The cornerstone of the ACA is the provision for a coverage mandate — whether that coverage includes complete subsidized services (Medicaid or another fed subsidized program) or via private insurer. In order that individual states comply with this most essential of the reform law’s benefits, HHS has announced that states have the option to create “essential benefits packages” as a method of increasing compliance within the ACA.

“Flexebility” is the key, according to Secretary Kathleen Sebelius.

The national health law lists 10 categories of health care that all insurance policies must cover: hospitalization, emergency care, out-patient services, maternity and newborn care, mental health and substance abuse services, prescription drugs, laboratory testing, preventive and wellness care, pediatric services (including dental and vision examinations), rehabilitative care and habilitative care such as services for children with developmental disabilities. But within those categories, the federal government is allowing each state to determine its own basket of essential benefits by choosing a “benchmark” package offered by any of a variety of insurers.

Sebelius: This move protects consumers by respecting states’ role in healthcare delivery under the ACA. Obama administration: This is the only way in which the mandate can be upheld while making essential services affordable in all fifty states. Consumers? Increased standardization among offerings of basic services by states under the ACA raises the possiblity of mandated coverage rather than making things too onerous for the feds in getting the legislation off the ground in just a couple of years. | LINK

Related posts:

1. Under Reform, New Laws to Increase Access to Mental Health Care Services about to Take Effect It is well known that in the pre-reform era of...
2. Federal Government Prods States’ Insurance Commissioners to Reconsider Childrens-Only Coverage Plans Yesterday, the federal government began advising states to push for...
3. CMS Chief Gets Hands Dirty, Rolls Out Obama Admin’s Quality Reform Plans Ten years. Ten billion dollars. That is the level of...

With the continued destigmatization of some forms of mental illness in the community (namely, the diagnoses of depression and anxiety), it comes as no surprise that we are more willing than ever to discuss treatment and prevention more openly. Oh, and it also doesn’t hurt that — within the general population at any given time — 10 percent of Americans are taking an antidepressant.

According to the Centers for Disease Control, the rate of antidepressant use has skyrocketed by a factor of 4X over the past 25 years. Females lead the pack in all age demos save for the youngest — ages 12-17. Interestingly, income status was not a predictor of use, the agency cites; although, slightly more than 1 in 12 persons taking the drugs is Caucasian. Most disturbingly, though, is the apparent lack of care access or followup once these drugs are prescribed: just under a third of patients have seen a mental health professional (or primary care physician — assuming the drugs are possibly given for off-label uses) within the previous 12 months. Excellent survey data here.

Related posts:

1. Xmas Eve Newswire: Genetic Variance Affects Drug’s Effectiveness & More Happy Holidays from Doctor Pundit!  Posting to resume 12/26/08. Plavix...
2. FDA Releases Data on Drug Reclamation Program Just how much is 121 tons? Ask the DEA. A...
3. Report: Branded Drug Use Sharply Down, Generics Way Up A healthcare informatics company issues a report today that I...

Alzheimer dementia continues to be among the most heavily researched and funded chronic diseases in medical science today. The increased awareness, brought into the spotlight and “modernized” more than 20 years ago following the high profile revelations of celebrites and politicians afflicted with the disorder, has led to increased patient education, public policy initiatives, and, of course, greater research monies in the effort to not only treat symptoms, but also to find a cure.

An international advocacy group is now asking municipalities to take awareness a notch higher with the commitment to even greater awareness of the disorder — addressing what it calls a “treatment gap”, hampering any gains on detection of the disorder at its earlier stages. Here in the U.S., the Obama admin is apparently hard at work in developing the country’s first-ever national anti-Alzheimer strategy aimed at sharply cutting the enormous healthcare costs associated with ancillary treatment .

The National Alzheimer’s Project: From Act to Action is an effort to support a committed and effective implementation of the National Alzheimer’s Project Act (NAPA). Information collected from individuals living with the disease, caregivers, providers and other stakeholders will be shared with the U.S. Department of Health and Human Services, which is responsible for creating a national strategy to address the crisis and coordinate across government agencies. This project is facilitated and supported by the Alzheimer’s Association.

Consider this effort an amalgam of citizen awareness and discussion (townhalls) and legislation (congressional passage of the National Alzheimer Project Act) garnering bipartisan^[1] support to fight a scourge that can leave heavy financial tolls on caregivers, families, and the healthcare delivery system itself.^[2] A daunting task, to be sure — but one that is sorely needed. Here’s looking forward to December — the date when the president makes his plans for these initiatives very public. | LINK

1. Just how bipartisan? In 2007, Newt Gingrich co-authored an article in Alzheimer’s and Dementia: The Journal of the Alzheimer’s Association, making the case for the creation of a federal Alzheimer strategy.
2. Alzheimer’s Association advocates sent more than 15,000 email messages to the White House asking the President to sign the National Alzheimer’s Project Act into law; on 1/4/11, he did — making this action the most significant legislative action with respect to Alzheimer funding intiatives up to this point.

Related posts:

1. Research Trends Positively Influence Approach to Alzheimer Dementia Research into better treatments and possible cures of Alzheimer dementia...
2. The State of HIV/AIDS Awareness in 2010 Year in and year out, it seems as though we’re...
3. HHS Makes Effort to Increase PCIP Rolls By the close of 2010, the Obama administration had hoped...

First, and almost immediately out of the box, it was the concern for serious mental health effects.^[1] Now, somewhat controversial smoking cessation drug varenicline (Chantix) is the target of the FDA with respect to the increased risk of heart disease for those taking it. Of course, the FDA rates this as only a “small” risk as it “continues to evaluate its safety”.

The new warning comes from a 700-person trial in which patients who took Chantix (varenicline) over 12 weeks were more likely to experience an adverse heart event after one year than those who received a placebo. All of the patients had already been diagnosed with heart disease. For both groups, the heart attack risk was still small: 7 out of 353 patients taking Chantix had a nonfatal heart attack, versus 3 out of 350 who took a placebo.

1. Pfizer, the drug’s manufacturer was also the target of claims of an increased risk of suicidal ideation for those taking the drug — to a lesser extent, night terrors and delirium.

Related posts:

1. NEJM Study: Two Popular Blood Thinners Effective for Stroke Risk Reduction in Appropriate Candidates No April Fool’s Joke here. A new study shows combining...
2. Saturday Briefs in Cardiac Medical News Vanderbilt University (my undergrad alma mater) has announced that it...
3. NEJM: Intensive Antidiabetic Treatment with Respect to Cardiac Risk Factors in Diabetics Harmful Diabetes mellitus, type 2 is an epidemic problem in the...

Depression and its effects on those preparing for (med students), entering (residents), and established in medicine (attending physicians) are well documented covariates. Among practicing surgeons, a new study in a surgical journal suggests that the link between depression/burnout and suicide is stronger than previously thought.

The high rate of suicidal thoughts among surgeons in particular (6.3% compared with 3.3% for the population as a whole) was “striking,” [the researchers] reported, especially considering that surgeons are highly educated, nearly all have jobs, and most are married — “all factors known to reduce risk of suicide in the general population.”

Another surprise was that older respondents were more likely to report suicidal thoughts — surgeons 45 and older had a rate of suicidal ideation that was 1.5 to 3.0 times the rate among older members of the general population, the researchers reported. The difference was significant[.]

Also, the perceptions of medical errors originating, in part from surgeons themselves, correlated greatly with suicidal ideation. The greater the surgeon perceived the error and its imagined consequences, the higher the degree of correlation. | LINK

Related posts:

1. NEJM: Sleep Deprived Surgeons Should Seek Informed Consent from Patients Prior to Elective Procedures Think about this: you’re about to have elective knee replacement...
2. Study: EDs Closing at Significant Rates The default line of thinking with respect to care access...
3. Popular Smoking Cessation Drug Increases Adverse Cardiac Risk First, and almost immediately out of the box, it was...

Since the late 20th century, innovation in long term care (LTC) has been fueled by a desire of healthcare systems  – in this case, owners of skilled nursing facilities — to achieve new quality benchmarks in healthcare delivery at a reasonable cost. Thanks to major pieces of legislation over the past 15 years emphasizing patient safety, healthful outcomes, and cheaper methods of treatment delivery; LTC as a discipline has undergone a sea change for the better. As a geriatrician, I have seen this evolution firsthand. That’s why I absolutely love seeing developments like this

Working with a psychiatrist and a pharmacist, [nurse and resident care coordinator in a Two Harbors, MN nursing home, Eva] Lanigan started a project last year to find other ways to ease the yelling, moaning, crying, spitting, biting and other disruptive behavior that sometimes accompany dementia. They wanted to replace drugs with aromatherapy, massage, games, exercise, personal attention, better pain control and other techniques. [..] Within six months, they eliminated antipsychotic drugs and cut the use of antidepressants by half.

The savings in cost due to the cessation of expensive psychotropics (even if informed consent enabled usage), the avoidance of chemical restraint and its obvious negative effect on patient safety, and the increase in patient quality of life without the need for specialized dementia care (again, at an enormous increase in care delivery cost) are at least three major reasons why innovation in geriatric care is so important in the age of reform. And it’s happening right here in Minnesota. Excellent.

Related posts:

1. Care of Patients with Significant Dementia Places Nursing Homes in Media Spotlight Nursing homes (NH) and — by extension — long term...
2. Minnesota’s Largest Acute Care Safety Net Announces Cuts in Care Delivery So much of what happens to safety-net healthcare delivery really...
3. Report: Minnesota Achieves ‘A’ Rating in Palliative Care Provisions As a geriatrician, another reminder of the work that I...

It is well known that in the pre-reform era of mental healthcare delivery, insurers have not treated those diagnoses and their associated coverage on par with those of physical (mostly finite) illnesses. As part of the Affordable Care Act, that’s about to change — albeit, not as sweeping as many advocates would like. Under the Mental Health Parity and Addiction Equity Act (2008), plans are not mandated to provide such services for mental healthcare delivery or addiction services. However, surrogate restrictions on effective coverage — in the form of highly variable copays and deductables — will end…essentially giving parity to a multitude of reimbursable mental health diagnoses.

Although generally pleased with this expansion of coverage, mental healthcare advocacy groups are cautiously optimistic. Insurers can still determine the exclusion of such coverage if they do not deem it “medically necessary” in certain situations (for example, being pre-qualified for services at the outset of one’s care or at a treatment crossroads when one’s coverage includes a change in diagnosis — making his/her coverage trajectory more expansive in the form of, say, more intense outpatient psychotherapies).

Facilitated by the PPACA of 2010, parity of mental healthcare delivery will get another boost — in the form of federal grants designed to increase the integration of such services into the whole of healthcare delivery. | LINK

Related posts:

1. Mass’ Group Insurer’s Insistence on Mental Healthcare Restrictions to Treatment Could Be Breaking Fed. Law Preauthorization as a requirement by insurance companies to continue providing...
2. Medical Assn. Aligns with Mental Health Lobby for Crack at BP’s Funds for Healthcare Access I have always viewed as circumspect the interest of certain...
3. Mental Health Services Chain Perpetuated Medicare Fraud Medicare reform as it relates to expenses for mental healthcare...

Most — if not all — state regulatory boards of medicine are able to compel the investigated healthcare provider in virtually all cases that come before them. It took a Massachusetts psychiatrist to challenge that state’s medical board on issues of patient confidentiality. In a case involving the anonymous psychiatrist’s pain management of a handful of patients, the Mass. supreme court ruled that the physician had the right to deny a subpoena by the Massachusetts Board of Registration in Medicine requiring the provider to submit records — nixing the board’s contention that it has a duty to uphold public safety at all costs (safety trumps confidentiality).

Paul R. Cirel, the Boston lawyer who represents the doctor, said in an interview that the board already has access to the records of all controlled substances prescribed by Massachusetts doctors. The ruling, he said, clarifies the state’s psychotherapist-patient privilege and prevents the board from obtaining records about the private relationships between therapists and patients.

The board’s investigation found that the psychiatrist’s narcotic prescribing patterns involved over 200 patients — with over 80 percent being prescribed oxycodone, 77 percent being prescribed diazepam (Valium), and a like number prescribed both. | LINK

Related posts:

1. When Patient Activism Becomes Problematic for Physicians The battlelines are drawn in the latest medicolegal war which...
2. Physicians: A Modest Response to a Modest GOP Proposal Readers of the Huffington Post are treated to a concise...
3. NEJM: Sleep Deprived Surgeons Should Seek Informed Consent from Patients Prior to Elective Procedures Think about this: you’re about to have elective knee replacement...

I have always viewed as circumspect the interest of certain medical specialty societies which take stands that could be viewed by some as political. The need for these groups to make some sort of societal statement applied to medical corollary without the acknowledgement of the majority of its members implies ever so slightly of a kind of elitism better served by organizations more overtly deemed “political”.

Consider the statement by the APA on the recent effects of the oil spill on the incidence of mental illness diagnoses and subsequent insurance claims for treatment.

Mental illnesses brought on by difficult situations surrounding the BP oil spill may be less visible than other injuries, but they are real. An entire way of life has been destroyed, and this is causing anxiety, depression, [PTSD], substance use disorders, thoughts of suicide and other problems,” said APA President Carol A Bernstein, M.D.

The position –  the result of a response to BP’s chief claims administrator essentially denying payment equity with physical ailments payable with the government’s escrow relief funds — sounds more like a pitch to the feds and Big Insurance for more action guaranteeing accessible mental health care under reform. Since the biggest oil fiasco in this country’s history won’t be fading in importance anytime soon, the drive is on for greater awareness of the need for improved access to mental healthcare services.

While there is nothing wrong in actively lobbying the federal government for goals like this — the timing of this announcement, the association with a prominent DC-area mental health lobby, and the strong interest in this particular tragedy (as opposed to other numerous, less newsworthy ones) — should remind healthcare providers of the blurred line between political activism and healthcare advocacy.

Related posts:

1. Prominent Healthcare Insurer Lobby Proposes Its Version of Access for All The nation’s largest healthcare insurance lobby & trade group (America’s...
2. Mental Health Patients’ Trust in Public Healthcare Delivery Tested in D.C. Let’s start this post by harkening back to the dawn...
3. Under Reform, New Laws to Increase Access to Mental Health Care Services about to Take Effect It is well known that in the pre-reform era of...

Often referred to as the “bible” for the medical discipline of psychiatry, the Diagnostic and Statistical Manual of Mental Disorders, still in its fourth edition overall, is preparing for a makeover — its first since 1994. This was the reference that was the handbook for getting through psychiatric rotations in medical school and residency. Its focus is to provide criteria for diagnosing mental disorders. Incorrectly referred to as a “cookbook” by many, the manual actually stands as complementary to the myriad postulates and patient presentations often part of the challenging workup toward a clinical psychiatric diagnosis.

Scheduled for release in 2013, the fifth edition is now in its final stages of preparation. Starting today, a task force commissioned with proposals for the upcoming edition is now soliciting public comment on proposed changes — which include everything from the proper nomenclature for substance abuse to the increasingly necessary strict determination of the diagnosis of autism. | LINK

Related posts:

1. Study: 20% of Young Adults Suffer from a Personality Disorder The years spent in college can be among the most...
2. Research into Origins of Dementia Exciting Yet Daunting It’s pretty startling to think that one of this planet’s...
3. Study: Spouses of Dementia Patients May Be at Increased Risk of Incident Dementia Although the prevalence rate of dementia is higher overall in...