The aging of our nation has brought us more than a heightened sense of healthful well being, it has also pushed the concepts of preventive care and chronic disease management well beyond the pages of medical literature.  Besides patients and doctors; healthcare organizations, third party payers, the federal government (Medicare) and disease-oriented associations are claiming a bit of the pie with respect to the constant flow of information about these issues.

Lately, the target condition is diabetes.  Or, rather, pre-diabetes.

Pre-diabetes occurs when blood sugar levels or impaired glucose tolerance is elevated, but not quite to the point defined as diabetes. More than 56 million Americans currently suffer from pre-diabetes, according to the U.S. Centers for Disease Control and Prevention.

“Diabetes has become the major problem in the United States,” Dr. Harold Lebovitz, a professor of medicine at the division of endocrinology and metabolism/diabetes at the State University of New York Health Sciences Center at Brooklyn, said during a noon teleconference Wednesday.  […]

“The issue is, do you wait until patients really develop these catastrophic complications?” Lebovitz said. “Last year, it cost $170 billion in direct and indirect costs to take care of people with diabetes.”

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There’s no easy money.  That’s the mantra echoed in an interesting piece today in the NYT.  Critics of Barack Obama’s healthcare financing plan are beginning to question the senator’s rationale for major policy points behind his pledge to “bring down premiums by $2,500 for the typical family”.  They also contend that the presidential candidate has no essential timeline with which to carry out his audacious initiatives.  Potential roadblocks:

• How does one begin to consider cost of healthcare savings if upfront costs for policy changes are daunting?  For example, take his pledge to spend $50 billion over five years to speed the computerization of health records,  or what about $6 billion a year on tax credits to small businesses that provide coverage to workers?
• When could one actually begin to realize the $2500 savings? Obama’s camp says by the end of the first term, but that’s not entirely a sure thing.
• Getting around the fact that Obama’s projecting that a robust overhaul consisting of 15 broad initiatives would generate savings of only 6 percent after 10 years (according to the Commonwealth Fund).

The heatlhcare debate just got a little more interesting. | LINK

Complacency is the assumed response to HIV as an all-encompassing term.  It follows, then, that the response to the following troublesome statistic will probably be met with relative inaction, at least initially. 

AIDS rates in the nation’s Latino community are increasing and, with little notice, have reached what experts are calling a simmering public health crisis.  Though Hispanics make up about 14 percent of the U.S. population, they represented 22 percent of new HIV and AIDS diagnoses tallied by federal officials in 2006. According to a survey by the Kaiser Family Foundation, Hispanics in Washington, D.C., have the highest rate of new AIDS cases in the country.

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Early news from another trial involving former blockbuster drug Vytorin will not be good for investors and its parent Pharma company.

The combination was significantly more effective than placebo in reducing the risk of ischemic events, a secondary composite end point of nonfatal MI, coronary artery bypass graft (CABG) surgery, PCI, hospitalization for unstable angina, nonhemorrhagic stroke, and cardiovascular death. Vytorin failed to meet a secondary goal of improving aortic-valve disease events, which included valve-replacement surgery, hospitalization because of heart failure, and cardiovascular mortality.

“The SEAS study has given a clear-cut answer to the question of whether intensive lipid lowering will influence the course of aortic-stenosis disease. I think we can conclude that it does not,” announced Dr Terje Pedersen (Ulleval University Hospital, Oslo, Norway), chair of the steering committee, during a conference call today with the media. “We have also shown there is benefit in treating such patients with the study drug combination, as we saw a reduction in the risk of coronary artery disease.”

You may recall that Vytorin encountered hot water (and its market share took a big hit) when a previous scientific trial showed no difference between this combination drug and simvastatin (one of Vytorin’s component agents) alone in the treatment of coronary artery disease and prevention of its adverse outcomes. | LINK | Previous Doctor Pundit coverage here.

It’s inevitable.  Electronic prescribing may be a early-adopter niche-driven tech blip on the EHR tableau, but it is here to stay; and the government is getting in on the act.  Medicare will now provide incentives for physicians who wish to incorporate this method of prescribing into their practices.  Makes sense.  The days of physicians getting a free pass on illegible prescriptions and healthcare’s expectations of working within this potentially dangerous construct are numbered — from a patient safety standpoint.  | LINK

• Colorado veterans oppose VA hospital plan to partner with an existing private non-profit.
• Wisconsin Medicaid fraud unit exposes tactics of neuroleptic drug maker.
• Holy menu, Batman!  NYC restaurants can be fined for not showing calorie counts on their offerings.
• House committee will investigate healthcare plan rescissions nationwide.

A congressional committee will investigate health insurers’ practice of canceling coverage when policyholders get sick, its chairman said Thursday.
The problem first came to light in California, but witnesses testifying before the House Oversight and Government Reform Committee suggested that it was more widespread. The problem affects the individual insurance market, in which 14 million Americans, including nearly 3 million Californians, purchase medical benefits on their own. In light of proposals to expand the individual market, the committee’s chairman, Rep. Henry A. Waxman (D-Beverly Hills), said the individual market demanded more scrutiny, especially of cancellation practices.

• McCain criticizes Obama for voting against so-called “partial birth” abortion ban.

It looks like the state of Louisiana gets it. As the discipline of primary care medicine becomes known more for cuts in Medicare and Medicaid reimbursements than for treatment and prevention of disease, the state — whose brush with hurricane Katrina in 2005 has done more for its sense of healthcare activism than in many other southern states — is being proactive in overhauling its healthcare delivery systems to its un- and underinsured. How is Louisiana approaching primary care reform? By lobbying hard for government pilot projects that emphasize parity among provider networks in the delivery of chronic disease management, while giving traditional fee-for-service Medicaid programs a run for their money. | LINK

Could this really be true?

Access to health care in the United States continues to elude more and more Americans, a new survey shows. […] “Despite the best efforts of millions of talented and dedicated health-care professionals, this latest scorecard demonstrates that we are losing ground,” Karen Davis, president of the Commonwealth Fund, said during a Wednesday teleconference.

Of course it is.  Silly of me to even ask. | LINK | LINK 2

One of the Twin Cities’ largest healthcare networks is in 11th hour renewal negotiations with one its third parties over reimbursement issues. A rarity among insurers and their preferred provider organizations (PPOs), contract negotiations running up to the last minute can only mean one thing for its disputing sides — we’re drawing a line, and if you don’t meet us there, Sayonara! | LINK

Michelle Hoyte, a former employer of the American Red Cross, was concerned.  So much so in fact that she invited a team of auditors to visit one of the service organization’s Philadelphia operations.  She then became a whistleblower and was subsequently terminated.  If you believe her version of events, it is because the organization’s senior leadership was essentially neglecting strict safety standards by refusing to recall over 500 units of blood products collected by improper methods. 

Blood collection is big business for the Red Cross, whose ability to steward the distribution of donated blood in this country far outstrips its logistical acumen in coordinating continental and worldwide disaster relief efforts.  Apparently, the drive for revenue from its well known association with blood donation is trumping concerns over its ability to protect the public; consequently,  the FDA is setting its regulatory sights on the Red Cross. | LINK

The Sophisticated Lady has been diagnosed with hepatitis C, the virus — which in some — may be pre-cancerous or a cirrhotic harbinger. The media say she’s “lucky” to be responding to treatment, a mix of anti-neoplastics and antivirals. Surmised to be secondary to her much publicized battle with drugs in the 1980s prior to her latter-decade career resurgence, the infection was found on routine screening during a physical checkup. | LINK

Today, the president is expected to veto the current law (passed by the Senate last week) which prohibits a projected 10.6% cut in Medicare reimbursements to physicians. This much is certain. A congressional override appears to be certain, also. What seems to be clear is that the fight between sides in this important issue will continue. What is less apparent, however, is what passage of the bill would ultimately mean for healthcare costs to the taxpayer over the next five to ten years.

Unsurprisingly, the Democrats are accused of being shortsighted by the Repubs — that grabbing the “low hanging fruit” of stabilized reimbursement doesn’t compensate for projected increases in overall Medicare covered healthcare costs yet to come. Of course, the Democrats are hurling barbs at the Republicans who criticize the bill’s “loophole” provision allowing for the influence of lobbyists on currently restricted formularies under Medicare Part D. Confused yet? | LINK

UPDATE: Both houses of Congress wasted no time in promptly overriding President Bush’s veto. | LINK

With organized medicine promoting the popular measure in an election year, Republicans broke heavily from the White House. A total of 153 House Republicans voted to defy the White House, an additional 24 Republicans from a June 24 vote that started the momentum toward passage of the Medicare doctors’ bill Tuesday. Twenty-one Senate Republicans voted for the bill this time, including four senators who had voted “nay” in the two previous Medicare votes.

As many are expecting the fate of a recent bill blocking cuts in Medicare reimbursements to physicians to head straight to veto, pundits from the healthcare policy sphere debate what the intended goals of its passage would have brought (or, will bring) to the overall business of healthcare.  Will shifting payments from physicians to payers give seniors more choice in their healthcare, as Republicans suggest; or, will this action limit access to care because of physician disenrollment — a concern of Democrats? | LINK