highest intake of fruits and vegetables was California, where people ate, on average, more than three and a half cups of fresh produce daily.

The information came from the Behavioral Risk Factor Surveillance System, an annual survey that asks people about their habits, from smoking and drinking to exercise and nutrition.

CDC nutritionists concluded in their report that new efforts are needed to encourage consumer demand for fruits and vegetables “through competitive pricing, placement, and promotion in child care, schools, grocery stores, communities, and worksites.”

A bill making its way through the General Assembly would do just that: HB 250 provides $1 million for hundreds of small corner stores around the state to buy low-cost equipment to stock fresh fruits and vegetables. The funds would be targeted to areas designated as “food deserts,” which are areas designated by the U.S. Department of Agriculture as urban neighborhoods and rural towns without ready access to fresh, healthy and affordable food.

The bill has passed the House of Representatives and has been funded in the House budget. But since being sent to the Senate in June, legislators in that chamber have taken no action on the measure.

The Senate also eliminated the state’s Physical Activity and Nutrition Branch of the Division of Public Health, a move that some public health experts worry will impede the state’s progress in getting people to adopt healthier lifestyles.

Using Job Training as a Path to Sobriety


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Career training programs have been shown to vastly improve a person’s chances of staying clean and sober.

By Christine Vestal

Stateline

At 52, Dajaun Alexander says he’s looking for a fresh start. He graduated from a cooking course here last week and has been chosen for a paid apprenticeship. His prospects for a full-time job after that are very good, his chef instructor said.

For Alexander, completing Community Servings’ 12-week course represents a rare achievement in a life punctuated by what he calls “bad decisions.” He is a recovering alcoholic with a history of incarcerations, broken relationships and spotty employment. Cooking, he said, “is my passion.”

Trainees learn safe food preparation and handling skills at the IFFS

Trainees learn safe food preparation and handling skills at Raleigh’s Inter Faith Food Shuttle. Photo credit: Hyun Namkoong

It may also be his path to sobriety.

The local food-preparation facility where Alexander trained is part of a national program known as Access to Recovery. The voucher program, launched in 2003 and currently funded at $100 million per year, aims to help low-income people in recovery restart their lives and avoid relapse.

Eleven states receive ATR grants for services from addiction treatment to what is called recovery support.

“Treatment is only one aspect of recovery,” said Rebecca Starr, a senior behavioral health consultant at Advocates for Human Potential and ATR project director in Massachusetts. “You’re still in a terrible neighborhood. You still have no money. And you still need a job.

“When someone has completed treatment, we don’t want to put them right back in the same situation they came from and expect a different outcome.”

Because most residents have insurance under the state’s 2006 health care reform law, Massachusetts chose not to use its federal grant money to pay for addiction treatment. Instead, those funds go to what Starr calls a safety net for recovery.

In the greater Boston and Springfield areas, ATR serves low-income veterans, women who are pregnant or caring for young children and adults who have recently been released from jail or prison.

ATR programs vary widely by state. But all include vouchers for necessities like interview suits, sets of tools, car repairs and cellphones. Some participants put the money toward driver’s licenses or high school equivalency tests; others use it to set up a checking account.

In addition to the vouchers, each state has developed a set of services and a target population. Michigan, for example, serves only Native Americans and uses tribal healing methods. Illinois and Ohio focus on adolescents in the criminal justice system. North Carolina works with local universities to help college students with addictions.

But Massachusetts’ career building program stands out.

Employment and addiction

According to the U.S. Substance Abuse and Mental Health Services Administration, the federal agency that funds the state-run programs, “employment is both an outcome and a core component of recovery.”

Massachusetts began offering career training, the project director said, because extensive research showed that finding and keeping a full-time job was the most important indicator of success in overcoming drug and alcohol addiction.

The state’s own study over the last three years shows that participants who found employment were 40 percent more likely to remain sober, find stable housing, rejoin their families and friends and avoid incarceration during the six-month program. Studies show that employment improves self-esteem, confidence and morale, and decreases the risk of relapse.

Career training was slow to take off as an alternative to vouchers in Massachusetts, Starr said. Because most people coming into such programs lived in disarray, they couldn’t justify giving up vouchers for critical basic needs to work on the longer-term goal of finding a career.

“Then we had an aha moment,” Starr said of the moment she decided to let everyone have the vouchers (close to $900 per person) and opt into the career program separately. Participants were also given a work-study benefit: $8 an hour for attending classes.

Enrollment soared. In addition to food services, Massachusetts trains workers in construction, commercial cleaning, hospitality services and computers.

Massachusetts set aside a portion of its $8 million ATR grant for training – tuition at Community Servings’ culinary arts program, for example, is $5,000.

In its previous grant period, Massachusetts received more than $10 million. Nationwide, more states received grants in 2010 than in the most recent period, which began in September 2014, because SAMHSA has been winding down the ATR grant program and Congress said it would not re-fund it.

But Karen Pressman, planning director at the state Bureau of Substance Abuse Services, said the state will continue the best elements of the program using existing state resources. In addition, state lawmakers may consider appropriating new funds, she said.

Future possibilities

“ATR has given us a chance to try out some evidence-based practices and incorporate them into our overall systems for recovery,” Pressman said. “For a long time, we’ve known that people recover in many different ways. Treatment is one of those ways, but often people recover through other paths. We wanted to make sure we supported people in whatever path they chose to recovery.”

Career training may not be for everyone in recovery, particularly if they don’t have stable housing, Pressman said. But many people need to get a job right away to pay rent or make court-ordered payments. Allowing people to get paid while they learned new skills helped get more people into the program, she said.

Through its ATR grants, Massachusetts has built an infrastructure of providers like Community Servings who have been trained in how to work with people in recovery. They and others can provide services in the future if the state is able to find funding. Other ATR providers include certified addiction coaches, housing specialists and case managers.

For Alexander, a lanky man with expressive eyes and a timid demeanor, the phone call he got from Community Servings’ training director accepting him into the program may have been the break he needed.

“I thanked her a hundred times on the phone and a hundred times more when I met her,” he said.

His eyes welled up when he described the first day of class.

“We got a chance to meet the CEO and the executive chef and everyone in the kitchen. Each one talked to us. For me, it was inspirational,” he said. In addition to the cooking skills, Alexander said the ATR program has given him “a sense of direction.”

Since he left Boston’s South Bay House of Correction in October, Alexander has been living in a nearby homeless shelter. He’s on several waitlists for subsidized housing. For now, he said, his goal is to get a job cooking for the elderly in a nursing home or assisted living facility.

“My instructor says I should aim higher. But who’s to say? I could do a job cooking for a little while and I might get recognized as someone who could be an executive chef.”

Stateline is a nonpartisan, nonprofit news service of the Pew Charitable Trusts that provides daily reporting and analysis on trends in state policy.

States Looking to Limit Patient Costs for High-Priced Drugs

States are beginning to limit what patients pay out of pocket for expensive specialty drugs that treat serious, chronic diseases such as rheumatoid arthritis and multiple sclerosis.

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By Michael Ollove

Stateline

As more expensive specialty drugs come on the market to treat some of the most serious chronic diseases, more states are stepping in to cushion the financial pain for patients who need medicine that can cost up to hundreds of thousands of dollars a year.

At least seven states – Delaware, Louisiana, Maine, Maryland, Montana, New York and Vermont – limit the out-of-pocket payments of patients in private health plans. Montana, for instance, caps the amount that patients pay at $250 per prescription per month. Delaware, Maryland and Louisiana set the monthly limit at $150 and Vermont at $100. Maine sets an annual limit of $3,500 per drug.

Image courtesy StockMonkeys.com, flickr creative commons

Image courtesy StockMonkeys.com, flickr creative commons

New York prevents insurers from listing specialty drugs in a separate category that allows for charging higher payments out of pocket.

In an effort to hold down prices, legislators in other states, including California, Massachusetts and North Carolina, have proposed requiring companies to make broad financial disclosures justifying their high drug prices. So far, no such law has passed.

Critics of pharmaceutical pricing say that while the measures would help bring financial relief to some patients, they would fail to control spiraling drug prices set by drugmakers. As expensive specialty drugs proliferate, consumers likely will incur higher out-of-pocket payments and health insurance premiums.

“None of those measures is going to be very effective in my view because they don’t get at the underlying issue of how drug prices are set,” said John Rother, president and CEO of the National Coalition on Health Care, a nonprofit that focuses on improving health care while lowering costs.

Expensive class of drugs

Specialty drugs are in a class called biologics, extremely complex medicines made from organic materials. They are often used to treat serious, chronic diseases, including some advanced forms of cancer, autoimmune diseases such as rheumatoid arthritis and diseases of the central nervous system such as multiple sclerosis. They also are used to treat hepatitis C, which afflicts approximately 2.7 million Americans, according to the Centers for Disease Control and Prevention.

In most cases, biologics are far more effective and cause fewer side effects than conventional drugs, leaving patients with no alternative but to take them.

But the price for these drugs far exceeds that of conventional drugs, largely because they have little or no competition. They also require special handling, such as refrigeration, and often must be administered intravenously, adding to their costliness.

On average, biologics cost 22 times what conventional medicines do. A 2011 AARP Public Policy Institute report said that the average specialty medicine costs more than $34,550 for a year’s course of treatment.

“The cost of these drugs is simply unsustainable,” said Leigh Purvis, the institute’s director of health services research.

Biologics also are gaining a growing share of the prescription market. According to a report last year from Express Scripts, a large prescription-management company, specialty drugs already represent nearly a third of the spending on pharmaceuticals in the U.S., although they represent only 1 percent of all prescribed medications.

Express Scripts projects that within two years, spending on specialty drugs will account for $4.40 out of every $10 spent on medicine.

Coinsurance limits

At least seven states are tackling the problem of high out-of-pocket payments for expensive specialty drugs by limiting coinsurance payments.

Insurers use coinsurance and copayments to impose cost-sharing on beneficiaries. Copayments are a set price – often $5, $10 or $15 – that patients pay for medicine, whatever the cost of the drug. With coinsurance, patients are required to pay a percentage of the actual cost of the drug. That means that the higher the cost of the drug, the more the patient has to pay out of pocket.

Coinsurance payments for specialty drugs range nationally from 28 to 50 percent of the price of a drug, according to a 2013 policy paper by Chad Brooker, a lawyer with the Connecticut health exchange.

The state-imposed caps apply both to copayments and to coinsurance. They provide some price protection for the patients taking the drugs, but also spread the high cost of the drugs to a wider population of consumers in the form of higher insurance premiums.

“The caps don’t actually lower the costs of the medicine; it just raises the premiums for everyone,” said Rother of the National Coalition on Health Care.

Covered California, that state’s health exchange, this year became the first state exchange in the country to impose a coinsurance cap on specialty drugs of $250 per prescription per month.

James Scullary, a spokesman for Covered California, said the cap would result in an overall premium increase of no more than 1 percent in the first year and no more than 3 percent in the first three years.

New York has taken a slightly different approach. It won’t allow insurers to put biologics in their own special category of drugs. Insurers place medications in separate tiers depending on whether they are generics, preferred prescription drugs or specialty drugs. The higher the tier, the greater the cost-sharing burden for the patient. New York has prohibited the use of the specialty tier.

In Delaware, the state forbids insurers from putting all specialty drugs for a particular disease in the specialty tier, so that patients are given at least one lower-cost alternative.

Neither method gets around the problem of higher premiums for everyone, Rother said. He and other critics call for another method of setting the price of prescription medicine.

Right now, drug prices are set by manufacturers, subject to mandated discounts for various federal health plans and Medicaid and through negotiation with other health plans. Critics have argued for a system of pricing based on the relative effectiveness of each drug.

‘Shaming’ drugmakers

A bill currently before the California Assembly would require drugmakers to report their costs for the development and manufacture of any drug with a price tag of more than $10,000 for a course of treatment. Massachusetts and North Carolina are considering similar measures.

The purpose of disclosure measures is to create pressure on the drug companies to lower their prices, AARP’s Purvis said.

“It’s meant to be educational and also to be used in kind of a shaming way,” she said. “If the manufacturer can’t produce information that makes the prices seem justifiable, it may give people more ammunition to say that they’re not.”

The pharmaceutical industry argues that transparency laws, which it opposes, would not provide a fair representation of what it costs drugmakers to develop new drugs. For every drug that makes it to market, the industry says, nine or 10 do not. Nor would disclosure provide information on what costs patients would have to bear, it says.

“All of [the proposed transparency laws] would create an inaccurate and misleading overview of costs of providing treatment, and don’t provide information on costs patients will have to pay out of pocket,” said Priscilla VanderVeer, a spokeswoman for the Pharmaceutical Research and Manufacturers of America.

Medicare Slow to Adopt Telemedicine Due to Cost Concerns


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By Phil Galewitz

Kaiser Health News

Donna Miles didn’t feel like getting dressed and driving to her physician’s office or to a retailer’s health clinic near her Cincinnati home.

For several days, she had thought she had thrush, a mouth infection that made her tongue sore and discolored with raised white spots. When Miles, 68, awoke on a wintry February morning and the pain had not subsided, she decided to see a doctor.

So she turned on her computer and logged on to www.livehealth.com, a service offered by her Medicare Advantage plan, Anthem BlueCross BlueShield of Ohio. She spoke to a physician, who used her computer’s camera to peer into her mouth and then sent a prescription to her pharmacy.

Don Craft checks his blood pressure.

Don Craft , a patient in the Roanoke Chowan Community Health Center project, checks his blood pressure. Photo credit: Amy Adams Ellis/NCHN

“This was so easy,” Miles said.

For Medicare patients, it’s also incredibly rare.

Nearly 20 years after such videoconferencing technology has been available for health services, fewer than 1 percent of Medicare beneficiaries use it. Anthem and a University of Pittsburgh Medical Center health plan in western Pennsylvania are the only two Medicare Advantage insurers offering the virtual visits, and the traditional Medicare program has tightly limited telemedicine payments to certain rural areas.

And even there, the beneficiary must already be at a clinic, a rule that often defeats the goal of making care more convenient.

Congress has maintained such restrictions out of concern that the service might increase Medicare expenses. The Congressional Budget Office and other analysts have said giving seniors access to doctors online will encourage them to use more services, not replace costly visits to emergency rooms and urgent care centers.

In 2012, the latest year for which data are available, Medicare paid about $5 million for telemedicine services – barely a blip compared with the program’s total spending of $466 billion, according to a study in the journal Telemedicine.

“The very advantage of telehealth, its ability to make care convenient, is also potentially its Achilles’ heel,” Ateev Mehrotra, a Rand Corp. analyst, told a House Energy and Commerce subcommittee last year. “Telehealth may be ‘too convenient.’”

But the telemedicine industry says letting more beneficiaries get care online would reduce doctor visits and emergency care. Industry officials as well as the American Medical Association, the American Hospital Association and other health experts say it’s time for Congress to expand use of telemedicine in Medicare.

Popular outside Medicare

“There is no question that telemedicine is going to be an increasingly important portal for doctors and other providers to stay connected with patients,” former Surgeon General Richard Carmona said in an interview.

Some health experts say it’s disappointing that most seniors can’t take advantage of the benefit that many of their children have.

“Medicare beneficiaries are paying a huge price” for not having this benefit, said Jay Wolfson, a professor of public health, medicine and pharmacy at the University of South Florida in Tampa. For example, he said, telemedicine could help seniors with follow-up appointments that might be missed because of transportation problems.

Aetna and UnitedHealthcare cover telemedicine services for members younger than 65, regardless of whether enrollees live in the city or in the country. About 37 percent of large employers said that they expect to offer their employees a telemedicine benefit this year, according to a survey last year by Towers Watson, an employee benefits firm. About 800,000 online medical consultations will be done in 2015, according to the American Telemedicine Association, a trade group.

Medicare’s tight lid on telemedicine is showing signs of changing. In addition to Medicare Advantage plans, several Medicare accountable care organizations, or ACOs – groups of doctors and hospitals that coordinate patient care for at least 5,000 enrollees – have begun using the service.

Medicare Advantage plans have the option to offer telemedicine without the tight restrictions in the traditional Medicare program because they are paid a fixed amount by the federal government to care for seniors. As a result, Medicare is not directly paying for the telemedicine services; instead, the services are paid for through plan revenue.

Republicans and Democrats in Congress are also considering broadening the use of telemedicine; some of them tried unsuccessfully to add such provisions to the recent law that revamped Medicare doctor payment rules and to the House bill that seeks to streamline drug approvals.

‘Changing this dynamic’

This year, Medicare expanded telemedicine coverage for mental health services and annual wellness visits when done in certain rural areas and when the patient is at a doctor’s office or health clinic.

“Medicare .. is still laboring under a number of limitations that disincentivize telemedicine use,” said Jonathan Neufeld, clinical director of the Upper Midwest Telehealth Resource Center, an Indiana-based consortium of organizations involved in telemedicine. “But ACOs and other alternative payment methods have the possibility of changing this dynamic.”

AARP wants Congress to allow all Medicare beneficiaries to have coverage for telemedicine services, said Andrew Scholnick, a senior legislative representative for the lobbying group. “We would like to see a broader use of this service,” he said. He stressed that AARP prefers that Medicare patients use telemedicine in conjunction with seeing their regular doctor.

The American Medical Association has endorsed congressional efforts to change Medicare’s policy on telemedicine, as has the American Academy of Family Physicians. “We see the potential for it … to improve quality and lower costs,” said Robert Wergin, president of the academy and a family doctor in Milford, Neb. He said such technology can help patients who are disabled or don’t have easy transportation to the doctor’s office.

Anthem, which provides its telemedicine option to about 350,000 Medicare Advantage members in 12 states, expects the system to improve care and make it more affordable.

“It’s also about the consumer experience and giving consumers convenience to be able to be face to face with a doctor in less than 10 minutes, 365 days a year,” said John Jesser, an Anthem vice president. Anthem provides the service at no extra charge to its Medicare Advantage members.

While seniors are more likely to have more complicated health issues, telemedicine for them is no riskier than for younger patients, said Mia Finkelston, a family physician in Leonardtown, Md., who works with American Well, a firm that provides the technology behind Livehealth.com. That’s because the online doctors know when they can handle health issues and when to advise people to seek an in-person visit or head to the emergency room, she said.

“Our intent is not to replace their primary care physician, but to augment their care,” she said.

Kaiser Health News (KHN) is a nonprofit national health policy news service. KHN’s coverage of aging and long-term care issues is supported in part by a grant from The SCAN Foundation.

Advocates Urge Measures to Prevent Drunk Driving


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MADD leadership and volunteers gathered at the legislature to push for a law requiring ignition interlock devices for all convicted drunk drivers.

By Rachel Herzog

If new legislation is successful, advocates for tighter restrictions on drunk driving won’t have to hold their breath for much longer.

In 2007, North Carolina passed a law requiring repeat drunk driving offenders or first-time offenders with a blood alcohol concentration of 0.15 or greater to have ignition interlock devices installed in their cars. Those devices require drivers to pass a breath test before starting their cars.

MADD National President Colleen Sheehey-Church spoke at a press conference at the General Assembly Tuesday, calling for the passage of two bills to require ignition interlocks for all convicted drunk drivers.

MADD’s national president, Colleen Sheehey-Church, spoke at a press conference at the General Assembly Tuesday, calling for the passage of two bills to require ignition interlocks for all convicted drunk drivers. Photo credit: Rachel Herzog

Now 25 other states have laws that require first-time offenders with a BAC of 0.08 or greater to install the devices. The advocacy group Mothers Against Drunk Driving is pushing to make North Carolina the 26th by calling for the passage of two bills that would do the same thing.

“We’re looking to do this with all offenders first time out of the gate so we can help reduce the amount of people dying here,” MADD’s national president, Colleen Sheehey-Church, said in a press conference at the General Assembly Tuesday.

Not the first time

Why impose the device on first-time offenders?

“A majority of people who kill or injure others in drunk-driving crashes do not have prior conviction,” said Frank Harris, MADD’s director of state government affairs.

According to the Centers for Disease Control and Prevention, convicted drunk drivers have typically driven while impaired at least 80 times a year before being apprehended for the first time.

Get notifications of new NC Health News stories to your newsfeed – “like” us on Facebook today! “When you consider that for a first-time offense, it’s really not their first time,” MADD volunteer Luke Marcum, a police officer, said. “We want to eliminate the likelihood that they’re going to turn around and do this again.”

This is the second year MADD has tried to get this bill passed in North Carolina, Marcum said, adding that it already has a lot of support from the law enforcement community.

How it works

According to a study by the private nonprofit Transportation Research Board, 50 to 75 percent of convicted drunk drivers continue to drive with a suspended license.

A person with an ignition interlock device installed in their car must receive training for the proper technique, to prevent them from having someone else blow into the breathalyzer device or using compressed air.

A person with an ignition interlock device installed in their car must receive training in the proper technique. Photo credit: Rachel Herzog

“The ignition interlock is not necessarily a harsher sanction,” Harris said. “It’s a more effective sanction.”

An ignition interlock allows people to drive but eliminates the possibility they drive drunk while the device is installed.

“We totally understand that an ignition interlock may not be a silver bullet, but it is the best technology that we have today,” Sheehey-Church said. “It’s something that can help teach someone how to drive sober.”

The device contains a breathalyzer, which the driver must use to prove their sobriety before starting the car. It also requires a running retest, which the driver must blow at random intervals, typically about five minutes after the car is started and about 40 minutes to an hour later.

The process takes about 20 seconds, and the device gives the driver a few minutes to pull over for retests.

Worth the cost

According to the CDC, interlocks are effective in saving lives and reduce drunk driving repeat offenses by 67 percent.

The devices cost $2.50 per day to lease from an interlock vendor, or more than $900 for the year their license would be suspended. The convicted drunk driver pays for their own device, and if they can’t afford it funds from other interlock users cover the cost.

“If you’re arrested for a DUI in North Carolina today, you should probably go see your banker and get you a personal note for about $10,000,” DMV and law enforcement consultant Mike Robertson said. “You’re going to pay an attorney, you’re going to pay insurance, you’re going to pay for an interlock device.”

Bryce Little, market coordinator for ignition interlock provider Monitech, demonstrates how to use the device. People with the device installed must pass a breathalyzer test before starting their car.

Bryce Little, market coordinator for ignition interlock provider Monitech, demonstrates how to use the device. People with the device installed must pass a breathalyzer test before starting their car. Photo credit: Rachel Herzog

But while people generally aren’t thrilled about the expense and inconvenience, they may find interlocks helpful in the long run. Bryce Little, market coordinator for the North Carolina-based interlock provider Monitech, said for some people they serve as a safety net from letting alcohol control their lives.

“People need to get to work, they need to go and do things,” he said. “So what they’ll do is they’ll get an interlock if they get a DUI, and they’ll have to use it.”

“It can really help them get back on the road, help them get back in a place where they would like to be,” Little said.

House Bill 877 was referred to a judiciary committee on April 15, and Senate Bill 619 was referred to another judiciary committee on May 7.

“I think the caucus supports it, and I think that there will be some work to do to get some minor roadblocks dealt with,” said Rep. Jonathan Jordan (R-Jefferson), one of the bill’s primary sponsors. “I think we can do that.”

 

 

Federal Grant Will Help Thousands Recover from Substance Abuse


More than 4,000 people who are working to recovery from substance abuse disorders will have some extra help, thanks to a $7.8 million federal grant that’s coming to North Carolina.

The Department of Health and Human Services announced late Monday that the grant, from the federal Substance Abuse and Mental Health Services Administration, will be targeted at helping people get sober and back on their feet.

According to a press release from DHHS, the grant will focus on homeless people, people getting out of jail or prison for drug-related convictions and pregnant and parenting women, among others.

 Did you know NC Health News is a non-profit? Last year, a third of our funding came from readers. Please consider a donation today! “There are some dollars for things like medical, dental, vision,” said Terri Conyers, a service director at Recovery Communities of North Carolina, the agency that will be managing the three-year grant.

“Imagine you haven’t been to a dentist in five years, but you can get cleaning, X-rays, exams,” she said. “That’s huge for someone. It gives people some hope.”

The grant will go to support recovery services, a different approach to providing substance abuse services than in the past. As Conyers explained it, recovery services take into account the fact that there’s no one way to get one’s life together after using substances for years.

“Every journey doesn’t have to look like my journey,” said Conyers, who talked about being drug and alcohol free since 2007.

Courtney Cantrell headshot

Courtney Cantrell, director of the state Division of Mental Health, Developmental Disabilities and Substance Abuse Services.
Photo courtesy NC DHHS.

“In the past, there were a only a couple of approved ways to get sober, and unless you took one of those routes you weren’t [considered] successful. But there’s a growing recognition that there are multiple ways to recovery,” she said.

And that’s the point of the funding, said Courtney Cantrell, who leads the state Division of Mental Health, Developmental Disabilities and Substance Abuse Services.

“This grant provides us with a great opportunity to extend the state’s services and enable people with substance use disorders to independently choose the services that will best support their recovery,” said Cantrell in a press release from DHHS.

No longer anonymous

in the past, one of the main pathways to sobriety was through mutual aid networks such as Alcoholics Anonymous or Narcotics Anonymous, but Conyers said a big shortcoming is that people involved in those movements remained anonymous. As a result, addicts and alcoholics didn’t talk publicly about their struggles or their successes, and the stigma against people with substance abuse problems never really abated.

“You see that guy at the corner with a sign, and you think, ‘He’s a bum, a drunk,’” Conyers said. “But a lot of those people recover. And then they fall off the radar once they get better. What happens when that individual gets sober? They become productive members of society.”

Recently, there’s been a movement to get more people to talk publicly about how they recovered from substance abuse and to encourage others to get their lives back together.

Conyers described how people who are starting to get drug free often just need a little help getting started. The SAMHSA grant money might go to paying someone’s first month’s rent before they get a paycheck, for instance.

“Say you’re a month behind in rent and you’re stressed out. It’s overwhelming,” she said. “So they would come into our office or the office of one of our partners [and] get an assessment.

“At that point, we sit down and make a plan for their recovery, what are thee goals you’d like to attain, what are your largest barriers at this moment,” then issue a rent voucher to help tide the person over. Conyers said her organization would then follow the person’s progress, providing encouragement, assistance and guidance.

“There’s some money for education, money for child-development classes, some parenting classes for when they’re getting sober and there’s children in their lives,” she said.

Recovery Networks of North Carolina is a relatively new organization, with offices in Wake, Durham, Johnston and Robeson counties, with other offices planned for Western North Carolina in the coming year. Conyers also said that with the grant money, the organization plans opening several “recovery community centers” in four locations around the state.

“You get sober and then you’re like, ‘What do I do with this time?’” she said. “These recovery centers will allow people to have sober life experiences and have fun with people who understand and are like-minded and share their experiences.”

Press Release: Shark Victim Update


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UNC Children’s chief surgeon, Dr. Bill Adamson, shares details about the care and treatment of 12-year-old Kiersten Yow, who was transferred to UNC Hospitals following a June 14 shark attack on Oak Island, N.C. As of 4 p.m., June 25, Yow remains in good condition. Here is her update:

Kiersten Yow, courtesy the Yow family

Kiersten Yow, courtesy the Yow family

Kiersten Yow was transferred to UNC Children’s Hospital from New Hanover Regional Medical Center on Monday, June 15, 2015, due to injuries she sustained during a shark attack the previous day. With her parents’ permission, I am releasing details regarding her subsequent care.

Kiersten had two surgeries during her first week at UNC—one on Tuesday, June 16, and another on Friday, June 19. In both cases, surgeons performed “operative debridement,” removing dead and damaged tissue from the wounds on her left arm and left leg, and changed the wound dressings.

Yesterday afternoon, June 24, Kiersten had her first reconstructive surgery. A team of surgical specialists covered the leg wound with a skin graft and completed initial reconstruction of the elbow, reattaching the tendons to provide maximal range of motion. Reconstruction of the elbow will continue in the coming weeks with surgical wound care and skin grafting on her arm.

Kiersten was walking with assistance before yesterday’s surgery and will be doing so again soon, although she is currently confined to her hospital bed for the skin grafting to heal. The bite wound on her leg, situated around the rear upper thigh, fortunately did not reach bone or the nerves that control the lower leg, so despite some muscle loss, we expect the skin grafting alone will provide her good function. With rehabilitative therapy, we anticipate she will remaster walking independently and even be able to exercise.

Kiersten continues to amaze her entire care team with her upbeat, can-do attitude, which is truly extraordinary for a girl her age given the trauma she experienced. There’s been no, “Why me?” or sulking, just a dogged determination to reestablish her independence and return to a normal life—and we are proud to play our part in getting her and her family there.

 

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