07.31.08
Posted in Brain Injury News at 1:05 pm by Last
The Center for Public Integrity has just released a shocking story disclosing that Paul Lees-Haley, Ph.D. and other researchers were paid millions of dollars by the welding industry which has been embattled in litigation over whether welding fumes contain manganese, a toxic metal that specialists suggest cause Parkinsonism.
According to the story, lawsuits against the welding industry have been ongoing since the 1970s. The welding products industry has consistently argued that there were no reliable scientific data to prove that welding fumes cause the Parkinson-like syndrome known as Parkinsonism.
Recently, in December, U.S. District Judge Kathleen O’Malley, who has been handling hundreds of these cases, ordered both sides to fully disclose payments made by any of the parties to researchers. Court documents obtained by the Center for Public Integrity demonstrate that “The welding companies paid more than $12.5 million to 25 organizations and 33 researchers, virtually all of whom have published papers dismissing the connection between welding fumes and workers’ ailments. Most of the money, $11 million, was spent after the litigation achieved critical mass in 2003; attorneys for the welders, meanwhile, spent about half a million.”
The documents revealed that Jon Fryzek who works for Maryland’s International Epidemiology Institute - “known for its industry-commissioned studies” was paid $971,000 from welding defendants.
The defendants also paid $860,000 to Paul Lees-Haley, while C. Warren Olanow, M.D., a Manhattan neurologist who has “published at least a dozen articles cited by defense experts” received almost $2.9 million. The Parkinson Institute in California received nearly $3.4 million to conduct a four-year study.
The revelations about Dr. Paul Lees-Haley strongly confirm the opinions published by Erin Bigler, Ph.D., an internationally-renowned neuropsychologist who recently published an article entitled “Motion to Exclude” in the Archives of Clinical Neuropsychology, where Dr. Bigler criticized defense forensic neuropsychologists.
The story published by the Center for Public Integrity can be found on their website and is also being published concurrently in Mother Jones magazine.
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07.29.08
Posted in Brain Injury Resources & Links at 1:06 pm by Last
The Brain Injury Association of New Jersey is offering a free copy of Preparing for Life after High School: The Next Steps, Living With Brain Injury. The booklet is reprinted with permission from the Brain Injury Association of America and describes the opportunities and resources available to students with brain injuries, their families, and others who care about them.
The booklet provides guidance on how to make a successful transition from a high school student to young adult and emphasizes the importance of understanding the student’s rights, of exploring options, of collaborative planning, and of flexibility. For more information, contact the Brain Injury Association of New Jersey at 732-745-0200.
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07.28.08
Posted in Uncategorized at 9:30 am by Last
Washington -- The Bush administration is running a full-court press on physicians to get them to embrace electronic prescribing well ahead of a new Medicare mandate that is a little more than three years away.
Under the Medicare payment bill that became law in July, doctors who prescribe electronically for Part D patients in 2009 will get an incentive payment equal to 2% of all the Medicare services they provide for the year. This bonus will phase down over five years and disappear at the beginning of 2014.
Starting in 2012, physicians who are still paper-only will see a cut in their total Medicare payment for the year.
A physician may be eligible for an exemption from the penalties if Medicare determines that compliance would represent a significant hardship. The law cites an example of a doctor who practices in a rural area that has insufficient Internet access.
The Bush administration did not support the measure as a whole but is moving forward aggressively to implement the e-prescribing provision, which President Bush did endorse. The Centers for Medicare & Medicaid Services will issue rules later this year that will determine exactly how the incentive system will work and when bonuses will be paid.
Plans also are in the works for a CMS conference this fall that will educate physicians about what technology to use and how to use it. The agency wants to take advantage of its "bully pulpit" to get as many doctors on board with this technology as soon as possible, said Kerry Weems, CMS acting administrator.
The question of cost
Physicians consider the incentive program a good first step, and the bonuses could help doctors absorb the costs of the new technology, said American Medical Association Board of Trustees member Steven J. Stack, MD. But additional government payments alone likely will not provide enough financial support for what can be an expensive undertaking, he said. Private industry partners need to provide doctors with extra assistance.
Although the prospect of future Medicare physician payment cuts for noncompliance is very real, Congress could step in to stop them if it determines that too many doctors would take a hit, Dr. Stack said. "Whether these financial penalties will prove insurmountable, we are going to have to take the optimistic approach and hope that we can work through them."
American Academy of Family Physicians President James King, MD, said the fact that several years worth of positive incentives will go by before penalties kick in takes some of the sting out of the e-prescribing mandate.
CMS estimates that it would cost each physician about $3,000 to purchase and install a basic electronic prescribing system and $80 to $400 per month to maintain it. A 2% Medicare payment bonus in many cases could cover these costs, Weems said.
To give an idea of the money available, he cited the lump-sum payments Medicare made last month for the Physician Quality Reporting Initiative. For the 2007 PQRI, which featured a 1.5% bonus and covered only six months of reporting, the average incentive paid to individual physicians was more than $600, and the average for group practices exceeded $4,700. The largest single payment to a group practice topped $200,000.
Under the new Medicare law, CMS will drop e-prescribing use from the list of PQRI measures. The quality reporting program will run all of next year, and Congress boosted the possible bonus to 2%. So in 2009, physicians could receive the additional 2% for e-prescribing under the new Medicare law and another 2% for reporting quality measures under PQRI.
The Bush administration expects that the e-prescribing incentive program will save Medicare an estimated $156 million over five years by reducing the number of adverse drug events. Without the safety and accuracy of electronic drug orders, patients have poorer health outcomes, and practices use up unnecessary resources clarifying orders to pharmacies, said Dept. of Health and Human Services Secretary Michael Leavitt.
"That's a lot of people needlessly hurt and a lot of time wasted," he said.
Barriers to overcome
The AMA has argued that physicians cannot fully adopt e-prescribing in Medicare until the government allows electronic drug orders for controlled substances. Physicians complain that the need to maintain a separate paper system for these medications, which make up about 10% of all prescriptions, renders moot any potential savings or efficiency gains from going electronic.
The White House took a big step toward removing that barrier to adoption in late June when the Drug Enforcement Administration proposed new regulations that would lift the ban on e-prescribing controlled substances. The rules would apply to all controlled substances Schedule II and higher. Schedule I drugs cannot be prescribed for medical purposes. The DEA is accepting comments on its proposal through Sept. 25.
Penalties for paper prescriptions will start in 2012.
The AMA's Dr. Stack welcomed the proposed end to the ban and said it was long overdue. But the additional requirements on physicians proposed by the DEA for e-prescribing controlled substances are too cumbersome to be practical, he added.
For example, the requirement that physicians carry around a portable data drive or other "hard token" that must be used to authenticate their identities on the e-prescribing system is too big a burden for practices, he said. Dr. Stack also criticized the proposed requirement that doctors review monthly prescription logs for all the controlled substances they order. He said the DEA's layers of protection are too stringent, given that electronic prescribing is less prone to drug diversion than is a paper-based system.
In addition, CMS still needs to finalize three additional standards on e-prescribing use before physicians can truly embrace the technology, Dr. Stack said. The agency must complete this work a minimum of two years before any Medicare penalties take effect, he said. This means CMS would need to finish the task by the end of 2009 to meet the AMA framework.
The DEA proposal hits on just one of the major roadblocks to e-prescribing adoption, but more daunting impediments remain, said Ned Milenkovich, a registered pharmacist and an associate with the law firm McDermott Will & Emery in Chicago.
"At the end of the day, the barriers are all going to come down to dollars and cost," he said. Physicians are going to need to determine if the positive benefits associated with going electronic outweigh the economic downsides that go along with taking on the new technology.
Some physicians who already have made the leap into e-prescribing have run into other problems that need addressing.
For example, state laws still prohibit electronically prescribing over state lines, and many independent pharmacies lack the ability to receive paperless drug orders, said the AAFP's Dr. King, who prescribes electronically when he can in his Tennessee practice.
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Posted in Uncategorized at 9:30 am by Last
Washington -- A New Jersey statute that broadens access to public health insurance for parents and mandates coverage for children also is intended to lay the groundwork for universal coverage in the state.
Under the measure, signed by Gov. Jon Corzine on July 7, parents with incomes of 133% to 200% of the federal poverty level now are eligible for the State Children's Health Insurance Program. The mandate that children have some form of insurance will take effect in July 2009. But the act does not penalize families with children who remain uninsured.
"It's a soft mandate," said Suzanne Esterman, spokeswoman for the New Jersey Dept. of Human Services.
Bill sponsor Sen. Joe Vitale didn't want to include penalties because he is concerned about insurance costs, said Laurie Cancialosi, his chief of staff. Vitale, who chairs the Senate Health, Human Services and Senior Citizens Committee, also wants to study, in advance of considering universal insurance measures in the fall, why people remain uninsured.
The expansion of parents' SCHIP eligibility is an attempt to get more children in the program, because if parents can't sign up, they are less likely to enroll their children, Cancialosi said. Children in families that earn 350% of the poverty level or less are eligible for SCHIP in New Jersey.
The law institutes premiums for parents enrolled in SCHIP who earn between 150% and 200% of the poverty level. The rate will be $32 per month for the first parent and $13.50 for the second. Parents who wish to enroll must already have children in SCHIP or must enroll with them.
The Medical Society of New Jersey and the state chapter of the American Academy of Pediatrics backed the bill. Michael J. Kornett, chief executive of the MSNJ, said the society supports getting more people access to health care but is concerned that there might not be enough funding. "It's nice to create an expectation, but can you follow through?"
The act anticipates that an additional 56,800 parents and 17,100 children will enroll in SCHIP by June 2011 at a total state cost of $64 million.
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Posted in Uncategorized at 9:30 am by Last
Washington -- There is no shortage of national health reform plans this year, but only one will come from four former Senate majority leaders.
Tennessee Republican Howard Baker, South Dakota Democrat Tom Daschle, Kansas Republican Bob Dole and Maine Democrat George Mitchell joined in 2007 to form the Bipartisan Policy Center. It is designed to forge consensus policy plans on five issues: national security, energy, agriculture, transportation and health care.
The first stage of the health project consists of four public forums -- one conducted by each former senator. They will use their findings to create a reform proposal they all agree upon and then advocate for it in Congress and at the White House. Daschle held his forum on April 24 in Washington, D.C. The others will hold their events in their home states in coming months. Daschle said he expects the center to offer a health reform proposal by the end of this year.
"Our hope is to solicit the views of as broad of an array of participants as we can make contact with," said Daschle, who along with Dole was interviewed by AMNews. Dole agreed that the recommendations will be driven by input from outside the policy center. "What we're not talking about is having a staff put together something and we sign off on it."
Still, day-to-day project guidance will be provided by Chris Jennings, a senior health care policy adviser to President Clinton, and Mark B. McClellan, MD, PhD, a senior health care policy adviser to President George W. Bush. Dr. McClellan also was Centers for Medicare & Medicaid Services administrator and Food and Drug Administration commissioner.
Four tenets will guide the effort:
- Preserving and improving quality and value.
- Increasing availability and accessibility of affordable coverage options in a reformed insurance market.
- Promoting the individual's role in health care coverage and cost.
- Securing a workable financing mechanism for the nation's health care system.
Ready for reform?
The proliferation of news outlets on cable TV and the Internet have allowed partisanship to flourish, Daschle said. But comprehensive health care reform could be easier for Congress to adopt today than in the early 1990s when President Clinton's effort failed, he added, because problems in our system have worsened.
For example, per-person spending was $3,300 in 1993 but eclipsed $7,000 in 2006, CMS said. Also, about 47 million people lack insurance today, an increase of 7 million since 1993, according to Census Bureau estimates.
U.S. health spending was $7,000 per person in 2006.
"My view is that people who may be totally against any change have come around to the view that something is going to happen, and we better get ready," Daschle said.
Although there's more partisan rhetoric from lawmakers today than in the past, Dole said he doesn't think Congress itself is more partisan.
New members are less shy about speaking their minds than in 1960 when he was first elected. "It just wasn't appropriate to have some whippersnapper like Bob Dole from Kansas in his first term in Congress say anything," he said.
Partisanship doesn't extend into the policy center's leadership, Dole and Daschle said. "We start with a good chemistry and a good working relationship, and we hope we can build on that," Daschle explained.
Dole said he can discuss anything with the others. "That's why we have a chance [to succeed]. ... There are no bomb throwers in this group."
Still, the former lawmakers will have to forge agreement from very different perspectives.
Daschle views the U.S. health system as facing three major interrelated problems: affordability, quality and access. But the country also needs to come to terms with myths about our health system, he said.
"We don't have anywhere near the best health care system in the world, and we should acknowledge that. We have islands of excellence, but those islands are in a sea of mediocrity," Daschle said. "But I also think we've got 21st-century operating rooms and 19th-century administrative rooms. We've got serious problems with regard to transparency."
Access, cost issues
Dole doesn't share this critical view but agrees that access and cost are major issues.
"Overall, we have a good system. How do you make a good system better and make it more available to the little kid down the block who's 5 years old and has never seen a doctor?"
Dole prefers reforms that limit government responsibility for health care. Daschle, meanwhile, authored a book, Critical: What We Can Do About the Health Care Crisis, that calls for a national board to oversee the U.S. health system the way the Federal Reserve board regulates the financial sector.
But Dole isn't worried that Daschle is closed to all other options. "Tom's got some ideas, but he's not going to try to sell us that book."
Dole said he doesn't have a preconceived plan for the project. "If you ask me today which way we're going, I would have no idea. We don't want to have any ideas at this point. We're trying to gather information."
He acknowledged that it's possible both presidential candidates, who have their own health reform plans, could ignore the policy center's recommendations. "What if they say, 'This is my plan, and why should we change?' I don't have a good answer. ... We may fall on our face."
But it's also possible the senators' recommendations will bridge the gap between the McCain and Obama plans, Dole said.
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