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Court rules home care aides are not entitled to overtime
BY PETE YOST The Associated Press

   WASHINGTON — Home care workers are not entitled to overtime pay under federal law, the Supreme Court ruled Monday, a setback for a growing labor force of more than 1 million people.
   The unanimous decision came in the case of Evelyn Coke, a 73-yearold retiree who spent more than two decades helping the ill and the elderly and is now in failing health herself.
   The Labor Department did not exceed its authority when it excluded home care workers from overtime protection and “courts should defer to the department’s rule,” Justice Stephen Breyer wrote, relieving employers and angering workers’ rights groups.
   The Bush administration opposed Coke’s challenge to the Labor Department’s 1975 regulation. A new administration should rewrite it to give workers the protection they deserve, said the Service Employees International Union, which represents hundreds of thousands of workers in that industry.
   The Clinton administration had drafted a regulation to cover the workers, but the rule was shelved after President Bush took office in 2001.
   Home care aides are the key to the independent life senior citizens want, but lack of adequate pay is fueling turnover rates of 40 to 60 percent annually, the employees’ union says.
   Government lawyers told the Supreme Court in April that the goal is ensuring that the elderly who most need home care service receive it “at a reasonable cost.”
   Nancy Duff Campbell, co-president of the National Women’s Law Center, called the decision “another blow to struggling, low-wage women.”
   Two weeks ago, the court limited workers’ ability to sue for pay discrimination, ruling against a Goodyear employee who earned thousands of dollars less than her male counterparts but waited too long to complain.
   Half of home care workers are minorities, and 90 percent are women, according to 2000 census data. Their wages remain among the lowest in the service industry, says the Bureau of Labor Statistics.
   “I would say, ‘If you feel it’s an easy job, step into my shoes,’ ” said home care worker Lori Reynolds in New York City, who said she is “truly disappointed” by the court’s ruling.
   In Coke’s case, the Supreme Court was “wrong about what Congress intended,” said Harold Craig Becker, Coke’s lead attorney.
   The Labor Department wrote the restrictive regulation after Congress expanded the law’s protections.
   Paying time and a half for hours in excess of 40 a week would cost billions, the home care industry says.
   “When you try to apply traditional labor law to this home-care scenario it’s really pretty impractical,” said Paul Hogan, founder of an Omaha, Neb.-based firm providing home health care services. The fi rm, Home Instead Senior Care, has 540 franchises in the United States with 41,000 full- and part-time caregivers.
   “Many seniors need long hours of companionship, even overnights,” said Hogan. “If the exemption is eliminated the cost of service would go so high it would drive many seniors into the gray market where they would be hiring home care workers directly. There would be no screening, no training, no supervision and no backup.”
   In New York City, the annual cost of the Medicaid-funded Personal Care Services Program would rise by at least a quarter of a billion dollars if the appeals court decision is allowed to stand, the city says.
   Coke’s former employer, Long Island Care at Home Ltd., says it would experience “tremendous and unsustainable losses” if it had to comply with federal overtime requirements.
   Many home care workers were brought under the law’s protection starting with Democratic administrations in the 1960s.
   In 1974, Congress broadened the law to cover workers in a variety of fields. The subsequent Labor Department rule reversed Fair Labor Standards Act coverage for home care workers who previously had the protection.  

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Panel: Childhood obesity should be addressed bluntly
BY LINDSEY TANNER The Associated Press

   CHICAGO — Doctors ought to quit using fuzzy terms to defi ne children’s weight problems and instead refer to truly fat kids as overweight or obese, a committee of medical experts recommended.
   Less-blunt terms used by the government and many doctors diplomatically avoid the term “obese.” Instead, they refer to children many would consider too fat as being “at risk for overweight” and “overweight” for those others would consider obese.
   Those categories don’t adequately define the hefty problem, according to the group, which was convened by the American Medical Association and funded by federal health officials including the Centers for Disease Control and Prevention.
   The nonbinding recommendations are designed as guidelines for pediatricians and other medical professionals who work with children. The CDC will consider whether to adopt the recommendations; the AMA has no plans to endorse them.
   Dr. Reginald Washington, a committee spokesman and member of the American Academy of Pediatrics, said Tuesday that some doctors have avoided the blunt terms for “fear that we’re going to stigmatize children, we’re going to take away their self-esteem, we’re going to label them.”
   The recommended terms cut to the chase, at least medically, but don’t mean that doctors should be insensitive or use the label in front of every patient, he said.
   “We need to describe this in medical terms, which is ‘obesity.’ When we talk to an individual family, we can be a little more cognizant of their feelings and more gentle, but that doesn’t mean we can’t discuss it,” Washington said. “The evidence is clear that we need to bring it up.”
   About 17 percent of U.S. children are obese and one-third are overweight, using the committee’s recommended definitions. Those numbers are rising, putting children at risk for diabetes, high blood pressure, cholesterol problems and other ailments more commonly found in adults.
   The obese category — the CDC’s “overweight” — is kids with a bodymass index in the 95th percentile or higher, or above 30. The overweight category — the CDC’s “at risk” — refers to children with a BMI between the 85th and 94th percentiles. The committee’s definition for overweight doesn’t include a specific BMI, but BMIs between 25 and 29 generally are considered overweight for adults.
   The definitions refer to children heftier than 85 percent to 95 percent of youngsters the same age and gender. With current obesity rates, that sounds mathematically impossible, but the percentiles are based on growth charts from the 1960s and 1970s, when far fewer kids were too fat.
   To some extent, the fuzzier labels let pediatricians “off the hook,” allowing them to avoid counseling patients who clearly need to lose weight, said Dr. Peter Belamarich, a pediatrician with Children’s Hospital at Montefiore in New York City.
   The blunter terms make sense if they motivate doctors to work with more kids who need help, “but you have to be real careful about labeling or saying it in front of a child,” Belamarich said.
   “I’ve had mothers ask me not to use the [obese] label,” he said. “Sometimes you can see it in the child’s face. They’re ashamed.”  

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HEALTH
AMC scientists study effect of omega-3 acid on Alzheimer’s
Researchers seek volunteers for clinical trials
BY KATHY RICKETTS Gazette Reporter

   ALBANY
   Nutritionists have long endorsed fish as part of a heart-healthy diet, and some studies suggest that omega-3 fatty acids found in the oil of certain fish, eggs, organ meats, micro-algae, fortifi ed foods, food supplements and human breast milk may also benefi t those suffering from Alzheimer’s disease.
   Now, researchers at the Alzheimer’s Center at Albany Medical Center are involved in a study of DHA (docasahexaenoic acid), to see if the omega-3 fatty acid can slow the progression of the disease.
   The local study is supported by the National Institute on Aging, part of the National Institutes of Health, and coordinated by the University of California, San Diego.
   The trial, which is taking place at 52 sites across the United States, is seeking 400 participants age 50 and older with mild to moderate Alzheimer’s disease. Albany Med is seeking about 20 volunteers.
POTENTIAL FOR PROGRESS
   “Because of its protective nature, DHA potentially could reduce the level of abnormal plaque, also known as amyloid, found in the brains of Alzheimer’s patients,” explained Dr. Earl Zimmerman, director of the Alzheimer’s Center at Albany Med, who will conduct the study locally. “Study volunteers will be critical to helping us fi nd out if DHA can make an impact on slowing the progression of this destructive disease.”
   Earlier studies at the University of California, Irvine, found that DHA slowed the accumulation of tau in mice. Tau is a protein that leads to the development of neurofibrillary tangles, one of the two signature brain lesions of Alzheimer’s.
   Researchers also found that DHA reduced levels of the protein beta amyloid, which can clump in the brain and form plaques, another kind of lesion associated with Alzheimer’s.
   “There is data to show that this antioxidant, DHA, when given to mice does cause some improvement, which looks promising,” said Zimmerman.
   Researchers will primarily evaluate whether taking DHA over several months will slow the progression of both cognitive and functional decline in people with mild to moderate Alzheimer’s. During the 18-month clinical trial, investigators will measure the progress of the disease by using standard tests for functional and cognitive change.
   For the clinical trial, the Martek Biosciences Corp. of Columbia, Md., will donate a pure form of DHA made from algae devoid of fish-related contaminants.
   Participants will receive either two grams of DHA per day in a capsule or an inactive placebo pill. About 60 percent of participants will receive DHA and 40 percent will receive a placebo. To ensure unbiased results, Zimmerman said the study will be double blind, meaning neither the researchers conducting the trial nor the participants will know who is getting DHA and who is getting the placebo.
DIET SUPPLEMENTS
   When asked if people should take omega-3 fatty acid supplements to lower their risk of developing Alzheimer’s disease, Zimmerman said he didn’t know.
   “There’s a lot of interest in this, but we won’t really know until after the study,” he said.
   For people who do take supplements, Zimmerman suggested looking for those that contain about 600 milligrams of DHA per dose.
   Zimmerman said participants will be tested every three months. There are no fees involved.
   “This study is designed to see if it slows the progression,” said Zimmerman. “So I’m guessing it will take about six months after the study ends to analyze the data.”
   That means the data will be made public in approximately 24 months.
   “It’s a very interesting field right now,” said Zimmerman. “There are trials of probably more than 100 different new drugs and compound approaches being tested. The goal is to stop the disease early.”
   Zimmerman said within three to four years, researchers hope to have a way to diagnose the disease early, manage it and eventually prevent it.
   “That’s what everybody is so excited about,” he said.
   An estimated 4.5 million Americans have Alzheimer’s disease, according to the Alzheimer’s Association. The disease gradually destroys a person’s memory and ability to communicate.
RISK FACTOR
   The risk for Alzheimer’s disease goes up as people age — 50 percent of people age 85 have Alzheimer’s disease; 25 percent of people age 75 have it; 18 percent of people age 70 have it. It is more common in women.
   While there is no sure way to prevent the disease, mental stimulation, exercise, eating a healthful diet, staying engaged in social activities and avoiding stress and not smoking lower people’s odds, according to the Alzheimer’s Association of America.

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Researchers hope home sensors can help predict Alzheimer’s
BY LAURAN NEERGAARD The Associated Press

   WASHINGTON — Tiny motion sensors are attached to the walls, doorways and even the refrigerator of Elaine Bloomquist’s home, tracking the seemingly healthy 86-year-old’s daily activity.
   It’s like spying in the name of science — with her permission — to see if round-the-clock tracking of elderly people’s movements can provide early clues of impending Alzheimer’s disease.
   “Now, it takes years to determine if someone’s developing dementia,” laments Dr. Jeffrey Kaye of Oregon Health & Science University, which is placing the monitors in 300 homes of Portland-area octogenarians as part of a $7 million federally funded project.
   The goal: Shave off that time by spotting subtle changes in mobility and behavior that Alzheimer’s specialists are convinced precede the disease’s telltale memory loss.
   Early predictors may be as simple as variations in speed while people walk their hallways, or getting slower at dressing or typing. Also under study are in-home interactive “kiosks” that administer monthly memory and cognition tests, computer keyboards bugged to track typing speed, and pill boxes that record when seniors forget to take their medicines.
   More than 5 million Americans, and 26 million people worldwide, have Alzheimer’s, and cases are projected to skyrocket as the population ages. Today’s medications only temporarily alleviate symptoms. Researchers are desperately hunting new ones that might at least slow the relentless brain decay if taken very early in the disease, before serious memory problems become obvious.
   Dozens of early diagnosis methods also are under study, from tests of blood and spinal fluid to MRI scans of people’s brains. Even if some pan out, they’re expensive tests that would require lots of doctor intervention when getting someone to visit a physician for suspicion of dementia is a huge hurdle. And during routine checkups, even doctors can easily miss the signs.
   Bloomquist, of Milwaukie, Ore., knows the conundrum all too well. She volunteered for Kaye’s research because her husband died of Alzheimer’s, as did his parents and her own mother.
   “It’s hard to know when people begin Alzheimer’s,” she reflects. “Alzheimer people do very well socially for short periods of time. If it’s just a casual conversation, they rise to the occasion.”
   Measuring how people fare at home — on bad days as well as good ones, not just when they’re doing their best for the doctor — may spot changes that signal someone is at high risk long before they’re actually demented, Kaye told the Alzheimer’s Association’s international dementia prevention meeting last week.
   “If you only assess them every once-in-a-blue-moon, you really are at a loss to know what they are like on a typical day,” Kaye explains.
   High-tech monitors under study:
   Researchers at New York’s Mount Sinai School of Medicine are heading a study that ultimately plans to recruit 600 people over age 75 to help test in-home “kiosks” that turn on automatically to administer monthly cognitive exams. A video of a smiling scientist appears onscreen to talk participants through such classic tests as reading a string of words and then, minutes later, repeating how many they recall, or seeing how quickly they complete connect-the-dot patterns.
   An Oregon pilot study of the motion sensors tracked 14 participants in their upper 80s for almost a year. Half had “mild cognitive impairment,” an Alzheimer’s precursor, and half were healthy. Impaired participants showed much greater variation in such day-to-day activities as walking speed, especially in the afternoons.
   Why? The theory is that as Alzheimer’s begins destroying brain cells, signals to nerves may become inconsistent — like static on a radio — well before memories become irretrievable. One day, signals to walk fi re fine. The next, those signals are fuzzy and people hesitate, creating wildly varying activity patterns.
   The pilot study prompted a fi rstof-its-kind grant from the National Institutes of Health to extend the monitoring study to 300 homes; 112 are being monitored already, mostly in retirement communities such as Bloomquist’s. Participants are given weekly health questionnaires to make sure an injury or other illness that affects activity doesn’t skew the results.
   In addition, participants receive computer training so they can play brain-targeted computer games and take online memory and cognition tests. The keyboards are rigged to let researchers track changes in typing speed and Internet use that could indicate confusion.
   Finally, a souped-up pill dispenser called the MedTracker is added to some of the studies, wirelessly recording when drugs are forgotten or taken late.

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HEALTH
Quick quiz can help flag dementia
BY SANDRA G. BOODMAN The Washington Post

   Distinguishing early signs of dementia from other memory problems can be an arduous and expensive process. But a brief questionnaire developed by neurologists at Washington University School of Medicine appears to be able to differentiate between mild dementia and forgetfulness, according to a study of 325 elderly patients.
   Researchers led by neurologist James E. Galvin developed the eight-item inventory called the AD8, which asks questions about recent changes in memory. Although the screening test is not a diagnostic tool, the researchers note, it can signal whether early cognitive changes are under way that would suggest the need for a more complete workup.
   Patients enrolled in a long-term study took the test, which asked if they had noticed a change in their ability to name the correct month or year, had trouble remembering appointments or had perceived problems exercising judgment. The patients’ answers were compared with those of a reliable observer,
usually a spouse or child.
   Galvin and his team found that the self-test, which took less than three minutes to complete, reliably distinguished patients with early dementia from those who were forgetful but did not show signs of cognitive impairment. Of the 325 patients, whose average age was 77, roughly 54 percent showed signs of dementia, according to the selftest. Previous studies had found that the test reliably differentiates between forgetfulness that is not clinically significant and symptoms of dementia.
   Because the questions are neutral in tone and do not attribute functional change to a cause such as Alzheimer’s disease, they may prove less threatening and yield useful results if no observer is available to report recent alterations in cognitive functioning.
   Information about the test and its scoring is available at http:// alzheimer.wustl.edu/About—Us/ PDFs/AD8form2005.pdf. The study appears in the May issue of the Archives of Neurology.  

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Main Entry: de·men·tia  
Pronunciation: \di-ˈmen(t)-shə, -shē-ə\
Function: noun
Etymology: Latin, from dement-, demens mad, from de- + ment-, mens mind — more at mind
Date: 1806
1 : a usually progressive condition (as Alzheimer's disease) marked by deteriorated cognitive functioning often with emotional apathy
2 : madness, insanity
— de·men·tial  \-shəl\ adjective

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Staph germ a growing concern
Study: Superbug infects thousands of hospital patients
BY MIKE STOBBE The Associated Press

   ATLANTA — A dangerous, drugresistant staph germ may be infecting as many as 5 percent of hospital and nursing home patients, according to a comprehensive study.
   At least 30,000 U.S. hospital patients may have the superbug at any given time, according to a survey released today by the Association for Professionals in Infection Control and Epidemiology.
   The estimate is about 10 times the rate that some health officials had previously estimated.
   Some federal health officials said they had not seen the study and could not comment on its methodology or its prevalence. But they welcomed added attention to the problem.
   “This is a welcome piece of information that emphasizes that this is a huge problem in health care facilities, and more needs to done to prevent it,” said Dr. John Jernigan, an epidemiologist with the U.S. Centers for Disease Control and Prevention.
   At issue is a superbug known as Methicillin-resistant Staphylococcus aureus, which cannot be tamed by certain common antibiotics. It is associated with sometimes-horrifi c skin infections, but it also causes blood infections, pneumonia and other illnesses.
   The potentially fatal germ, which is spread by touch, typically thrives in health care settings where people have open wounds. But in recent years, “community-associated” outbreaks have occurred among prisoners, children and athletes, with the germ spreading through skin contact or shared items such as towels.
   Past studies have looked at how common the superbug is in specifi c patient groups, such as emergencyroom patients with skin infections in 11 U.S. cities, dialysis patients or those admitted to intensive care units in a sample of a few hundred teaching hospitals.
   It’s difficult to compare prevalence estimates from the different studies, experts said, but the new study suggests the superbug is eight to 11 times more common than some other studies have concluded.
   The new study was different in that it sampled a larger and more diverse set of health care facilities. It also was more recent than other studies, and it counted cases in which the bacterium was merely present in a patient and not necessarily causing disease.
   The infection control professionals’ association sent surveys to its more than 11,000 members and asked them to pick one day from Oct. 1 to Nov. 10, 2006, to count cases of the infection. They were to turn in the number of all the patients in their health care facilities who were identified through test results as infected or colonized with the superbug.
   The final results represented 1,237 hospitals and nursing homes — or roughly 21 percent of U.S. inpatient health care facilities, association officials said.
   The researchers concluded that at least 46 out of every 1,000 patients had the bug.
   There was a breakdown: About 34 per 1,000 were infected with the superbug, meaning they had skin or blood infections or some other clinical symptom. And 12 per 1,000 were “colonized,” meaning they had the bug but no illness.
   Most of the patients were identified within 48 hours of hospital admission, which means, the researchers believe, that they didn’t have time to become infected to the degree that a test would show it. For that reason, the researchers concluded that about 75 percent of patients walked into the hospitals and nursing homes already carrying the bug.
   “They acquired it in a previous stay in health care facility, or out in the community,” said Dr. William Jarvis, a consulting epidemiologist and former CDC officials who led the study.
   The infection can be treated with other antibiotics. Health care workers can prevent the spread of the bug through hand-washing and equipment decontamination, and by wearing gloves and gowns and by separating infected people from other patients.
   The study is being presented this week at the association’s annual meeting in San Jose, Calif., but has not been submitted for publication in a peer-reviewed medical journal.  

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SCHENECTADY COUNTY
More nursing home beds sought
Proposal needs state approval
BY MICHAEL LAMENDOLA Gazette Reporter

   Schenectady County is seeking a compromise with the state Health Department that would allow constructing a 240-bed nursing home rather than reducing Glendale Home to 168 beds.
   The county is under state mandate to decertify 192 beds at the 360-bed nursing home and consolidate services into a single wing there by June 2008.
   County officials say the state proposal is based on erroneous information and will leave the county with fewer nursing home beds to care for a rapidly aging population.
   “We have been discussing options quietly but productively with the Health Department for months,” said county Legislature Chairwoman Susan Savage, D-Niskayuna. “We believe the department recognizes that the recommendations of the Berger Commission are unrealistic.”
   The Berger Commission, also known as the Commission on Health Care Facilities in the 21st Century, issued recommendations last year as part of efforts to modernize the state’s health care system and save up to $800 million a year in Medicaid and other insurance costs. The recommendations became law Jan. 1.
   State Health Department spokeswoman Claudia Hutton said, “We have not made any promises. We understand what it is they are proposing, but we have to see their whole plan and then we will evaluate whether it meets with Berger.”
   The county is required to submit a preliminary plan to the state by Saturday on how it will meet the Berger Commission mandates. The county Legislature will meet Thursday to vote on the plan.
   The county asks to reduce beds at Glendale from 360 to 308 on Sunday and to 240 beds by June 2008. It also asks for state approval to build a 240-bed nursing home, to replace the aging and obsolete Glendale Home.
MORE REVENUE
   The county had hoped to build a new 280-bed nursing home by 2009. A new nursing home would allow the county to increase its state reimbursement rate and thereby generate more revenue for the facility.
   But under Berger, the state will not accept any certificate of need applications for the establishment, construction or renovation of a county nursing home until the completion of another study. The study would examine the county’s role in providing nursing home services, especially to people who are indigent, and to examine alternative services.
   To reduce Glendale’s beds under the state mandate, the county would have to stop admitting people to the nursing home for one year, according to County Manager Kathleen Rooney.
   “The other nursing homes in Schenectady County are currently operating near capacity and cannot absorb 110 to 120 residents Glendale can no longer serve,” Rooney said. “This will result in families needing to fi nd facilities outside of Schenectady County and very likely out of the region.”
   The county’s annual subsidy to maintain Glendale under this scenario would increase by $1.5 million, Rooney said. The county’s subsidy for 2007 is $6.4 million, representing 22 percent of the home’s budget.
   The state wants the county to consolidate beds in the C-Wing, an addition built in 1960. It is one of three structures on Glendale’s Hetcheltown Road campus in Glenville. The other structures were built in 1934 and 1979. Beds are in the 1934 and 1979 buildings while the 1960 building is used for administrative and support services.
   Rooney said C-Wing cannot be operated as a stand-alone facility; it does not contain boilers, dining facilities or other “critical services.” These are contained in the other buildings, which the county would have to keep open, she said.
   Further, officials from St. Clare’s and Ellis hospitals have told the county that the loss of Glendale beds would backlog emergency rooms, would result in a shortage of short-term hospital beds and would affect additional health care services in the region.
   Rooney said the county consistently downsized Glendale, which once had a capacity of more than 500 beds, in response to the growth of services designed to keep the elderly out of nursing homes, which are more expensive than home-based care.
   Additionally, the need for nursing home beds in Schenectady County and in the region is expected to increase, Rooney said. The number of frail, elderly people age 85 and older is projected to increase by 3,000 people in the Capital Region over the next five years, she said.
   “Schenectady County’s elderly population was the fastest growing of any county in the state in 2006,” Rooney said.

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CAPITOL
Following rate hike, panel will study malpractice costs
The Associated Press

   Regulators in New York approved a 14 percent increase in medical malpractice insurance rates on Monday and Gov. Eliot Spitzer formed a task force to find ways to rein in the high cost of the coverage.
   The state Insurance Department said the latest rate hike was lower than insurance companies wanted and “is necessary to avoid further financial deterioration of the companies and perhaps an irreversible crisis in an already severely distressed market.”
   State Insurance Superintendent Eric Dinallo will lead the task force, which will report back to Spitzer by the end of the year. It will include state Health Commissioner Dr. Richard Daines and representatives of physician and hospital groups, the insurance industry, consumer groups, health plans, trial lawyers and state lawmakers.
   “I am concerned that the increasing cost of medical liability insurance will drive some physicians out of the field and will discourage young people from entering the medical profession in the first place,” Daines said.
   Consumer groups questioned the rate increase and said there hasn’t been a recent increase in medical malpractice claims. They’ll urge the new task force to focus on the root problems of malpractice by reducing medical errors and correcting industry mismanagement.
   “We look forward to the New York Insurance Department carefully examining remedies that specifically address the true reasons behind the hike,” Joanne Doroshow, executive director of the Center for Justice and Democracy, said in a prepared statement.
   The Center for Justice and Democracy, Center for Medical Consumers and New York Public Interest Research Group on Monday released an analysis of 30 years of state insurance data by actuary J. Robert Hunter, director of insurance for the Consumer Federation of America and a former federal insurance administrator. Hunter’s research found that since the mid-1980s, there hasn’t been a signifi cant increase in the amounts medical malpractice insurers paid out in claims, including all jury awards and settlements.  

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“I am concerned that the increasing cost of medical liability insurance will drive some physicians out of the field and will discourage young people from entering the medical profession in the first place,” Daines said.

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$1.7 million slated for state medical database
System would give doctors instant access to patient records  
  
By ALAN WECHSLER, Business writer
First published: Tuesday, July 10, 2007

ALBANY -- A statewide medical database that could put a patient's health records at any doctor's fingertips has taken another step forward with the approval of $1.7 million in state funding.
  
The Health Information Exchange of New York, known as HIXNY, was created in 1999, though work began in earnest in 2005. Today, the group is looking to hire a chief executive.

A working information system could be in place in less than two years, project officials said Monday.

"I think things are going well," said Ray Murphy, HIXNY project director and former chief information officer at the health insurance company Capital District Physicians' Health Plan. "We have been moving forward as quickly as we could."

At the heart of the proposal is the growing trend by hospitals and physicians of investing in computer systems to store patient records. Such systems make it possible for doctors to access patient records from home or from a hospital.

HIXNY wants to turn these piecemeal records systems into a secure, Internet-based database that would allow, say, a doctor at Albany Medical Center Hospital to access the records of a patient in Long Island.

Such access would give doctors the medical backgrounds of all patients, detailing what medications they're on, what diseases they have, even the readings of their last electrocardiogram.

Before HIXNY was awarded the grant last week under the state HEAL-NY program used for health care improvements in the state, money came in from its members: three health insurance plans, eight hospitals, four large physician groups, three community health centers and two trade associations. Backers believe the program will reduce medical errors.

But HIXNY didn't get all the money it hoped for. In late 2005, backers applied for $9.5 million in state funding. Instead, more money will have to come from participating hospitals and doctors' offices.

And the technology isn't cheap. Columbia Memorial Hospital in Hudson -- which is not a HIXNY member -- estimates the cost of training staff and setting up technology to get access to HIXNY will run from $1.5 million to $2 million.

While the hospital plans to raise capital, such a program won't be in place in the next two years, said President Jane Ehrlich.

"There's no question it's of tremendous value to patients," she said. But, she added, "There is a capital investment that's considerable." Wechsler can be reached at 454-5469 or by e-mail at awechsler@timesunion.com.

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"I think things are going well," said Ray Murphy, HIXNY project director and former chief information officer at the health insurance company Capital District Physicians' Health Plan. "We have been moving forward as quickly as we could."

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HIXNY wants to turn these piecemeal records systems into a secure, Internet-based database that would allow, say, a doctor at Albany Medical Center Hospital to access the records of a patient in Long Island.

Such access would give doctors the medical backgrounds of all patients, detailing what medications they're on, what diseases they have, even the readings of their last electrocardiogram.

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Internet-based database that would allow, say, a doctor at Albany Medical Center Hospital a devient minded hacker, or someone with connections, or someone who can blackmale, or insurance companies, or employers to access the records of a patient in Long Island.

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Also commonly titled as Nineteen Eighty-Four



In 1984, Winston Smith lives in London which is part of the country Oceania. The world is divided into three countries that include the entire globe: Oceania, Eurasia, and Eastasia. Oceania is a totalitarian society led by Big Brother, which censors everyone's behavior, even their thoughts. Winston is disgusted with his oppressed life and secretly longs to join the fabled Brotherhood, a supposed group of underground rebels intent on overthrowing the government. Winston meets Julia and they secretly fall in love and have an affair, something which is considered a crime. One day, while walking home, Winston encounters O'Brien, an inner party member, who gives Winston his address. Winston had exchanged glances with O'Brien before and had dreams about him giving him the impression that O'Brien was a member of the Brotherhood. Since Julia hated the party as much as Winston did, they went to O'Brien's house together where they were introduced into the Brotherhood. O'Brien is actually a faithful member of the Inner-Party and this is actually a trap for Winston, a trap that O'Brien has been cleverly setting for seven years. Winston and Julia are sent to the Ministry of Love which is a sort of rehabilitation center for criminals accused of thoughtcrime. There, Winston was separated from Julia, and tortured until his beliefs coincided with those of the Party. Winston denounces everything he believed him, even his love for Julia, and was released back into the public where he wastes his days at the Chestnut Tree drinking gin.

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Lack of universal health care holding U.S. back

   When I was 20 I was turned away from a hospital for not having health insurance.
   One of the reasons my father didn’t move to this country was because he didn’t have health insurance.
   My cousin’s husband will be paying $1,000 a month for the next 12 months in order to keep health insurance while he recovers from surgery at home.
A relative of a friend was denied a CAT scan despite her husband’s pleas and subsequently died of a brain aneurysm.
I already knew the health care system was unconscionably wrong when I moved here from Scotland at the age of 13 and didn’t have health insurance until the age of 21.
I just saw the movie “Sicko” and concluded that the U.S. public has been ignorant about how much better health care in this country could be.
I declare that I will support HR 676 and any congressperson who will work to pass it.
ANGELA DUPIN
Scotia  

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SCHENECTADY
Merger calls for building funds
St. Clare’s, Ellis ask state to help with new facility
BY MICHAEL LAMENDOLA Gazette Reporter

   Ellis and St. Clare’s hospitals are asking the state to fund construction of either a new hospital or a new women’s health center as a way to meet state mandates that they consolidate and absorb the services provided by Bellevue Woman’s Hospital in Niskayuna.
   The two city hospitals forwarded their request Friday to the state Department of Health. The request will not be available to the public until after Aug. 1 , a department spokeswoman said.
   The hospitals are asking the state to provide five years worth of funding to study and put in place either proposal. They are also asking the state for money to study the longterm effect of maintaining multiple hospital campuses versus a single campus, and that the state help bail out St. Clare’s $34 million unfunded pension obligation.
   The hospitals did not release financial information with their request. “It is premature to discuss dollar figures. We want to give the Department of Health a chance to analyze it,” said Beth Krueger of Behan Communications, a public relations firm hired by the hospitals. “We will leave it up to the health department to determine what is appropriate.”
   Claudia Hutton of the state Department of Health had no comment. She said department staff will review the hospitals’ request along with those they are receiving from other facilities affected by the findings of the Berger Commission.
   Dr. Brian Gordon, a Schenectady County legislator and surgeon, said a new hospital could cost between $300 million and $500 million to build, based on a formula of $1 million per hospital bed. He also said a proposed woman’s health center could cost about $20 million. Both would require several years to build.
   The Berger Commission, formally known as the Commission on Health Care Facilities in the 21st Century, issued recommendations last year as part of efforts to modernize the state’s health care system and save up to $800 million a year in Medicaid and other insurance costs. The recommendations became law Jan. 1. The state and federal governments have set aside about $2 billion to help hospitals and nursing homes adopt the recommendations.
   The commission recommended that Ellis and St. Clare’s consolidate by 2009 and that the state close Bellevue Woman’s Hospital by 2008. The closing of Bellevue is opposed by Bellevue officials as well as area political leaders. The state Senate approved legislation to keep Bellevue open, but the Assembly adjourned for the year before voting on similar legislation.
   Gordon said the Ellis and St. Clare’s proposal for a new hospital is not workable. “I couldn’t think of a better idea than a new hospital, but I don’t think it is realistic. If there is a total pool of $2 billion, I don’t think Schenectady will get one quarter of it,” he said.
   “We have precious little time to make a realistic decision and we should be spending our time on how to allocate care and use our existing facilities to the best of their abilities,” Gordon said.
   He said the hospitals have not even determined where they would build the new hospital, and if they can’t “do a brand new hospital, they would divide services between them.”
   This would be in keeping with the two-hospital, two-campus health care system they proposed as a way to handle the Berger mandates. Under this proposal, Ellis would build a women and children’s health center on its campus. The center would provide comprehensive services similar to those now provided by Bellevue, including abortion and contraceptive services. St. Clare’s, a Catholic hospital, would not be affiliated with the stand-alone center, as abortion and contraceptive services are opposed by the Catholic Church.
   Krueger said the center would “ensure all services are available in the community.” She said the proposal to build a new hospital offers a rare opportunity “to really take a look at all options at this time. This is the time to see what is viable and to present both options.”
   Hospital officials said they developed their request following advice and guidance of physicians, staff, community leaders, elected officials and others. “We have concluded … that the community’s interest is best served by a thorough examination of all responsible alternatives,” Ellis Chief Executive Officer James Connolly said in a statement.  

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Nursing home
workers to unionize
   SCHENECTADY— Employees at The Avenue Nursing Home voted Friday to join a health care workers’ union.
   The nearly 200 workers will be members of 1199SEIU, the largest union of health care workers on the East Coast.
   They are licensed practical nurses, certified nursing assistants and dietary and housekeeping employees at the home owned by Capital Living and Rehabilitation Centres.
   Workers cited better staffi ng as a reason for joining the union.
   A few blocks down the road at Dutch Manor Nursing Home, also owned by Capital Living, a union vote was narrowly defeated.
   But workers who want to be unionized will file a complaint with the National Labor Relations Board to overturn that vote.
   “We want a union at both of these nursing homes. We even had the support of the families of the residents,” said Freddie Rambo, a porter at Dutch Manor, which has fewer than 100 employees.

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Consider long term, not just short, with hospital merger plan
PATRICIA A. FOX, M.D.
Schenectady
The writer is vice chief of staff at St. Clare’s Hospital for plastic surgery.

   I remain deeply concerned about the plans for restructuring Schenectady’s hospitals. Our city is involved in a wonderful renaissance downtown with the introduction of new and the expansion of existing businesses. We are proud of these changes and congratulate all involved.
   We have received a mandate from the Berger Commission and, as a community, we must look to this as an opportunity. We have three hospitals in our county, and our needs are best met by consolidation. Our medical staffs have expressed a unanimous desire for a single facility, a true consolidation of services. Support for this is truly overwhelming. Rather than fighting over the survival of Bellevue, let’s work toward a consolidation of all three hospitals into a new entity.
   These hospitals employ a signifi cant number of the Schenectady County citizens. We need to ensure the viability of our medical system for the next 50-plus years. It is essential to the economic health of our city and county. How can we do this?
   Consider the options: a new campus and new hospital, site to be determined; a new hospital on the St. Clare’s site (20 acres); a remodeling of the existing Ellis Hospital (12-acre site). Explore funding options, seek out prospective major donors and discuss the economic issues with Metroplex.
   I am very concerned that the most desired options are being downplayed while the agenda to grow Ellis Hospital is rushed forward — citing monetary concerns without any effort to investigate possible financing options. Such an agenda lacks the progressive, forwardlooking approach Schenectady County deserves. It leaves us with a limited site with intrinsic logistic problems including environmental concerns related to road access, power grid needs, parking and future expansion needs.
   I hope we are not too late to alter course, as this is our opportunity to bring a renaissance to the health care segment of our economic engine and maintain and enhance the efficient delivery of quality health care in our community. With a new facility, we will be able to attract new staff and physicians to our community and continue to provide the high standard of care we have come to enjoy and expect.
   We entrusted the committee with the task of creating a joint governance structure. I ask that in this process, they look to the future and make a recommendation that is progressive and will provide a long-term solution to our health care needs — not an expensive short-term model.
   Don’t discount the needs, desires and will of the people and doctors of Schenectady.  

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Nursing home
workers to unionize
   SCHENECTADY— Employees at The Avenue Nursing Home voted Friday to join a health care workers’ union.
   The nearly 200 workers will be members of 1199SEIU, the largest union of health care workers on the East Coast.
   They are licensed practical nurses, certified nursing assistants and dietary and housekeeping employees at the home owned by Capital Living and Rehabilitation Centres.
   Workers cited better staffi ng as a reason for joining the union.
   A few blocks down the road at Dutch Manor Nursing Home, also owned by Capital Living, a union vote was narrowly defeated.
   But workers who want to be unionized will file a complaint with the National Labor Relations Board to overturn that vote.
   “We want a union at both of these nursing homes. We even had the support of the families of the residents,” said Freddie Rambo, a porter at Dutch Manor, which has fewer than 100 employees.

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To build or not to build is hospitals' dilemma
Officials say state-mandated combination of Ellis, St. Clare's facilities will be costly in either case  
  
By ALAN WECHSLER, Business writer
First published: Tuesday, July 17, 2007

SCHENECTADY -- How much to build a new hospital in Schenectady? Opinions vary, but everyone agrees on one thing: It won't be cheap.
  
On Friday, Ellis and St. Clare's hospitals asked the state for funding to help with a state-mandated merger. They had two ideas: keep both buildings and get rid of duplication, or build a new hospital.

Susan Savage, chairwoman of the Schenectady County Legislature, said state Department of Health officials had told her a new hospital would cost about $1 million per bed.

Ellis and St. Clare's officials haven't said exactly how big this new hospital would be, or what it might cost. But another county legislature member -- Brian Gordon, an orthopedic surgeon who practices in Schenectady -- said he expected it would cost from $300 million to $500 million.

"A new hospital would be ideal for our community," he said. "However, I don't think it's a realistic expectation -- it's so unlikely we may be wasting the precious little time we have."

Neil Golub, chairman of Bellevue Woman's Hospital, said he had heard from Ellis that a new hospital could cost as much as $600 million. Ellis officials refuse to discuss the cost issue.

"Building a third hospital in Schenectady is the most absurd, idiotic idea I've ever heard," he said. "Where are they going to get the money?"

Ellis Hospital, with 220 beds, and St. Clare's Hospital, with 160 beds, are two of dozens of hospitals around the state that have asked the state Department of Health for funding. They say they need the money to comply with a state edict to either close or merge. Bellevue, under the edict, has been told to close, and officials there are pushing to stay open. Ellis and St. Clare's want to build their own women's center at Ellis, possibly under the Bellevue name.

But there's not much to go around -- just $550 million. Bellevue, which has 40 beds, had also submitted an application by the Monday deadline. President Anne Saile estimates it will cost Bellevue -- which she said is now making about $250,000 a month profit -- about $40 million to close down and resolve its debt.

State officials say hospitals shouldn't expect the state to pay for everything.

"We're not the first place to go for money," said Claudia Hutton, a spokeswoman for the Department of Health. "We never have painted that this $550 million is going to solve everyone's problems. It can't; it just isn't enough."

A look around the nation shows how expensive a new hospital can be. A new Childrens Hospital Los Angeles, scheduled to open in 2009 with 317 beds, will cost an estimated $548 million. A new general hospital in San Francisco has been reported to be $622 million. A 165-bed hospital in Phoenix is estimated at $189 million.

In western Maryland, two hospitals in the city of Cumberland are being replaced by a single, new hospital. The 277-bed, seven-story building will cost about $257 million by 2009.

"Instead of investing money in old buildings, we thought it would be prudent to invest in one hospital," said Kathy Rogers, a spokeswoman for the Western Maryland Health System.

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I just saw this on WRGB online!!!!!!

TOP HEADLINE
Bellevue Set to Close: Ellis Will Take Over
After months of speculation sources have confirmed to CBS 6 News that Bellevue Woman's Hospital will be closing its doors. According to the chairman of the board Neil Golub, as of November 1st of this year the hospital will be taken over by Ellis Hospital. Golub says that the board met with the the State Health Department on Wednesday night and they were informed of the takeover.
July 19, 2007 - 4:47PM

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SCHENECTADY COUNTY
Ellis to take over care at Bellevue Deal satisfies Berger Commission
BY BOB CONNER Gazette Reporter

   Ellis Hospital will take over Bellevue Woman’s Hospital, maintaining services at Bellevue’s Niskayuna campus “for a period of time yet to be determined,” according to an Ellis statement released Thursday.
   Anne Saile, Bellevue’s chief executive officer, said “We were victorious” in the campaign to maintain women’s hospital services, although Bellevue will be surrendering its operating certifi - cate by Nov. 1.
   Claudia Hutton, spokeswoman for the state Department of Health, said the Ellis-Bellevue agreement will satisfy the requirement of the Berger commission law that Bellevue close. The law, which took effect Jan. 1, puts into effect proposals of a commission headed by Stephen Berger that called for health-care cuts statewide to make the system more efficient and save public money.
   Ellis CEO James Connolly said he will seek “an absolutely seamless and transparent continuation of services” at the Bellevue campus, and does not anticipate any layoffs.
   Connolly said Ellis will be guided by reaction from the Health De- partment to its building plans, and it is possible that the Bellevue campus could stay open indefi - nitely if Ellis decides in the end not to go ahead with new construction.
   The Berger law also requires Ellis and St. Clare’s hospitals, both in the city of Schenectady, to enter into a joint governance agreement. Those hospitals have jointly submitted plans to the DOH calling either for a new women’s and children’s center at Ellis or an entirely new hospital. DOH approval and financial aid would be required for either plan.
   Saile said Thursday’s agreement means Ellis “is going to own Bellevue, basically.” The price has yet to be determined, she said, but she expects the money to be provided by the state and to be used to pay off Bellevue’s debts.
   Ceil Mack, spokeswoman for St. Clare’s, said it learned about the Ellis-Bellevue agreement Thursday, and does not expect it to affect the negotiations between Ellis and St. Clare’s.
   Scott Reif, a spokesman for Senate Majority Leader Joseph Bruno, R-Brunswick, said: “The news about Bellevue Women’s Hospital is unfortunate, especially since the Senate passed a bill to keep them open and the Assembly refused to take it up.” The Senate bill to exempt Bellevue from the Berger law passed that house unanimously in June, but the equivalent bill in the Assembly did not make it out of the Health Committee.
   Schenectady County Legislator and Minority Leader Robert Farley, R-Glenville, said the Ellis-Bellevue agreement was “sad news,” and that it is unclear how long Ellis will maintain full services at the Bellevue campus.
   But Schenectady County Legislature Chairwoman Susan Savage, D-Niskayuna, said, “What we see today is some kind of compromise,” and “I’m glad that the Bellevue facility will remain open.” Savage added, “I don’t think it makes any sense to replicate services” that are now offered at Bellevue by building a new facility at the Ellis campus or elsewhere.
   Earlier this week, Savage suggested moving the Glendale nursing home from Glenville to the St. Clare’s campus in Schenectady, which would mean losing at least a substantial part of the hospital there. Farley and his father, Sen. Hugh Farley, R-Niskayuna, both said Thursday that they opposed that proposal, in part because Schenectady County cannot afford to lose the hospital services offered at St. Clare’s.
   Robert Farley said the proposal could adversely affect negotiations between Ellis and St. Clare’s and that the county should not play any role in driving St. Clare’s out of operation. He said the county should either build a new nursing home or rehabilitate the Glendale Home.
   Savage said it will be up to St. Clare’s how it reacts to any possible proposal from the county. “There is a lot of interest on the part of the diocese” in selling or leasing St. Clare’s to the county for use as a nursing home, she said. Ken Goldfarb, spokesman for the Roman Catholic Diocese of Albany, declined to comment on Savage’s proposal and referred questions to St. Clare’s.
   Although St. Clare’s has a $34 million unfunded pension obligation, Connolly, the Ellis CEO, said it does not have other long-term debt, and he hopes state aid can ease the transition so that all three hospital campuses can be united under one management. “I don’t have an immediate reaction one way or the other” to the proposal to put the county-owned nursing home at the St. Clare’s campus, Connolly said.
   Mack, the St. Clare’s spokeswoman, said Thursday that Savage’s plan has not been considered by St. Clare’s, although she declined to rule it out. St. Clare’s is moving ahead with implementation of the Berger law, Mack said.

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Grand hospital plan within reach after Bellevue deal

   Finally, some movement in the right direction on the health care front in Schenectady County:
   The state-imposed compromise announced Thursday, in which Ellis Hospital will take over Bellevue Woman’s Hospital in November makes a lot more sense than the previously announced Ellis plan to build a new women’s health care facility on its Nott Street campus, which would have rendered Bellevue superfluous. While the deal still doesn’t preclude Ellis from doing that, and from eventually closing the Bellevue campus, why would it want to spend $25 million for an addition that duplicates services it offers only a few miles away?
   The space Ellis was planning to use for the women’s facility could instead be used to add more beds, which might be needed if the 200 currently at St. Clare’s were sold to Schenectady County. On Wednesday, county offi cials indicated an interest in buying part of the hospital for a new nursing home. St. Clare’s is a good location for the nursing home — better than the existing one in rural Glenville; it’s on a bus line and is more accessible to employees and clients. And retrofi tting a hospital building for use as a nursing home is bound to be less expensive than spending $55 million to build a new one.
   Assuming that not all of the space at St. Clare’s would be needed for the nursing home, some medical services could continue to be offered there by the jointly run Ellis/St. Clare’s. That would be useful to the new nursing home’s patients, as well as the greater community. Meanwhile, money from the partial sale of the campus to the county could help solve the hospital’s $34 million pension liability issue.
   The above scenario seems like a good way for all parties to come away better off than they are now. Granted, Bellevue will no longer be independent; but at least its mission will be preserved and most of its jobs will survive. St. Clare’s would also be giving up a lot, but that was the Berger Commission’s mandate. And while Schenectady probably needs more beds than the 368 currently at Ellis, it doesn’t need a whole new hospital.
   The county probably needs more nursing home beds than the 168 mandated by Berger, but not the 240 it wants to build. So moving it to St. Clare’s seems like a reasonable compromise. And the above changes could probably be implemented for far less money than the various grandiose plans that have sprung up in the aftermath of the Berger report.

Quoted from bumblethru

And unionizing will help.....how?

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I ALSO SAY DONT SPEAK FOR ME.......

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Doctors shy away from Medicaid
Managed care aimed at helping low-income families needs physicians
BY JAMES SCHLETT Gazette Reporter

   The boy was 1 year old. Skin was peeling all over his body.
   His single mother late last year took the child to Dr. Robert Paeglow’s family practice in Albany’s West Hill neighborhood. The doctor diagnosed the boy with eczema, an inflammatory skin condition. There was little more he could do.
   “We weren’t able to get a dermatologist. We called around to a few places, but we couldn’t get him in,” said Paeglow, Compassion in Action/Koinonia Primary Care’s founder who also goes by “Dr. Bob.”
   Paeglow was unable to find a skin specialist to treat the boy because the boy’s health coverage was provided by Medicaid, a government insurance program for low-income parents, children, seniors and people with disabilities. Sixty percent of patients at Paeglow’s practice are covered by Medicaid.
   Paeglow years ago knew a dermatologist at Albany Medical Center who would treat Medicaid patients, such as the boy suffering from eczema. But that specialist has established a practice outside the hospital and no longer accepts Medicaid.
   With no one else to turn to, Paeglow prescribed oral steroids for the boy. While the drugs helped the boy, the doctor called it “a Band-Aid approach.”
   “Your resources are extremely limited when you’re dealing with a patient who has Medicaid,” Paeglow said.
   Over the years, Paeglow said he has seen those medical resources all but dry up. Doctors in the Capital Region say it is nearly impossible to find dermatologists, orthopedic surgeons, dentists and psychiatrists who accept referrals for Medicaid patients.
   The specialty care dilemma has been exacerbated by the state’s low Medicaid reimbursement rate for physicians. Nationwide, doctors who treat Medicaid patients are becoming harder to find.
   “We balance the budget on my back, and who can do that? So many [medical] groups have said we’re not going to do it,” said Paeglow, who treats a lot of his patients for free.
PHYSICIANS BACKING OUT
   Between 1997 and 2005, the percentage of physicians nationwide who reported receiving no Medicaid revenues rose from 12.9 percent to 14.6 percent.
   Twenty-one percent of physicians by 2005 had stopped accepting new Medicaid patients — a rate fi ve times higher than for privately insured patients, according to a 2006 study by the Center for Studying Health System Change, a Washington D.C. research organization.
   The nation’s physician flight from Medicaid is not a new trend for the state. “The other states are catching up with New York,” said Moe Auster, a staff attorney for the Medical Society of the State of New York, a Lake Success-based trade organization.
   Paeglow said he receives about $30 per visit for fee-for-service Medicaid patients. The same visit would net about $60 under a Medicaid managed care plan, and a private health plan could pay signifi - cantly more than that amount.
   In the CSHSC survey, five out of six doctors who stopped accepting new Medicaid patients blamed inadequate reimbursement rates for that cessation in care.
   “Specialty care is probably more challenging, particularly for people with Medicaid and especially for people without insurance,” said CSHSC spokeswoman Alwyn Cassil.
   More than 79,200 doctors in private practices participate in New York’s Medicaid program. Between April 1, 2006, and March 31, 2007, physicians withdrew from the program, according to the state Department of Health, which supervises the Medicaid program.
   To address those defections, the Health Department might include provisions in its 2008-09 budget that would enhance Medicaid reimbursements for ambulatory care, said Health Department spokesman Jeffrey Hammond. The agency might also develop incentives based on quality performance to lure more doctors into the Medicaid program.
MANAGED CARE PLANS
   Doctors’ growing aversion for Medicaid threatens to hamper lawmakers’ attempts to reform the health program. Medicaid covered 4 million New Yorkers at an estimated cost of $46 billion during the 2006-07 fiscal year.
   For more than a decade, the state has been requiring some counties to adopt mandatory Medicaid managed care enrollment plans. Managed care plans deliver benefits through health maintenance organizations, clinics, hospitals or physician groups.
   In the spring, Schenectady, Washington, Fulton and Montgomery counties abandoned voluntary Medicaid managed care plans for mandatory ones. By July, 39 percent of Schenectady County’s 14,310 residents eligible for Medicaid had been enrolled into managed care plans for the government program. The county expects to reach up to 80 percent enrollment within a year.
   The Medicaid managed care drive is intended to encourage lowincome and disabled New Yorkers to receive more preventative care treatment, such as annual physicals and other routine checkups. Those services can catch health problems early, lowering the chances patients will end up making expensive trips to hospital emergency rooms.
   As managed care plan rolls grow, more Medicaid patients are being steered toward physicians who practice in large groups, hospitals, academic medical centers and community health centers. Between 1997 and 2005, the percentage of solo and two-physician practices that didn’t accepted new Medicaid patients increased from 29 percent to 35.3 percent, according to the CSHSC study.
SOME GAINS, SOME LOSSES
   “We don’t know if that’s harmful. We have reason to be concerned. Access is getting tighter,” Cassil said of the concentration of Medicaid care.
   Capital District Physicians’ Health Plan, the region’s leading Medicaid managed care plan with 4,600 providers, has seen some doctors withdraw from its Medicaid network in recent years.
   “There have been no major influxes. There’s been some losses. There has been some gain,” said Kristin Marshall, a spokeswoman for the Albany health insurance company.
   Fidelis Care provides Medicaid coverage in 32 counties for 14,000 New Yorkers. It has 8,700 Medicaid managed care members in Albany, Saratoga, Schenectady, Rensselaer, Fulton and Montgomery counties.
   Fidelis’ Medicaid members in that six-county region are served by 585 doctors. In recent months, Fidelis has added 50 physicians to its Medicaid network, said Peter Avvento, an assistant vice president of marketing for the Catholic insurance company.
CONTRIBUTION CAP
   The Medicaid program is a federal-state partnership that has become increasingly burdensome on all levels of government. In 2004, New York picked up 32 percent of its Medicaid bill and counties paid 17 percent of that total. The federal government picked up the remaining 51 percent of the bill.
   Ballooning health care expenses two years ago prompted the Legislature to cap counties’ contribution to Medicaid. In 2004, Schenectady County’s bill was $174.8 million. Last year’s bill totaled $196.1 million, according to the Health Department.
   The Health Department is chiefly responsible for federal compliance and spending matters, though it controls only a portion of the program. The agency’s Offi ce of Medical Management largely administers the program. It oversees eligibility policy, benefits systems, federal relations, practitioner fees and pharmaceutical reimbursements, according to the Medicaid Institute at United Hospital Fund, a New York City health services research organization.
DEMAND FOR DOCTORS HIGH
   Essential to New York’s managed care strategy is ensuring there are enough doctors to treat Medicaid patients. The recruitment of those physicians is more pressing in places such as Fulton County, which lacks a large-scale community primary care health center that exclusively treats the uninsured and Medicaid populations.
   John Rogers, the director of fi - nancial assistance for the Fulton County Department of Social Services, said the county has been struggling to find doctors for Medicaid patients. The search for local specialists is more dire because they are already in short supply for private health plan patients.
   Between January and July, the number of Fulton County residents enrolled in Medicaid managed care plans has more than doubled from 1,052 to 2,752. During the same period, Schenectady County’s managed care ranks have grown by 13 percent from 4,982 to 5,623, according to the Health Department.
   MAXIMUS, a Reston, Va., provider of government program management, consulting, information and technology services, is helping Fulton and Schenectady counties enroll residents in managed care plans. The transition to a mandatory Medicaid managed care system will last about 12 months. Schenectady County Department of Social Services Commissioner Dennis Packard said the county seems to have enough physicians who accept Medicaid to meet the increased demand for preventative care services.
   “We haven’t heard anything about any stressors on the network,” said Packard.
   While that is true for primary care services, local medical experts said that is not the case for specialty care.
   The managed care push promises to be a boon for Hometown Health Centers in Schenectady.
   The community health center, with more than 50 practitioners last year, had 28,000 visits from Medicaid patients for family practice, pediatric, dental and dental outreach services. That Medicaid population accounts for 55 percent of Hometown’s business.
   “If we lose our current Medicaid market, then our future survival will be seriously threatened. It is therefore imperative that Medicaid patients are assigned to Hometown Health Centers under Medicaid managed care,” Hometown Executive Vice President Angella Timothy said in a prepared statement.
   “We are fully prepared to continue to serve Medicaid patients in Schenectady County in the new Medicaid managed care market,” she added.
SOME IMPROVEMENT
   In 1997, Albany, Saratoga and Rensselaer counties adopted similar mandatory Medicaid managed care programs. Schoharie County has a voluntary program.
   Jim Sinkoff, president and chief executive officer of Whitney M. Young Jr. Health Services, said the managed care push has improved Medicaid patients’ access to primary care services in Albany County. The Albany-based nonprofit community health center mainly treats the uninsured and people on Medicaid.
   “It’s helping, but it’s not solving the problem, because some of the specialists are not taking the program,” said Dr. Peter Forman, a family practitioner with Community Care Physicians in Albany.
   Forman in September will open a private family practice in Delmar. Citing a moral obligation to help the poor, Forman said he will accept Medicaid patients at his new practice. He said he understood why other physicians would refuse those patients, because the Medicaid reimbursements do not cover the cost of care.
   “It’s quite a conundrum,” said Forman, who is also the director of pre-doctoral education for the Department of Family and Community Medicine at Albany Medical College.
   The unavailability of specialists in some areas has severely curtailed Medicaid patients’ access to care, especially in the mental health field.
   Only 11 percent of the 5 million New Yorkers covered by Medicaid or the state children’s health insurance program received mental health services in 2006. Prescriptions made with neither the service of a specialty practitioner nor a mental health diagnosis accounted for a third of those treatments, according to a June report commissioned by the state Office of Mental Health and conducted by the Public Consulting Group.
   In the 2006-07 state budget, the Legislature ordered the study on New York’s mental health reimbursement system.
   The study found that primary care physicians attempt to fill the specialty care gap, “but they have neither the time nor, in some cases, the expertise to keep people out of jeopardy.”
   Although outpatient mental health services are the least expensive, they remain underutilized by the people who most need them. Outpatient services represent a “small slice” of New York’s mental health landscape, the report notes.
   “The current reimbursement system for mental health outpatient services is a complex matrix that is not working,” the report states. “ … Care must be given to do no harm to consumers and to ensure that changes do not create an environment that results in increased homelessness, arrests or hospitalizations. This work should continue with attention given to redesigning the reimbursement system in concert with the state’s reform agenda.”
   Hammond, of the Health Department, said his agency is reviewing patient accessibility to health care and to providers. Its review will identify regions where specialty care is needed most and then step up recruitment efforts in those areas.

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Spitzer signs bills on health care, 911 service
The Associated Press

   Gov. Eliot Spitzer has signed bills into law that will provide added consumer protections to people in the health care system and alert consumers about potential shortcomings of Internet phones.
   One law broadens the rights of health care consumers, physicians and hospitals associated with managed care health plans and streamlines rules so medical decisions can be made and acted upon faster.
   “This legislation secures important new rights for health care consumers, doctors and hospitals and represents the type of coordination among all stakeholders in the health care system that will be necessary in our march toward universal health coverage for all New Yorkers,” said Governor Spitzer.    The law limits a health plan’s ability to deny care it had preauthorized and empowers consumers to appeal decisions to deny a request to see a specialist who doesn’t participate in the health plan, among other measures.
   Sen. Kemp Hannon, who sponsored the bill in the Senate, said: “Improving the processes for payment and access are essential steps to improving delivery of quality healthcare services for all New Yorkers.”
   Assembly Health Committee Chairman Richard Gottfried called the measure “an important step ahead for making sure health care decisions are based on what is right for the patient, and for protecting patients and health care providers in dealing with health plans.”
   Daniel Sisto of the Healthcare Association of New York State called the measure an important piece of reforming managed care. “It will help bring more accountability to managed care organizations and greater protections for consumers and providers,” he said.
   Spitzer also signed a bill that requires companies selling Internet phone service to clearly inform consumers of the limits of 911 emergency call service. Although the federal government requires Internet phone services to provide enhanced 911 emergency response access, when customers move to another community they often don’t realize their 911 call would go to their former home area.
   “This law is necessary to make people realize that not all 911 telephone services are the same,” said Assemblyman Richard Brodsky of Westchester. He sponsored the bill with Sen. Andrew Lanza, a Staten Island Republican.
   “We have an obligation to make sure all people are protected, especially with something as important as 911 emergency services.”  

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National health care needs to be the focus

   The health-care system in this country is seriously broken — if not dead. The chasm between the salaries and perks of the CEOs of the health-care corporations, and the fact that millions of Americans are uninsured or underinsured, is unconscionable.
   Real solutions must be provided. We can no longer wait to fix this system that is filled with corporate greed. Our representatives in Congress must address this issue and discontinue playing the game of politics. People are dying needlessly.
   The presidential candidates should take this opportunity to lead the way — and forge a new path to health care. The people of the United States are due no less.
Show the American people that we matter — not politics. Health care for all Americans!
BONNIE KOSHOFER
Schenectady  

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August 1, 2007     
Contact:  Lisa Blumenstock, Press Secretary
     
McNULTY: HOUSE MEDICARE BILL INCLUDES $28 MILLION FOR AREA HOSPITALS (Washington, DC) - Congressman Michael R. McNulty announced today that the House passed H.R. 3162, the Child Health and Medicare Protection (CHAMP) Act of 2007, which includes an additional $28 million for area hospitals due to an adjustment in the Medicare wage index for Albany, Schenectady, and Rensselaer county hospitals.“For a number of years, the Medicare program has underpaid hospitals in our area for the wages they pay their employees. This inequity has made it difficult for hospitals in the Capitol Region to recruit and retain nurses and other heath care professionals. I am pleased that the House has approved this increase, which will result in $28 million more for hospitals in Albany, Schenectady and Rensselaer counties. This is a major victory not just for the hospitals, but also for the entire community,” said McNulty.Hospitals in the Capital region face stiff competition from hospitals in nearby counties for nurses and other critical staff. Emergency room nurses and other hospital staff can travel 30 to 40 minutes to hospitals in nearby counties and earn 30 to 40 percent more than they can in the Capital Region. In addition, area hospitals must compete with local insurance plans, doctor’s offices, state government and others businesses for nurses and other health professionals.Hospitals in the Capitol Region and around the country have been experiencing a shortage of staff because nurses and other health care staff can often find better paying jobs in real estate, in retail establishments, or in offices.The Medicare program has allowed hospitals in other parts of the country to appeal for higher payments. Unfortunately, the way the federal Medicare program is structured, Capitol District hospitals did not have this option. As a result, local hospitals were receiving Medicare payments far below other areas in the region. The passage of this bill is an important first step in rectifying that inconsistency. The bill passed the House today by a vote of 225 to 204. The Senate must now pass the bill before it is sent to the White House for the President's review.Below is an estimate of the potential increase in Medicare reimbursement for area hospitals:Hospital     Amount
St. Clare’s     1.5 million
Albany Medical Center     9.0 million
Seton Health     2.2 million
St. Peter’s     7.7 million
NE Health     4.1 million
Ellis     3.5 million
Total     28 million# # #

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The health-care system in this country is seriously broken — if not dead. The chasm between the salaries and perks of the CEOs of the health-care corporations, and the fact that millions of Americans are uninsured or underinsured, is unconscionable.
   Real solutions must be provided. We can no longer wait to fix this system that is filled with corporate greed. Our representatives in Congress must address this issue and discontinue playing the game of politics. People are dying needlessly.
   The presidential candidates should take this opportunity to lead the way — and forge a new path to health care. The people of the United States are due no less.
Show the American people that we matter — not politics. Health care for all Americans!
BONNIE KOSHOFER
Schenectady  

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the fact that millions of Americans are uninsured or underinsured, is unconscionable

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NEW YORK STATE
New law for care of indigent praised
BY SARA FOSS Gazette Reporter

   There’s a huge pool of money in New York to compensate hospitals for medical care provided to people who cannot or do not pay for it. Even so, uninsured patients often struggle to get the treatment they need.
   Last year, the state passed a law requiring hospitals to notify patients that they’re eligible for fi - nancial assistance and discounted bills. The law is known as “Manny’s Law,” named for a 24-year-old Long Island man without health insurance who died of a ruptured blood vessel in his brain after a procedure to reduce swelling was postponed for months by his hospital.
   Advocates for the poor have praised the new law, saying lowincome patients should be able to get the health care they need at reasonable rates. They are also encouraged by another development: The state Department of Health plans to review the state’s system of reimbursing hospitals for charity care to see if there are ways to improve it. The department’s new Indigent Care Technical Advisory Committee is holding public hearings on the issue; the next one is set for Aug. 13 in Syracuse.
   This year, the state will provide $847 million in Medicaid funding to hospitals for losses from bad debts and charity care. Bad debts are amounts considered uncollectible, including unpaid co-payments and deductibles, insured services that insurance companies decline to cover and money owed by patients who do not pay their bills. Charity care includes the reduction in charges a hospital makes when a patient is considered indigent.
   Experts view the state’s upcoming indigent care review as part of a broader process: providing all New Yorkers with health coverage.
   The state Health Department has put out a request for proposals for achieving universal health coverage in New York. The goal is to develop alternative proposals for achieving universal coverage, either through a system that combines private and public health coverage mechanisms, a publicly financed system or a combination of both types of systems.
   When he took office in January, Gov. Eliot Spitzer made it clear that one of his priorities is universal health care.
   The state has already started working toward that goal. In the fall, officials will begin reaching out to uninsured children and enrolling them in Child Health Plus, New York’s insurance plan for kids. The budget for 2007-08 makes more families eligible for Child Health Plus. And the state is streamlining enrollment in all publicly sponsored health insurance programs to make it easier for low-income people who qualify for such programs to get coverage.
SAME GOAL
   According to the state Department of Health, 16.5 million New Yorkers have health insurance, while close to 2.5 million remain uninsured. Of those with insurance, 9.3 million have employer-sponsored insurance and more than 7.2 million are covered by governmentsponsored health insurance such as Medicare, Medicaid, Family Health Plus and Child Health Plus.
   “We’re doing a lot of things at once all with the same goal, which is changing the way the state pays for health care through the Medicaid program to come up with a better, fairer reimbursement system,” said Claudia Hutton, spokeswoman for the state Department of Health. Hospitals that handle a disproportionate amount of the indigent care cases in their area are unhappy with the current system, but other hospitals think it’s fine, Hutton said.
   “If we’ve got that much of a pool of money, it seems like we should be able to provide it in a way [hospitals] think is fair,” Hutton said. “Right now, we reimburse [hospitals] based on the quantity of visits or the complexity of what you perform during a visit. That discourages primary care, and we don’t want that.”
   One of the Indigent Care Technical Advisory Committee’s big tasks will be to review how indigent care pool funds are allocated, and whether that formula needs to be changed.
   Right now, hospitals with higher rates of bad debt and charity care get a higher percentage of those costs covered by the indigent care pool. The committee will study whether that practice should continue.
   Trilby de Jung, a health law attorney with the Empire Justice Center and a member of the state’s indigent care committee, said it’s difficult to tell how much money New York is providing for charity care. “The money from the pool does not follow the patient,” she said, adding that better definitions of bad debt and charity care are needed, as is more information on how hospitals are using money from the pool.
MASS. MODEL
   According to the Department of Health, hospitals report almost twice as much bad debt as charity care; in 2004, public hospitals reported more than $400 million in bad debt, versus $176 million in charity care.
   Last week Raymond Sweeney, executive vice president of the Healthcare Association of New York State, which represents hospitals, nursing homes and home care agencies, testified before the Indigent Care Technical Advisory Committee. He said the state’s hospitals provide more than $1.6 billion annually in uncompensated services to low-income insured and under-insured patients, and absorb approximately $2 billion in losses annually in providing care to Medicaid recipients. “The indigent care funding that is made available is, therefore, critical to sustain the state’s not-for-profit and public hospitals to provide continuous access to low-income, medically indigent patients,” he said. He said distributions from the indigent care pool cover only about 50 cents of every dollar recognized as the cost of care for the poor.
   After Massachusetts mandated health coverage for every resident as part of its new system of providing universal care, it cut charity care funding, de Jung said. But she warned that charity care is always going to be needed because, even when insurance is mandatory, some people will slip through the cracks. Forty-five percent of New York’s uninsured residents, she said, qualify for public programs such as Medicaid, but are not enrolled. “We can cut down on that number, but I don’t know if we can eliminate it,” she said.
FOCUS ON SERVICES
   “New York,” de Jung continued, “has a lot to learn about how to bring people into coverage. Even if you’re bringing people into coverage, that doesn’t mean they can get care.” She said coverage has to be meaningful — if people have coverage, but doctors refuse to accept it because the reimbursement rate is too low, then it’s not meaningful.
   “If you go to the trouble of signing up for Medicaid, and you still can’t find a dentist, you may let your coverage go and become uninsured,” she said. “With universal coverage, we need to do more than just sign people up. We need to make sure people have services.”
   The big issue with universal coverage, de Jung said, is whether the state can make it affordable for low-income people.
   Manny’s Law requires hospitals to charge patients with incomes at or below 300 percent of the federal poverty level amounts on par with what insurance companies would pay for such services; patients who earn less will receive a sliding scale discount that is even lower. Hospitals must also set up a charitable program and publicize it.
   A February report by the Healthcare Association of New York State titled “When Will it End? Eight Straight Years of Losses for New York’s Hospitals” says that Medicaid payment shortfalls make it difficult to ensure that patients have access to the services they need. In 2004, the report says, New York hospitals lost $1.7 billion providing emergency and outpatient services to patients whose care is funded by Medicaid.  

Quoted from Shadow

The only problem is that old Hillary caused health care costs to rise and now it costs us more money than it did b4. It only makes sense that if you treat x number of people for nothing the hospital/doctors have to raise their rates to break even and every year the cost of medical care goes up and up with no end in sight.

Quoted from senders

Is healthcare birthcontrol--or is birthcontrol just a convenience, kind of like the clapper when you want to turn off a light in your house without making much of an effort?

Is healthcare viagra--or is viagra just a convenience, kind of like keeping a job your not so good at anymore even when ya know the boss isn't too pleased with your work, because it truly was all about you?