Aboite Counseling
Tuesday, May 13th

Clarion Health Makes WSJ Blog for Employee Health Fiasco

Filed under: Healthcare,Indiana,Indiana University,insurance
Tags: Clarian, Emloyees, Health, Indiana, Indianapolis

This came through this morning from the Wall Street Journal Health Blog. Rather than summarize it, I"ll just post the whole thing.

Fines for Bad Health Set Off Employee Backlash

Posted by Sarah Rubenstein

Employers are eager to try wellness programs for their employees to restrain healthcare costs. Who could argue with the idea that the best way to avoid medical bills is to keep from getting sick in the first place?

TherapyTry the employees at Clarian Health in Indianapolis. The hospital system had to halt a program to encourage wellness even before it got off the ground after workers objected to increases in health insurance premiums tied to missed health goals, reports the Chicago Tribune.

Clarian set minimum standards for tobacco use, body mass index, blood pressure, blood glucose and cholesterol, the Tribune reports. Employees who didn't meet the targets and weren't working toward them would wind up paying as much as $30 more per paycheck for health insurance, the newspaper said.

The reaction from some of the health system's 13,000 employees was less than positive. "Some of them quite frankly didn't get the essence of what we were trying to do," Sheriee Ladd, Clarian's vice president of human resources, told the Tribune.

So Clarian changed the plan, offering extra money in paychecks of employees who meet the health standards or are following a plan to improve.

That seemed to mollify most everyone. The revised program drawing 95% participation during this past fall's enrollment period.

Alice on 05.13.14 @ 12:42 PM CST [link] [No Comments]

FDA: Allowing Big Pharma's Off Label Advertising

Filed under: Announcements,Ethics,Healthcare,Pharmacology,psychiatrist,psychiatry,Rx Meds
Tags: FDA, food and drug administration, off-label, Pharmaceutical

According to the Indianapolis Star this morning, the Food and Drug Administration will continue allowing pharmaceutical companies efforts to market a drug's "off-label" uses, as long as the companies adhere to certain guidelines. This "marketing" includes giving physicians articles describing "off-label" use. In the past this practice has come under fire as the companies themselves sponsored the research and the articles were not published in peer reviewed journals. According to the new guidelines;

Articles should not be false or misleading and should come from a peer-reviewed journal that is not influenced by the company. The proposal also says companies should attach a disclaimer to the materials indicating that the FDA has not reviewed them.

Drug industry advocates said the proposal firmly establishes FDA's role as a regulator of medicine--" not information.

However, these "advocates" have a lot to gain by the ruling.

Off-label prescriptions account for an estimated 21 percent of overall drug use, according to a 2006 analysis in the Annals of Internal Medicine. The practice is common in treating conditions such as cancer, where doctors will prescribe drugs approved for one type of cancer for another.
Alice on 05.13.14 @ 12:31 PM CST [link] [No Comments]

Thursday, May 8th

Harvard's Poll on Socialized Medicine

February 16, 2008

Filed under: Healthcare,insurance,Politics: Healthcare ��" kurtglmft @ 4:08 pm
Tags: Harvard University, Poll, socialized medicine

Here is some interesting stuff from United Press International about socialized medicine. While the presented stats are somewhat shocking, the Blogmeister wonders if this is more about the frustration most Americans have with healthcare than an endorsement of Socialized Medicine.

Americans are uncertain if a socialized medical system would be better or worse than the current system, a U.S. survey found.

Among those who say they have at least some understanding of socialized medicine "any system of medical care that is publicly financed, government administered, or both" 45 percent say it would be better, 39 percent say it would be worse, 12 percent do not know and 4 percent say about the same.

The poll, by the Harvard School of Public Health and Harris Interactive, found 60 percent believe that Medicare is socialized medicine, 47 percent feel that the veterans healthcare system is socialized medicine.

Fifty-five percent of younger adults ages 18 to 34 are more likely to view socialized medicine positively compared to seniors age 65 and older at 30 percent.

Nineteen percent of the uninsured think that a socialized medicine system would be worse than the current system compared to 57 percent who think it would be better.

The telephone survey of more than 1,000 adults was conducted twice, once in January and once in February has a sampling error of plus/minus 3 percentage points in 95 out of 100 cases.

Alice on 05.08.14 @ 02:01 AM CST [link] [No Comments]

One Reason Not to Socialize Medicine

Filed under: Healthcare,insurance,Politics: Healthcare,poverty ��" kurtglmft @ 6:17 pm
Tags: British National Health Service, Healthcare, socialized medicine

Today, United Press International carried a report highlighting one of the reasons why socialized medicine may not be the way to go. Long story short, when you put bureaucrats in charge of healthcare (not that they aren't already in the U.S., we just call them MBAs), stupid things happen.

Specifically, The British National Health Service decided patients were waiting too long to see doctors at emergency rooms. So, the Labour party instituted a policy where all patients had to be seen by physicians within four hours of being admitted an Emergency Room. When hospital administrators could not meet the requirements of the policy, they just stopped admitting people to the emergency room. According to the story;

…the delays not only pose a health risk to patients, but keep ambulances occupied and unable to answer emergency calls.

"This is evidence of shocking systematic failure in our emergency services," Lamb said. "As well as thousands of patients being stuck in ambulances when they should be getting urgent treatment, there will be countless others left waiting longer for ambulances to arrive."

The Mail said current figures show that last year alone, an estimated 43,576 people were forced to wait for more than an hour to enter a British emergency medical unit for treatment.

If you don't believe me, check out the story for yourself.

Alice on 05.08.14 @ 01:32 AM CST [link] [No Comments]

Mental Health: Meds, Therapy, or Both?

Filed under: Counselors,Depression,Disorders,Healthcare,Mental Health Centers,Mental Health Prof's,Pharmacology,psychiatrist,psychiatry,psychologist,psychology,Psychosis,Rx Meds,schizophrenia,social work,social worker
Tags: Agency for Healthcare Research and Quality, anitpsychotic, antidepressant, Arizona State University, Department of Health and Human Services, Depression, Genetics, Jason Robert, medication, medicine, neuroscience, Psychosis

In a story by the UPI, the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services in Washington, said consumers spent 17 billion dollars on Anti-depressants and anti-psychotic drugs. Accounting for just over 13 percent of the 127 billion U.S. consumers spent on prescription drugs in 2005.

However, in another UPI story today;

In a speech at the annual meeting of the American Association for the Advancement of Science in Boston, Jason Robert of Arizona State University said that while understanding biology is crucial to the understanding of psychosis, "there is more to psychosis than mere biology."

Robert said claims that genetics and neuroscience will revolutionize medicine and elaborate predictions about new diagnostic tools and new treatments are not being borne out "because they fail to grapple with the complexity of human beings..." as brains, bodies, and, embedded in culture, steeped in history, and dynamically creating their own worlds. If we’re really going to have personalized medicine, we have to be focusing not just on the genome, but the person."

Rather than having a caricature of culture in mind, "what's really critically important is understanding cultures dynamically, as complex, historic, social and political structures that dramatically influence people's lives."

Ignoring all except biology may mean never having the capacity "to actually influence the well-being of the patient," he said.

Mental health professionals have long known of their patients propensity to want an easy way out of their difficulties by just taking a pill to address their mental health needs. However, while medication is a wonderful way to feel better and treat the biology of a disorder, almost no one recommends pharmacology alone in the treatment of mental health difficulties.

When I was in school, the prevailing thought about how one develops some of these biologically based disorders was some people are more than likely born with the predisposition to develop these disorders, BUT it was an individual's life experiences that brought these predispositions out. Of course, I'm not including things like adjustment disorders (where the environment, social and otherwise, are to blame) or Developmental Disabilities (which are entirely biologically based).

Medication does not address any of the underlying experiences leading to a disorder. Nor does it help develop new coping mechanisms for situations affecting the disorder. Americans need to see psychotherapy as they do physical, occupational, speech, and/or other therapies that work in conjunction with medicine. For example, if one breaks their leg, they would see a physician to set the leg, then begin working with a physical therapist to teach them how to use the newly set leg now and in the future. They would probably also address what may have happened in the past to cause the fracture. If Americans used this same rationale with psychiatrists and mental health therapists, we would probably see dramatic "cure" rates for those afflicted with mental health issues.

However, because of stigma, time constraints, or whatever else, we see more people taking medications to feel better about what is going on in their life, which never really seems to change. Conversely, we also see people who spend years in therapy never getting better either, because, for one reason or another, they don’t want to see a psychiatrist. However, the people who, in my experience, seem to get better faster and go on to live well adjusted lives are those who employ the services of both professionals.

Alice on 05.08.14 @ 01:11 AM CST [link] [No Comments]

Friday, May 2nd

2004 Indiana Health Insurance Law Misses Mark

February 27, 2008

Filed under: Healthcare,Indiana,Legal/Law,Politics: Healthcare,Politics: Legislators
Tags: Craig Fry, Golden Rule Insurance, high risk insurance, hoosiers, Indiana, insurance, Patricia Miller, pre-existing condition, UnitedHealth Group

The Indianapolis Star Business section has a great in-depth story on the 2004 insurance change in Indiana that allowed insurance companies to either deny insurance policies for pre-existing conditions, or waive coverage for 10 years for those conditions. At the time, it was touted as a way for more people to be covered, at a lower price, because the insurance companies would not have to cover "high risk" patients. In addition, in 2004, Indiana was only one of two states requiring insurance companies to cover these "high risk" patients. When the law was being discussed in the legislature, the insurance companies told our representatives they were in support of this measure, because it would help more of the citizens of Indiana get coverage, at a lower cost.

Well surprise, surprise. We now find more people are not covered, and, in fact, there are less people covered and the insurance companies continue to make record profits.

Here are some quotes from the story:

Sen. Patricia Miller, R-Indianapolis, sponsored the change in Indiana law and hoped it would reduce the number of people denied health insurance.

She also wanted to limit the increasing number of people who had no choice but to seek insurance through the state's high-risk insurance pool, which covers people who can't get insurance from any other source. The pool was facing insolvency.

"We believed having some insurance was better than having none at all," Miller said.

Miller said she's had no complaints.

Rep. Craig Fry, D-Mishawaka, opposed the measure and still thinks it benefits only insurance companies. He called the measure just an effort by the insurance industry to "take advantage of people who need health insurance."

Rich Collins, chief executive of Golden Rule Insurance Co., an Indianapolis-based subsidiary of UnitedHealth Group that sells individual policies, said Hoosiers have access to a strong and competitive health insurance market.

Collins said his company offers coverage to more than 89 percent of applicants.
"The fundamental issue is that health care is expensive," he said.

I'll let the reader make up their own mind as to what was really going on back in 2004, but I thinking it’s pretty clear this turned into a huge bonus for the insurance industry at the expense of citizens regardless of the intent.

Mr. Collins also got my dander up as he hit on a pet peeve of mine. "Health care" is not the same as health insurance. While "health care" may be expensive, health insurance is generally 30% higher to cover administering the policies, and paying his salary. Making health insurance much more expensive than health care.

Alice on 05.02.14 @ 10:36 PM CST [link] [No Comments]

DOC Makes Improvements At Girls School

March 2008

Filed under: Children's Issues,IN Judiciary,Juvenile Justice,Legal/Law,Local (NW IN) News
Tags: Bill Bruinsma, Department of Corrections, Girls School, Indiana, juvenile, Peter Nemeth, South Bend, St. Joseph county

Remember back in December when I posted this about St. Joseph County Judge Peter Nemeth? The story then was he refused to send female juveniles to the Indiana Girls School for a variety of complaints.

Well, today's South Bend Tribune is reporting the Department of Corrections is making some staffing changes that are encouraging to Nemeth. Specifically;

The DOC has announced it will end a two-year-old arrangement to house boys and girls at the same Indianapolis Juvenile Correctional Facility by moving the boys to a recently renovated section of the Logansport Juvenile Correctional Facility.

Nemeth said he was encouraged by the DOC's announcement that a "staffing plan for the facility is being developed to ensure the appropriate deployment of staff."

"If they are actually doing a staffing plan... if it means more than just words, I think that is real progress," the judge said. "I applaud them for that."

Girls will be moved into the unit being vacated by the boys. The unit will house girls in single rooms that lock from a central control location, along with a special management unit specifically programmed for girls struggling with mental health issues.

"It looks like they are going to do what we want them to do," said Bill Bruinsma, executive director of the St. Joseph County Juvenile Justice Center. "We'll have to see what staffing they're going to add in and what kind of programming they're going to put into it...It's a step in the right direction."

However, Nemeth doesn't appear completely sold on the changes,

Nemeth said he still will avoid sending girls to the Indianapolis facility until he knows more details about the changes, especially whether staff-to-child ratios improve. Instead, he said he is sending girls who are the most difficult to rehabilitate to a private juvenile detention facility in Vincennes, at a daily cost to the county of $138, compared to $60 a day at the Indianapolis DOC girls school.

Alice on 05.02.14 @ 10:23 PM CST [link] [No Comments]

25 Tips for Staying Married

March 16, 2008

Filed under: Marriage & Family,marriage counseling,marriage therapy
Tags: Divorce, marriage, staying married, tips

The Evansville Courier-Press carried this article today. As I read through them I was struck by how correct this writer is:

1. Always put her first--- before work, friends, even basketball. Act as if she's the best thing that ever happened to you, because we all know she is.

2. Keep no secrets. Pool your money. Allow nothing and no one to come between you.

3. Pick your fights with care. Play fair. Show some class. Hurtful words can be forgiven, but they're hard to forget.

4. Fall in love again every day. Kiss her in taxis. Flirt with her at parties. Tell her she's beautiful. Then tell her again.

5. Never miss an anniversary or a birthday or a chance to make a memory. Memories may not seem important now, but one day they'll be gold.

6. Never give her a practical gift. If she really wants a Shop-Vac, let her pick it out herself.

7. Go to church together, and pray every day for each other and your marriage.

8. Pay your bills on time and make sure you each have a living will, a durable power of attorney and life insurance, lest, God forbid, you need them.

9. Love her parents as your own, but don't ask them for money. Never criticize her family or friends. On her birthday, send flowers to her mother with a note saying, "Thank you for giving birth to the love of my life."

10. Always listen to her heart. If you're wrong, say you're sorry; if you're right, shut up.

11. Don't half-tie the knot; plan to stay married forever.

12. Never go to bed mad; talk until you're over it, or you forget why you were mad.

13. Laugh together a lot. If you can laugh at yourselves, you'll have plenty to laugh about.

14. Never criticize, correct or interrupt her in public; try not to do it in private, either.

15. Remember that people are the least lovable when they are most in need of love.

16. Never fall for the myth of perfectionism; it's a lie.

17. When you don't like each other, remember that you love each other; pray for the "good days" to return and they will.

18. Tell the truth, only the truth, with great kindness.

19. Kiss at least 10 seconds a day, all at once or spread out.

20. Memorize all her favorite things and amaze her with how very well you know her.

21. Examine your relationship as often as you change the oil in your car; keep steering it on a path you both want it to go.

22. Be content with what you have materially, honest about where you are emotionally, and never stop growing spiritually.

23. Never raise your voice unless you're on fire. Whisper when you argue.

24. Be both friends and lovers; in a blackout, light a candle, then make your own sparks.

25. Finally, be an interesting person, lead your own life. But always save your best for each other. In the end, you will know you were better together than you ever could've been apart.

Here's to happily ever after.

Alice on 05.02.14 @ 09:55 PM CST [link] [No Comments]

The Bailout AND Mental Health Parity???

October 3, 2008

Wow, this was a shocker when it came across the news feed. Apparently Senate proponents of mental health parity had only one legislative vehicle left to carry their bill this year... the mortgage industry bailout bill! What is mental health parity you ask??? Well, according to the Associated Press:

"Currently, insurance plans routinely require mental health patients to pick up more of the initial costs of their care through higher deductibles and co-payments. Other times, insurance plans have stricter limits on how often patients with mental problems can see their doctors."

Specifically, the bill would make coverage the same whether the patient had a mental or physical problem and...

"...apply to health plans that cover more than 50 employees"..." potentially reaching 113 million people nationwide."

Parity is a good idea for many reasons. First, a more mentally healthy workforce is a better workforce. Second, it will help put mental health care on a par with physical health care and reduce some of the stigma still prevalent in the population. Still, it had it"s detractors. Anyone know who??? Of course, our friends at big insurance who successfully lobbied so the legislation does not mandate that group health plans cover mental health or addiction treatment. But if they do, the coverage must be equitable with other medical coverage.

Now, according to the AP, they (insurance companies) support the legislation.

For those not following all this drama, the legislation has been negotiated and renegotiated for almost seven years. It even came up for a vote a time or two. Now that all sides agree, it should pass, but the authors lacked a way to get it in front of the entire Senate. So, in a common strategic move, they have tacked it on to the mortgage bailout bill, which passed the Senate on Wednesday, and is up for a House vote today. So, despite how one may feel about the current mortgage mess, if you are a supporter of parity, you may want to support the bailout bill and encourage your Representative to as well.

Alice on 05.02.14 @ 01:51 AM CST [link] [No Comments]

Big Insurance and "The Sentinal Effect"


Dr. Benjamin Brewer had a great article on the Wall Street Journal site about insurance companies requiring preauthorization for medications and services. Most people don't know, as mental health professionals, we almost always face the same unjust scrutiny by big insurance. As this quote points out, insurance companies, in an effort to save money, hope that by making the preauthorization process as difficult as possible, we will all just give up, saving them money.

"They want me to incur the overhead and frustration that comes with trying to prove to a non-doctor that I know my patient and what I'm talking about. They want to cut costs, and they don't really care about how it affects my patients or my practice. If they make the process hard enough, they hope I'll just give up. There is even a term in the managed care literature for that kind of deterrence: the "sentinel effect."

Just so you don't have to click over, the Sentinal effect "deters utilization by requiring the administrative effort necessary to authorize the procedure. Studies have shown the sentinel effect to be persuasive."

This "administrative effort" transfers over to big money, in my practice at least a third. Of course this is passed on to our patients, but not the one's who have insurance, as the insurance companies won't pay us for the time it takes to cut through their red tape. Instead, we have to charge higher rates, and pass the costs on to our private pay clients.

Just another example of how Big Insurance IS the problem in healthcare... Not the answer.

Alice on 05.02.14 @ 01:28 AM CST [link] [No Comments]

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