Close Concerns Weblog

Medicare System Overhaul proposed

There’s a new (proposed) system in our nation, and this version includes sweeping changes in Medicare in order to reward and penalize various health care providers and organizations based on quality of care. Two bipartisan leading senators, Max Baucus (D-Mont.) and Charles E. Grassley (R-Iowa), believe the overhaul of the current system would create financial incentives for providers to coordinate care that is currently fragmented. Some of the components include recommendations to slow the growth of Medicare, hold doctors and hospitals more accountable, and to improve the quality of care of patients with chronic illnesses.

 

A five percent bonus would be received by family doctors and internists for Medicare patients for office visits and some “primary care services”. General surgeons in rural areas would also receive bonuses; Medicare payments to other specialists would probably be reduced. Some other components include the following proposals:

·         increasing Medicare payments to doctors exceeding ‘national standards’ of quality care (and penalties to those who do not meet minimum federal standards).

·         awarding bonuses to facilities or hospitals that provide superior care for certain selected other conditions like heart attacks and pneumonia.

·         physicians will also be encouraged to hire nurses for follow-up care once patients are discharged from the hospital disease relating to their chronic illness.

 

Generally we like the creative thinking though we would want to make sure that doctors didn’t become motivated to avoid patients with diabetes who need more care than average; we are also curious whether payments to specialists who care for people with diabetes would be reduced – that would definitely not be in all our collective best interests.

 

Increased drug spending in youth population

A recent Wall Street Journal article suggested the greatest increase in drug spending came from youth (aged 19 and below) – up about 5% over the past year. Although spending fell among seniors by one percent, total overall spending was still highest in the senior group, unsurprisingly. In 2008, health plans spent an average of $1,700 per senior compared to approximately $200 per youth. The report also mentioned diabetes drugs as the drivers for the increase among youth, linked to obesity among kids.

New Insulet PDM 200 = most excellent

I've been using Insulet's new PDM 2000, its next-gen personal diabetes manager, for over a week now and I'm hooked. The reliability and ease of use have been terrific. Overall, it feels very 2009, from the cool color screen to the buttons that seem to move faster to the smaller, sleeker overall package. Stay tuned for the more comprehensive diaTribe "Test Drive" on the PDM 2000 coming out in the next couple of weeks.

One in 8 million - the blind wine taster

Check out this story in the NY Times today (Friday May 8) - for its "one in 8 million" series, the NY Times profiles Alexandra Elman, who lost her sight due to diabetes in 1995. She got her dog in 1997. It's a wonderful story, all told through Alexandra's voice. I wrote the reporter to see if we could learn more about her diabetes. Thank you, NYTimes... really inspired and inspiring.

http://nytimes.com/packages/html/nyregion/1-in-8-million/index.html?hp&hp#/alexandra_elman

New Bluetooth-enabled blood glucose meter reaches the US

The first FDA cleared and CE certified Bluetooth ® blood glucose meter recently was announced and launched in the U.S. by Entra Health Systems. The MyGlucoHealth meter and MyGlucoHealth Network form an “integrated telemedicine platform”. It’s a great start to bringing our many meters, log books, and other forms of data into the same place and saved for patients and healthcare professionals to review.

The meter works in combination with a real-time online data collection network to upload and manage readings using a mobile phone or computer. Patients can securely transmit and evaluate readings while communicating results to families or physicians.

Test results can be seen in three seconds and has a blood sample size of 0.3 microliters. This compares to most other meters that have ~ five seconds and 0.03 microliters Test strips are automatically coded, which is a big advantage. All in all, this sounds pretty competitive – we don’t know what kind of strips it uses or if these will be covered by insurers, which is always a big question. The technology can monitor the testing results and also the patterns of the testing. The company points out that the network can set up reminders to test more frequently and even notify the patient’s family or caregivers when results exceed certain thresholds or fluctuate.

We’re happy to see a Bluetooth-enabled device finally hitting the market and potentially eliminating the need for the box of cables and mismatched meters. However, we wonder how many people with diabetes would feel like a wireless leash was attached to their meter if their family and caregivers were immediately seeing each and every reading at all times – it will be interesting to test reactions!

Diabetes Trips to ER Means Greater Risk of Dementia

Older adults with type 2 diabetes have increased risk of dementia after one single episode with a low blood sugar sending them to the emergency room. A new study published recently in JAMA found that one episode of severe hypoglycemia increased risk of dementia at a later age by 45%. Two episodes increased the risk by 115% and three or more episodes raised the risk by 160%.

The 16,667 patients who were in the Kaiser Permanente system had a mean age in the mid-60s. Their records were analyzed for trips to the hospital or emergency room for hypoglycemia from 1980 through 2002 and then followed from 2003 to 2007 for signs of dementia.

 

Approximately 9% of the patients had serious episodes of hypoglycemia in the 22-year period and 11% were diagnosed with dementia between 2003 and 2007. Study author Rachel Whitmer, a research scientist with Kaiser Permanente, emphasized the study’s results and correlation to the importance of blood glucose control.

Seven-Plus is some iteration ...

"Overall, I’m very optimistic about the SEVEN PLUS. I think that however much I loved the SEVEN, the SEVEN PLUS really represents a great improvement over the first-generation SEVEN, and both the trend arrows and the rate of change information in particular are big steps. I’ve found that the trend arrows really help me to improve my management—I got really good at not checking my blood glucose after eating cake, and then I got good at not looking at my CGM for 9 hours, but it’s awfully hard to ignore two arrows straight up (as long as you’re looking at your CGM) for 24 hours!"

-- Kelly Close's review of the SEVEN PLUS continuous glucose monitoring system - see our new issue, diaTribe #15, here.

Future Fast Food Near Schools – Fat Chance

Recent studies report an increased obesity rate among teens at schools where fast-foot restaurants were less than a tenth of a mile (one city block) away. It’s not a small chance, either – the increased risk is 5.2 percent. A city councilman from Queens proposed a ban on building/placing new fast-food restaurants within one tenth of a mile of a school. That sounds GREAT to us. Ironically, councilman Goia presented the proposal at a school opposite a McDonald’s. Immediate proximity is cited by researchers to directly impact the rate of childhood obesity. However, a location .25 and .5 miles away from a school did not impact the rates.

The study itself culled data from eight years of 1,047 California high schools, finding that caloric intake would increase 30 to 100 calories per day depending on the proximity of a restaurant. Students who were Hispanic and female had the greatest impact. Pregnant women were also studied and found to gain more weight if a fast-food outlet was within a tenth of a mile of their home.

The study, which was published in February 2009 culled data over eight years from 1,047 California high schools. It found that caloric intake could increase 30 to 100 calories a day depending on the proximity of a fast-food restaurant and that the effect was greatest for students who were Hispanic and female.

And good news, Mr. Gioia is clearly on the money and thinking really broadly and thoughtfully about this – he does not recommend the proposal as the only measure. Instead, he suggests it should be accompanied by other tactics like placing green markets in poorer neighborhoods and including education about healthy eating. He mentioned that the neighborhoods with the highest obesity rates were those that had 28 fast-food restaurants within a tenth of a mile of a school.

 “If we’re not willing to move harmful substances away just one block, what are we willing to do?” he asked.

Let’s get more discussions like this going – and also try to get good information to fast food outlets so they have healthier choices that are cheaper and more likely to sell. As we understand it, McDonald’s is one of the largest buyers of fresh apples in the world, as of 2005 – that is a major change from some years back and great to see.

Report card weighs in – Grades, Weight, and Massachusetts

Report cards are adding a new dimension this fall in Massachusetts when public schools will begin sending reports home to parents. The reports will include alerts of too much or too little weight on their children, a main component of a campaign to combat childhood obesity.

Modeled after initiatives in Arkansas and New York City (the usual front-runners of setting trends in combating obesity), the screenings won unanimous approval earlier this month from the Massachusetts Public Health Council, which consists of an appointed board of doctors, academics, and service providers.  It will be phased in over the next two school years and will be more than a standard report, providing recommendations and suggestions for parents. This is excellent – a very comprehensive strategy composed of more than just information, which was a problem with earlier attempts to heighten parent awareness of problems.

More than 286,000 students will undergo initial evaluation before the end of the 2010-2011 school year. Students in the first, fourth, seventh, and 10th grades will be measured and weighed to calculate the students’ BMI.

Most health professionals and medical associations were entirely supportive of the initiative, but others had their doubts, discussing the cost of another unfunded mandate and the line parents would walk  between encouraging healthy eating and perhaps focusing too much on weight loss strategies. While we hope there will be a responsible balance, of course, the threat of obesity weighs so heavily that we wouldn’t like to think that too much focus on weight loss strategies is really a threat. (Clearly, this assumes those who are at normal weight would be counseled on healthy eating and exercise, but not on losing weight.)

Massachusett’s public health commissioner, John Auerbach, said he believes the financial cost to school districts will be nominal, in part because many were already weighing and measuring students annually.

"Right now, in many situations, the data from height and weight measurements sit in a file, and even if it's concerning, the parent may not find out," Auerbach said.

"This helps us make sure the most important person in that child's life finds out." Here, here …thank you Massachusetts, and bring this on in California and across the rest of the country!