Jen’s Posterous

http://ascannerbrightly.blogspot.com/2009/03/medical-data-privacy-consumers-v.html

Amen.

Health types - it pays to read the local business press...

"Maryland now has two universal health care plans to cover more than 800,000 uninsured residents."

My own sweet MD received dubious honors as the next state to go for broke (literally, figuratively) with 'universal' coverage "Healthy Maryland" plan for the uninsured.

This could mean ME, if I don't move to Canada, Timbucktoo, or other points on the compass, as well as my father.

"It is unclear how businesses view Healthy Maryland, but talk within the health care industry suggests Maryland’s employers may not have to worry about it until next year. Annapolis insiders say CareFirst, Hammen and Middleton are floating the Healthy Maryland plan this year as a way to gauge lawmakers’ and the public’s appetite for the plan and to encourage more debate about health care coverage."

One thing to applaud (?):

"...officials of Owings Mills-based CareFirst said the region’s largest health insurer did not want to wait for progress to be made on the federal level."

Insurers are afraid legislation will drive them to provide plans of this nature anyway, and are seeking the PR win via proactivity?

If you can't beat the bill, help draft the policy from the ground? And maybe those nice appreciative legislators will give you some tax breaks or something, like a bite of the stimulus bill, as a result?

Gotta love the wording:

"HOOK: Maryland state legislators unveil unprecedented budget-neutral plan, "Healthy Maryland," to provide universal health care to Maryland’s nearly 800,000 uninsured."

National stats on how healthcare spending will break the American piggybank wide open are easy to find.

Let's take a micro-look at how healthcare costs, utilization, and budgeting are affecting small-town USA, and how even in the non-profit hospital space, significant monies flow in and out through various donation, gift, and other channels. Here's what keeps me up at night when I read the latest release about the stimulus bill budgeting...

Spending is never quite what it seems on the healthcare balancesheet, not from the individual perspective, and not from the systemic perspective.

Exhibit A: St. Mary's Hospital of Maryland. I worked there as a Patient Advocate my senior year of undergrad.

Quick disclaimer - I've also received excellent post-trauma care at the hospital, and still count that job as one of my favorite to date. Because it supports so many in my community (including most of my immediate family), I follow its activities from afar.

I just received their latest edition of "Healthy Living," a community-oriented print newsletter.

A quick and dirty read of the newsletter reveals these interesting stats about costs/expenditures we're counting (or not counting) in HC:

* Breast cancer accounts for approximately 33% of all cancer Dx (and on the rise), leads to purchase of breast coil for one MRI machine, also new 64 slice CT scanner. Where is condition-specific research influencing how we budget for healthcare acquisition of equipment, personnel, and thus incentives for R&D, training, recruitment, education, etc?

* Volunteers (aka unpaid employees) donated more than 7k hours over past fiscal year, and made over 5k 'pastoral' visits...it's home health with a religions/faith-based bent, and is accounted for nowhere on the balance sheet - where's the DRG for this? By what percentage is our national healthcare spend REDUCED via volunteerism and donated time? How will the graying of the boomers, increased workloads, and rising sedentary lifestyles REDUCE future volunteerism in the healthcare space?

* The hospital's Annual Gala was sponsored by Wyle, Alliance Anesthesia Associates, AMEWAS Incorporated, Associates in Radiation Medicine, Eagan McAllister, IAP World Services, ManTech Systems Engineering Corp. This is smorgasboard of pharma, HC, and defense/contracting players (community-based since we live near Patuxent Naval Air Surface and Warfare base PAXRiver). Raises $175k for Foundation Scholarship program, aka recruit and pay for education of future employees. By what percentage is our hospital's ability to recruit INCREASED by gala/fundraising activities? How will this be affected by recessionary/depression related pressures?

* St. Mary's Hospital Auxiliary group raised $15,1000 for mobile EKG machine for ER (Aux. donated more than 4.3 MILLION in gifts since 1970). What percent of our hospitals' budget lines are raised by auxiliary groups? How do they contribute to HIT, EMR, etc. spending, if at all?

* According to 2005 data (!), 13.4% of people UNDER 65 were uninsured in St. Mary's County. A rise in the uninsured (and underinsured) populations affects spending how? What percentage of nonprofit assistance programs jump in here and contribute? How do we quantify that?

* For FY 2008 (1 July 07-30 June 08), the hospital provided more than 3M in 'charity care,' at reduced or no cost. How do increases in charity care provided affect the bottom line nationally?

* SCARY: "The hospital saw a 68% increase in individuals utilizing (not applying for, USING) the hospital's Payment Assistance Plan from fiscal year 2006 (!) to fiscal year 2007." A financial assistance counselor is cited as saying that "over the last six months she has seen an increasing number of individuals who fall within the middle-class designation (according to Federal Poverty Guidelines) requesting help. How will time spent with patients counseling them on payment alternatives change the face of daily business and operations at our hospitals? Will we outsource this? Do we quantify it?

In other words, how much is counseling people about how to pay for their healthcare REALLY costing us?

http://www.crookedbrains.net/2009/02/toys.html

Creepy but gut-wrenching series for the Active Life Movement, created by Latinworks. http://www.latinworks.com/new_latin4/index.html

"....instead of using fat kids, they show fat toys: a superhero, a doll and others childhood toys."

http://adweek.blogs.com/adfreak/latinworks/

Yikes.

Link courtesy of the fascinating @floatingbones.

http://floatingbones.com/.

Immersing myself in ice-flow like anatomical structure theory to avoid working in Photoshop.

This is one he&^ of a way to procrastinate....

"Developing Orphan Products: FDA and Rare Disease Day."

http://www.fda.gov/consumer/updates/oda020808.html

http://rarediseases.info.nih.gov/rarediseaseday.aspx

Happy Rare Disease Day...if you're one of 25M Americans who haz one, the government haz incentives for pharma to build you a pill.

We define a rare disease as having such a low prevalence that your family doc would only expect to see about 1 case/year.

The NIH Office of Rare Diseases quantifies a rare disease as having a prevalence of less than 200k affected patients (in the US), or 5 people for every 10k in a community.

Thank another form of Reaganomics for pumping support via the Orphan Disease Act, signed into law in 26 years ago.

Rare Disease resources:
http://rarediseases.info.nih.gov/

Why rare diseases will increasingly be a focus of medical research:

1. incentives - yay ODA!
2. genomics and personalized medicine (80% are genetic in origin)
3. they hit kids (75%)
4. 1+2+3 = a PR home run for Big Pharma, who could sorely use one

Get your Rare Disease Day poster here:
http://rarediseases.info.nih.gov/files/RDD_POSTER_FINAL.pdf

Source: Immunogenic males: a genome-wide analysis of repro...[J Evol Biol. 2009] - PubMed Result.

"In Drosophila melanogaster, mating radically transforms female physiology and behaviour."

What kind of delta are we talking here?

* "increase in the oviposition rate"
* " reduction in female receptivity"
* "activation of the immune system"

"The fitness consequences of mating are similarly dramatic - females must mate once in order to produce fertile eggs, but additional matings have a clear negative effect."

Before you write off this post ladies, consider that we share almost 60% of our genome with those lil' critters who appear if your bananas hang around too long.

"We propose that both sexually antagonistic and natural selection have been important in the evolution of the innate immunity genes, thereby contributing to the sexual dimorphism and rapid evolution at these loci."

"Gene flow has a way of equilibrating and eliminating variation across adjacent populations." - Razib, Gene Expression