Changes in store for uninsured with medical conditions

By Kaye Spector

Plain Dealer Health and Medical Writer

 

A pre-existing condition is a medical problem that a person has, or has a history of, when applying for a health insurance policy. Right now, insurance companies can deny coverage, charge higher premiums or refuse to cover anyone with a pre-existing condition.

The medical concerns can range from heart disease and cancer to diabetes or asthma and hypertension, said Dr. George Kikano, chairman of the family medicine department at Case Western Reserve University.

Most people with a pre-existing condition are simply denied coverage. That will change with the health care overhaul signed into law this week, as the health care safety net is extended to millions of Americans previously locked out of the health care market.

Right now, who can't get insurance because of a pre-existing medical condition?

Typically, they are people who are unemployed or work for a small company of less than 100 employees.

Unlike larger employers that are self-insured, smaller companies that purchase insurance are hit harder by chronic, costly illnesses because costs are spread out over a smaller group.

The insurance companies have to charge the individual as much as it's going to cost them, said J.B. Silvers, professor at Case Western Reserve University's School of Medicine and faculty director of the Health Systems Management Center at Case's Weatherhead School of Management.

How many people with pre-existing conditions couldn't get coverage?

In 2007, the Commonwealth Fund Biennial Health Insurance Survey estimated that 12.6 million non-elderly adults were unable to obtain health care insurance because of a pre-existing condition.

That number represents about 36 percent of the nearly 35 million who tried to purchase health insurance directly from an insurance company.

In another study, by the Kaiser Family Foundation and Harvard, one in 10 people with cancer said they could not obtain health coverage. Six percent of those surveyed said they lost their coverage because of being diagnosed with cancer.

"Right now, most or all group health coverage really doesn't [cover] pre-existing medical conditions," Silvers said.

 

How does the health care reform law impact people with pre-existing conditions?

In six months, insurance companies can no longer deny children coverage because of pre-existing medical conditions.

It's unclear what the added cost of providing this coverage may be for insurance companies -- and, ultimately their premium-paying customers, said Jennifer Tolbert, principal policy analyst at the Kaiser Family Foundation.

Only a small proportion of U.S. children have serious pre-existing conditions and many already have health care coverage, Tolbert said.

The thinking is that since the number of uninsured chronically ill children is small, the costs of coverage will be more easily absorbed, Silvers said.

Within 90 days, adults with pre-existing medical conditions unable to get health care coverage for six months, will be able to purchase coverage through a new, temporary high-risk pool. Premiums will be set as if they did not have pre-existing medical conditions, with the government paying the difference, Tolbert said. The bill set aside $5 billion for the plan.

That special pool will end in 2014, when coverage will be extended to a wider part of the population through Medicaid and new state-run insurance exchanges.

Also in 2014, insurance companies will no longer be allowed to deny insurance to anyone with pre-existing conditions.

Why the wait until 2014 for adults?

The four-year wait allows time to establish the new exchanges, aimed at providing a competitive, consumer-friendly, online place to purchase private insurance for people unable to obtain coverage through an employer.

With the new law's mandate that everyone purchase insurance, it's expected that many healthy people will be buying at the new exchanges, as well. That will spread the health care costs among a larger group of people, Silvers said.

"If they did it now, they would have to take on a big risk," Silvers said. "It works if everybody's in the pool and nobody discriminates. Then it evens out. You get the average." 

 

Warm wakeup from surgery has roots with Cleveland doctor

By Kaye Spector
Plain Dealer Health and Medical Writer

Before the late-1990s, most surgery patients woke up from general anesthesia feeling cold, their teeth chattering and their body shuddering with uncontrollable shivers.
Not anymore.

Today, patients wake up from surgery comfortably warm, wearing a gown inflated with circulating air, lying on a mattress filled with gel or resting under a blanket puffed up with air. Medical staffs closely track patients' temperature during and after surgery.

Starting in January, the government began to require that hospitals report on their efforts to maintain normal body temperatures, as does at least one major hospital accrediting association.

It was research pioneered in the mid-1990s by an anesthesiologist now working at the Cleveland Clinic that helped changed the way the medical profession thinks about maintaining a surgery patient's body temperature.

A series of studies by Daniel Sessler, professor and chairman of the Clinic's Outcomes Research, showed that a slight decrease in body temperature during surgery -- up to 4 degrees Fahrenheit -- causes a three-fold increase in the risk of surgical wound infection or heart problems, increased blood loss and a 20 percent longer recovery.

And, Sessler says, "it makes people really uncomfortable."

Regulating patients' body temperature is something "we take very seriously," says Dr. Karl Wagner, an anesthesiologist at MetroHealth Medical Center.

It wasn't always that way. Operating rooms are kept cool for the comfort of the heavily gowned surgeons who operate under hot lights. Medical staff assumed that's why patients were chilled.

Concerns about temperature "used to be for the comfort of the surgeon," says Dr. Mark Aeder, UH medical director for surgical quality. "Now it's for the safety of the patient."

Sessler's discovery was serendipitous. When he first began his research, his goal was to explore how anesthesia affects the body's temperature regulatory system. He had no idea lower body temperature could affect infection or recovery rates.

"When I started, I made a conscious decision to study temperature regulation -- even though I didn't think it was important -- because I liked the physiology," Sessler said. "There was no evidence there was an effect."

When a person becomes cold, blood vessels in the arms and legs constrict to keep warm blood in the body's core to preserve vital organs. Work by Sessler and others showed that anesthesia keeps those blood vessels open, causing the body core to lose heat through the arms and legs.

Lower core temperature also resulted in a defect in platelet function, impaired coagulation and increased blood loss.

And, after the anesthesia is stopped for an unwarmed patient, the resulting blood vessel constriction inhibits blood and oxygen flow to the wound, resulting in increased risk for infection.

"A very small difference in temperature makes a profound impact on the outcome," Sessler says.

After the research became known, many patient warming devices came on the market, says Michelle Slater, R.N., a perioperative educator at Fairview General Hospital.

In recent months, Fairview General Hospital started using one of the newest: a hospital gown, that uses warm, forced-air to maintain body temperature. Hospital managers already were working toward complying with the national patient safety goals and the Joint Commission recommendations.

At about $15 per gown, they cost a bit more per patient than the forced-air blankets, Slater says, but hospital managers thought it was worth the investment because of the improved patient outcomes. Plus, there are no blankets or fabric gowns to launder.

Patients receive the single-use Bair Paws gown, made by Minnesota-based Arizant Healthcare, at check-in and wear it until they return to their room.

Initially, patients control the warm air; the surgical staff takes over after the patient is under anesthesia.

Although better infection and recovery outcomes are great for patients, as a nurse, Slater knows that feeling comfortable is important to them too.

"There's nothing worse," she says, "than feeling cold."

 

FDA tightens focus on food label claims

By Kaye Spector
Plain Dealer Health and Medical Writer

Food labels are coming under increasing scrutiny of late, from consumers as well as the U.S. Food and Drug Administration.
They have their own reasons: Health-conscious buyers say they want nutrition information, while the agency wants to improve labels' scientific accuracy and usefulness.

Americans' use of the label has increased in recent years, says a newly released FDA survey conducted in 2008. Fifty-four percent of consumers reported “often” reading the label before purchasing a product, a 10 percent jump over the 2002 survey.

The most-cited reason was to measure such aspects as calories, salt, vitamins or fat – information contained on the “Nutrition Facts” panel on the side or back of a product. The second most-cited reason was to gain a general idea of nutritional content.

Many consumers also are using nutrition claims on the front of food packages to make purchasing decisions: 72 percent of those surveyed reported using claims such as “low-fat,” “high-fiber” or “cholesterol-free” either often or sometimes; 67 percent used the claim “zero grams of trans fat” in their decisions.

At the same time, people expressed different degrees of trust about these claims. Forty-one percent said they trusted claims such as “low- fat” or “high fiber,” while 56 percent believe some or none are accurate.

It's these front-of-label claims that prompted the FDA recently to issue warning letters to 17 food manufacturers, saying one or more of their products featured misleading health or nutritional claims.

The products ranged from baby food to olive oil and frozen coconut cream pie. Among them:

Nestle's Juicy Juice All-Natural 100% Juice Orange Tangerine and Juicy Juice All-Natural 100% Juice Grape labels wrongly imply they are 100 percent juice when they are actually juice blends with added flavors, the FDA said.

Salada Naturally Decaffeinated Green Tea claims it will treat, prevent or cure diseases such as Alzheimer's, rheumatism and cancer, assertions not allowed on food products, the FDA said.

Diamond of California Shelled Walnuts similarly claims that it will treat, prevent or cure diseases such as heart disease, arthritis and cancer, the FDA said.

Several baby food products, with brand names such as Beechnut, Gerber and Parent's Choice, make health claims, which are not allowed on products for children younger than 2 because dietary levels have not been established for that age range.

The FDA also took issue with products like Nestle Drumstick Classic Vanilla Fudge, Gorton's Fish Fillets and Mrs. Smith's Coconut Custard Pie that trumpet one aspect – such as having no trans fat – but do not identify high levels of other substances – such as saturated fat.

Companies that receive warning letters have 15 business days to inform the FDA of how they will correct their labeling. Several of the manufacturers, including Nestle, Gerber and Diamond, have said they are working to make the changes.

The FDA, under Commissioner of Food and Drugs Margaret Hamburg, says nutrition labeling is a new priority.

The warning letters follow a statement by Hamburg in October encouraging food companies to review their labels to ensure they comply with FDA regulations, are truthful and not misleading.

The agency is expected to soon propose calorie and nutrient guidelines for front-of-package labeling.

“I think it is long overdue,” said Kristin Kirkpatrick, a registered dietitian who counsels patients in the Cleveland Clinic's Lifestyle 180 program. “I think people are drawn to these products because of health claims. And a lot of times these foods will do more harm than good.”

Kirkpatrick teaches her patients to go to the nutrition facts box and the ingredient list for the real skinny on what's in a product, and not the marketing claims on the front, in the ads or on the Web site.

Food-borne illnesses carry big price tag; 3.2 million Ohio cases, national study estimates

By Kaye Spector

Plain Dealer Health and Medical Writer

 

Ohio has an estimated 3.2 million cases of food-borne illnesses annually, 762,000 of which originate from eating produce, says a wide-ranging study released today.

Nationwide, the study by the Produce Safety Project at Georgetown University estimates some 76 million American are sickened from consuming contaminated food annually, resulting in 5,000 deaths.

These food-borne illnesses, such as salmonella and e. coli, also cost Ohioans an estimated $5.8 billion a year in health care spending and quality-of-life losses.

That ranks Ohio seventh in the nation; when calculated per capita, it’s 18th.

The study, authored by Ohio State University assistant professor and former Food and Drug Administration economist Robert Scharff, is the first-ever estimate of the financial burden of food-borne illness state by state.

“In public health,” said Jim O’Hara, Produce Safety Project director, “it is critical to have a measure of the problem you are trying to attack.”

The report’s scope is the most sweeping to date.

As the basis of their modeling, researchers used CDC data on 27 bacterial, viral, parasitic and unknown pathogens.

The most cited data until now had been a 15-year-old FDA study that looked at just five pathogens.

Also, because health officials believe that much food poisoning goes unreported, the incidence numbers include a calculation that for every case recorded by the Centers for Disease Control and Prevention, 20 go unreported, Scharff said.

The calculation of loss includes measures such as “quality of life,” death, pain and suffering, and functional disability. These factors have never before been taken into account.

This enlarged scope puts the nation’s price tag for health-related costs of food-borne illness at $152 billion a year.

That’s up to five times the government’s previous estimates, which have ranged from $6.9 billion to $35 billion annually.

“It really illustrates how serious food-borne illness is as a problem in our society,” Scharff said during a press briefing Tuesday, hosted by Make Our Food Safe. The coalition includes American Public Health Association, Center for Science in the Public Interest, Consumers Union and the Pew Charitable Trusts.

The coalition hopes to put pressure on the U.S. Senate to pass comprehensive food-safety legislation. In July, The U.S. House passed its food-safety bill, which includes new regulations and reporting mandates.

“It’s important to families to know they have purchased food that isn’t going to harm their family in some way,” said U.S Rep. Rosa DeLauro, a Democrat from Connecticut.

“If people can’t engage in the humanitarian aspect, maybe they are willing to listen on the economic issues,” she said.

 

 

Soy losing its reputation as a fringe food, growing as nutritional choice for table

Soy, which most Americans once considered the province of vegetarians, the lactose-intolerant and Asian cuisine lovers, is losing its reputation as a fringe food.

Americans' joy for soy has grown so much that consumption doubled between 1997 and 2003, either through whole foods such as tofu and tempeh or through soy isoflavone concentrates added to processed foods including nutrition bars, yogurt and baked goods.

“I think there's a lot of good marketing going on,” says dietitian Mary Beth Kavanagh, a nutrition instructor at Case Western Reserve University. “There's a perception that it's healthier than other foods.”

Soy's reputation as a heart-healthy food increased in recent years after clinical studies showed consumption of at least 25 grams of soy protein per day moderately lowered total and low-density lipoprotein (the “bad” cholesterol).

High cholesterol is a major risk factor for coronary heart disease, which can lead to heart attack.

Some scientists point to soybean components, such as the isoflavones genistein and daidzein, as being responsible for soy's cholesterol-lowering properties.

To eat the 25 grams of soy protein necessary per day to lower cholesterol takes some dedication, however. You would need to drink 3.5 cups of soy milk (7 grams of protein per serving). Or, eat 2.5, half-cup servings of tofu (10 grams of protein per serving).

But even if you don't eat enough soy to improve your heart health, it still is a good choice nutritionally.

Soy is high in good-quality protein and contains all the essential amino acids. It has a healthy balance of carbohydrate and fat and is loaded with vitamins and minerals. To get the full health benefits, eat it in its whole forms: soy milk, tempeh, tofu, roasted soybeans or soy flour.

Processed soy foods, such as hot dogs, chips, burgers and snack bars, are high in protein but typically contain low levels of isoflavones.

“You can't compare them for the benefits,” says Amy LeJeune, a dietician at University Hospitals' Ireland Cancer Center. “It's like adding junk food in some regard.”

If you can't stomach the thought of eating tofu, sorry: Soy isoflavone supplements in food or pill form aren't going to do the job, says an advisory published by the American Heart Association.

That's probably because supplements are absorbed differently from whole foods, LeJeune says.

“Most people want to take a pill and be done with it,” she says. “But there's synergy with food.”