Two-thirds of Maryland voters support increasing the state’s tobacco tax, according to a new poll from the Maryland Citizens’ Health Initiative, the group that pushed the dime-a-drink tax on alcohol last General Assembly session.

The group says their poll by Opinion Works shows 65 percent endorse the idea of another $1 a pack tax on cigarettes while less than 30 percent oppose it. About 72 percent of Maryland voters like the idea of taxing cigars and smokeless tobacco at the same rate as cigarettes. (The phone poll of more than 800 people was conducted last week.)

The group believes increasing the tax will cut consumption and fund health care programs, especially among youth who have adopted the use of cigars, especially flavored one. As of 2010, 15.2 percent of adults and 14.1 percent of high school students in Maryland were smokers.

The U.S. Centers for Disease Control and Prevention say smoking and secondhand smoke cause 443,000 deaths and $96 billion in related disease annually – or $10.47 per pack consumed if lost productivity is counted. The average price nationally for cigarettes is about $5.58.

“Increasing taxes on cigars and smokeless tobacco is a public health imperative,” said Vincent DeMarco, president of the Maryland Citizens’ Health Initiative, in a statement. “The people of Maryland strongly support this because they know doing so will reduce the use of these deadly products by young people.”

What DeMarco doesn’t have is the support of the leadership in Annapolis. The extra buck would bring the total in taxes to $3, among the highest in the nation. The tax has been raised three times in 1999, mostly recently in 2007.

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A new study from Johns Hopkins shows that there is little benefit to imaging patients’ backs before treating their pain with an epidural steroid injection.

MRIs are routine before the injections, the most common procedure performed at the nation’s pain clinics, but they do little more than add time and money to treatment, the study suggested.

“If we’re trying to cut back on unnecessary medical costs, we should stop routinely doing MRIs on almost everyone who comes to us needing [such injections],” said study leader Dr. Steven P. Cohen, an associate professor of anesthesiology and critical care medicine at the Hopkins School of Medicine, said in a statement.

The study, published in the Archives of Internal Medicine, found MRIs do not generally avert procedures, lower risks or improve outcomes -- the injections are a short-term fix and don’t work on everyone. And an MRI costs roughly $1,500.

Cohen studied patients being treated for sciatica at pain clinics around the country. With the condition, a nerve at the bottom of the spinal column is pinched and the patient has severe pain and tingling in the lower back and down the leg. Injections reduce inflammation near the source of the pain.

One group had images to help inform the treatment, and the other group was treated based on a physical exam and a description of the pain. The treatment barely varied between the groups, probably because there isn’t always a connection between an abnormal MRI finding and symptoms. And after three months, the patients reported no difference in how they felt.

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Categories: Business of health, Medical studies
        

The Maryland Health Care Commission released its 2011 quality report on health insurance plans in the state and Kaiser Foundation Health Plan of the Mid-Atlantic States came out on top.

The report includes quality and customer satisfaction information in 22 areas in four categories including primary care, chronic care, behavioral health and member satisfaction.

Kaiser had scores above the state average on 14 of 22 measures, and included the high marks in all four categories. CIGNA HealthCare Mid-Atlantic had eight above the state average and all other plans had four or fewer scores above the state average.

Kaiser has also performed well on past reviews.

Maryland’s HMOs performed at or better than the regional average on 13 of 22 measures, and Ben Steffen, acting executive director of the commission, said many plans can point to some strong performance. But he said the overall scores show that the health maintenance organizations and the point of service plans need to up their efforts.

Dr. Joshua Sharfstein, secretary for health and mental hygiene, said in a statement, “The report contains important information on health plan quality and our new state initiatives on advanced primary care, health information technology and employer wellness that will be beneficial to employers and employees.”

See the whole report at www.mhcc.maryland.gov.

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Consumer Reports took a look at health care plans around the country and found in Maryland that the best among the private insurers was Johns Hopkins US Family Health Plan, which is used by members of the military, retirees and their families.

Nationally, the program ranked 23rd among private HMOs. Kaiser Foundation Health Plan of the Mid-Atlantic States was next (33rd nationally), followed by Cigna HealthCare Mid-Atlantic (79th nationally), Employer Health Programs (106th nationally) and Aetna Health (131th nationally).

CareFirst BlueChoice was 7th in the state (194th nationally) and United Healthcare of the Mid-Atlantic was 9th (225th nationally).

Consumer Reports analyzed 830 health plans ranked by the National Committee for Quality Assurance, an independent non-profit group. Included were 540 HMOs, 285 PPOs, Medicare and Medicaid plans and plans for employers and individuals. All told, they serve 127 million Americans.
The rankings considered consumer satisfaction, treatment and prevention.

Among Medicare plans in Maryland, the Kaiser Foundation Health Plan of the Mid-Atlantic States was ranked at the top (17th nationally) and among Medicaid HMO plans, Priority Partners HMO was ranked at the top.

To see the list and get more information, go to http://www.consumerreports.org/health/insurance/private-hmo-1.htm.

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While many health care regulations are in place to provide consistent and quality care, as well as protect the vulnerable, some are outdated, expensive and not particularly useful.

So, the state Department of Health and Mental Hygiene endeavored to clean house. Officials began collecting input from the public in April and have released a draft report on changes that could be made in the fall – some changes may be done through regulation and others may require legislation.

Joshua M. Sharfstein, the department secretary, said he heard those who operate facilities about the costs of regulations, some that may no longer necessary or could be tweaked. The changes could have wide ranging impact.

In Maryland, there are: 230 skilled nursing facilities serving an estimated 25,240 individuals; 1,375 licensed assisted living providers approved to care for almost 20,000 residents; 123 licensed adult medical day care programs with capacity to serve approximately 7,000 adults; 1,500 licensed community mental health programs and with some 116,948 consumers; 200 community based providers for those with developmental disabilities at 2,600 sites serving more than 22,500 people; and 1,000 certified substance abuse treatment programs with about 21,000 seeking treatment a month.

Many of the regulations on the list for change had to do with the level of training providers needed, the intervals for reporting, the definitions of providers and changes in technology.
“Some of the regulations are important for protection of public,” said Sharfstein. “But there is a real balance to be struck. We don’t presume they every regulation needs to stay there forever. We need to look on a case by case basis.”

To see the report or make a comment, click here.

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Johns Hopkins Medicine and the nation’s largest drug store Walgreens have agreed to work together to improve care for those with chronic diseases.

Officials will use (anonymous) patient population data to conduct research into disease management and prevention and determine better methods of treatment. They also plan to train the Walgreens workers.

“By collaborating with Johns Hopkins Medicine, we will access some of the best expertise in health care to develop research, protocols and training programs designed to improve patient outcomes through our nationwide network of accessible community pharmacists, nurse practitioners, physicians and other clinicians,” Kermit Crawford, Walgreens president of pharmacy, health and wellness, said in a statement.

The focus will be on chronic conditions such as asthma, diabetes, obesity, high blood pressure and heart disease, said Dr. Fred Brancati, professor of medicine and director of the Division of General Internal Medicine at Johns Hopkins University School of Medicine.

Such arrangements aren’t unusual for Hopkins, which has worked with other corporations to improve health care of workers and employees.

“It makes sense medially, and under health care reform, it makes sense financially,” he said of the Walgreen’s agreement.

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GBMC Healthcare has enhanced its use of information technology in ways it said will improve and lower the cost of care.

The system - which owns Greater Baltimore Medical System, Gilchirst Hospice Care and Greater Baltimore Medical Associates - has implemented the following technology tools

* A Computerized Provider Order Entry (CPOE) system - This allows all physician orders, such as requests for lab work and follow-up visits, to be done by computer. No orders will be written by hand. The medical system believes this will help with patient safety and cut back on medication errors.

* Electronic health records - Patient records will be kept on a computer rather than in paper files.

* Electronic practice management system for physician offices - Physician offices will be able to automate their patient registration and schedule clinical activity such as prescription writing and lab results management. The system, eClinicalworks, will be rolled out first at Greater Baltimore Medical Associates (GBMA) practices. GBMA is the group of more than 40 multi-specialty physician practices on the hospital's Towson campus and in satellite locations across the region.

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Youth exposure to alcohol advertising on TV increased 71 percent between 2001 and 2009, according to a new report from the Center on Alcohol Marketing and Youth at the Johns Hopkins Bloomberg School of Public Health.

Alcohol companies are supposed to be self-regulating, but the number of ads seen by American kids on TV increased from 217 to 366 in that time frame – or an ad a day, the study shows.

“One a day is great for vitamins but not for young people being exposed to alcohol advertising,” said David H. Jernigan, the center director, in a statement. “This is a significant and troubling escalation, and shows the ineffectiveness of the industry’s current voluntary standards.”

The Distilled Spirits Council responded by saying that the report is misleading and biased. The industry is serious in its opposition to underage drinking, and research shows its advertising isn't making that problem worse.

"CAMY Director David Jernigan’s conclusion that the '[i]ndustry standards need to be tightened to protect youth from alcohol marketing' ignores the fact that while advertising on cable television increased from 2001-2009, the latest federal government statistics released yesterday show that alcohol consumption rates among 8th, 10th and 12th graders have continuously declined during this same period and are at historic lows," the group said. 

"Simply put, CAMY’s claim that an increase in alcohol advertising is causing teens to drink is undercut by the federal government data and unsupported by the body of scientific literature.

The CAMY report says youth drinking is still a real problem -- and the industry isn't living up to its promises. The beer, distilled spirits and wine industries had agreed in 2003 to place ads only when the percent of underage kids watching was 30 percent or less. That was down from 50 percent. 

Ads for spirits on cable is driving the increase, the report said. The youth exposure there is up 3,000 percent, the report said.

Continue reading "UPDATE: Alcohol ads seen by more youths " »

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States can benefit economically if their residents quit smoking, according to a new study by Penn State University researchers and released today by the American Lung Association.

That much may be obvious – fewer people smoke, fewer people get sick, seek treatment, miss work and die. But this study took a closer look at the cost and benefits of smoking cessation programs for states, which are implementing the programs as part of health care reform.

The American Lung Association says tobacco use kills 393,000 Americans every year, and the study will be used as another tool in the group’s efforts to sell cessation programs as not only a health benefit but a financial one.

The economic costs to the country from smoking are more than $301 billion, including $67.5 billion in lost productivity and $117 billion in premature death costs. Direct medical expenditures cost $116 billion.

The study found that per a $5.51 pack of cigarettes, the costs and work productivity losses average $18.05. But for every dollar states invested in comprehensive smoking cessation programs, they would receive an average of $1.26 return on investment (In Maryland, the study finds that figure would be $1.34). And since the highest rates of smoking are found among people with Medicaid benefits, the state and federal government could save more.

The Lung Association is encouraging the government and private insurers to add programs. Maryland is one of seven states that require private plans to cover treatment.

Maryland and its consumers’ direct costs now from smoking are an estimated $2.2 billion annually, with work productivity losses at $1.3 billion. Premature death adds $2 billion for a total cost to the economy of $5.5 billion. More study information can be found here.

Associated Press photo

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Returning to work after having a baby can be a challenge in general, but what about breastfeeding?

The American Academy of Pediatrics recommends breastfeeding for at least a year. And the state says a few area hospitals are making it easier for new moms to stay on schedule.

The Maryland Department of Health and Mental Hygiene is honoring Greater Baltimore Medical Center, Anne Arundel Medical Center and Johns Hopkins Hospital for programs and policies that support the practice after the moms return to work.

Their “Breastfeeding-Friendly Workplace” provides short breaks and a private space for the mothers to pump and store breast milk among other programs. (Those two provisions are now required by the new health care reform law, though employers don’t have to pay for the time and small companies are exempt if it would cause an undue hardship.)

Health and Mental Hygiene Secretary John M. Colmers said there are benefits to companies to aid new moms: Parental absenteeism is lower and so are healthcare costs because breastfed infants are sick less often. He said studies estimate a $400 savings on health care in baby’s first year. It’s not bad for morale and productivity, too, he said.

Colmers points to a U.S. Department of Labor stat: nearly three-quarters of all mothers are in the work force, including 60 percent of mothers of very young children.

The state health department can offer guidance. Find more information on setting up support programs at work or an application for the workplace award at www.marylandbreastfeeding.org.

So, what's the situation in your office?

Baltimore Sun file photo/Chiaki Kawajiri

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Categories: Business of health, General Health, Health care reform
        

When mosquitoes start biting, everyone reaches for the old standbys: insect repellent and citronella candles. And while researchers at Johns Hopkins say they work okay, they don’t work on all mosquitoes, and they either need high concentrations or can cause skin rashes.

They want to make better products -- mosquito bites don’t just cause itching and irritation, they also transmit diseases.

They looked into what’s in the insects’ molecular makeup that responds to the man-made compound DEET in repellent and the aromatic botanical liquid citronellal in candles and sprays.

In two studies, published in Neuron and Current Biology, the researchers found three taste receptors on insect tongues, legs and wings were needed to detect DEET. Pore-like proteins called TRP channels were needed to detect citronellal. In both cases, they sent chemical messages to the insects’ brains causing an “aversion response.”

Finding these molecules and channels that detect the repellents “opens the door to identifying more effective repellents for combating insect-borne disease,” said Craig Montell, a professor of biological chemistry and member of Johns Hopkins' Center for Sensory Biology.

And who wouldn’t want a better repellent?

Associated Press photo

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An effort this summer to win endorsements from General Assembly candidates for an alcohol tax has yielded 140 signatures, potentially giving the tax it's best chance of passing in years, according to the health advocacy group Maryland Citizens’ Health Initiative.

The group wants passage of a “dime a drink” tax to pay for increased health care for the disabled and poor. An estimated $249 million would be generated from such a tax.

Letters asking for endorsement were sent to all candidates for the legislature, though not the gubernatorial candidates. Among those signing the pledge were 18 incumbent Senators and 45 incumbent members of the House of Delegates, including five standing committee chairs and several members of the panels that would consider the legislation. Others who did not sign on have said they support raising the alcohol tax if it’s tied to increasing health care coverage. 

Lawmakers have avoiding raising taxes on spirits since 1955 and have not been raised on wine and beer since 1972. The tax, assessed at the wholesale level, would mean an extra 60 cents for a 6-pack of beer, 59 cents for a bottle of wine and $2.25 for an average bottle of spirits.

Though few want to talk about raising tax during a campaign season, and others have pledged no new taxes during an economic downturn, the health care group hopes to make the tax a campaign issue.

“We are thrilled that so many candidates, including Democrats and Republicans from all across the State, have already endorsed this life-saving proposal,” Vincent DeMarco, president of the Maryland Citizens’ Health Initiative, said in a statement. “They know that the public strongly supports increasing the alcohol tax to save lives and fund critical state programs. With this growing support, we are very hopeful that a dime a drink alcohol tax increase for health care and community service needs will pass
in the 2011 Session.”

DeMarco said the money specifically should be used ahead of the national roll out of health care reform to provide coverage for those with mental health and developmental disabilities, those with drug and alcohol addiction and poor adults without children.

The health care group also says that the tax should help reduce alcohol abuse. A Johns Hopkins University Bloomberg School of Public Health study found that the 10-cent tax would mean 15,000 fewer cases of alcohol dependence.

Associated Press photo

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Categories: Business of health, Health care reform
        

The healthcare industry is a pretty lucrative business and so are the salaries of the CEOs running Baltimore-area hospitals.

The Sun did an analysis looking at the compensation packages of the heads of 28 hospitals and health systems in the Baltimore area. Eight walked away with packages over $1 million. Nobody made under six figures.

Some of the perks they collected included gym and country club memberships and money for tax preparers and financial planners. One CEO had a discretionary fund that seemed to have no clear guidelines on how it should be spent.

The hospitals say their executives work long hours and have expertise that justify their pay. They also say they have to offer competitive salaries to attract the best talent.

But more critics have been scrutinizing hospital CEO pay in recent years, questioning whether they are making too much. Non-profit hospitals in particular have come under fire because they get tax breaks and devote a portion of the business to charity work.

We want you to chime in. What do you think about the pay of hospital heads? Are they getting paid what they're worth? Or do they need a pay cut?

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Categories: Business of health