Health Care Coverage Is Not Enough. We Need Delivery System Reform. Huffington Post

Another downside to the options the Republicans are considering behind closed doors.

It’s well known that the bill to repeal the Affordable Care Act (ACA) now making its way through the Senate would deny coverage to tens of millions of Americans.  Less well known is that it would also hit the brakes on “delivery system reform,” the work of doctors and hospitals to improve quality and reduce costs. In other words, it would make quality of care worse.

http://www.huffingtonpost.com/entry/health-care-coverage-is-not-enough-we-need-delivery-system-reform_us_596b777de4b0d6341fe98c85#

Little support for nutritional interventions for autism -CHD

From Consumer Health Digest. 

A review of special diets and dietary supplements advocated for children with autistic spectrum disorders has found insufficient evidence to recommend their use. The reviewers considered randomized controlled trials that tested the use of the gluten/casein-free diet, other dietary approaches, omega-3 fatty acids, digestive enzymes, methyl B12, levocarnitine, and camel’s milk. [Sathe N and others. Nutritional and dietary interventions for autism spectrum disorder: A systematic review. Pediatrics 139(6): 2017] The published review was derived from a systematic review, “Medical Therapies for Children with Autism Spectrum Disorder (ASD)—an Update,” which will eventually be published on the Agency for Healthcare Research and Quality Web site.

Prohibitions on Campaigning at a Public Hospital facility

Wanted to remind all the candidates, the County Hospital District Commissioners, their supporters and the staff of Jefferson Healthcare, that Washington State law, RCW 42.17A.555 (formerly RCW 42.17.130) establishes a broad prohibition on the use of “the facilities of a public office or agency” to support or oppose a ballot proposition or to assist an election campaign for public office. This prohibition is enforced by the state Public Disclosure Commission (PDC). Persons who violate the prohibition may be subject to civil penalties of up to $10,000 and could be referred by the PDC for criminal prosecution. RCW 42.17A.750.
A full discussion on this topic, including state law RCW chapter and verse can be found at the January 2017, AWPHD Legal Manual.  Located at: 

http://mrsc.org/getmedia/f3986741-4f36-4c91-9e5d-da6dd3be9306/AWPHD-Legal-Manual.aspx#page34

Even the notion of a Commissioner walking a candidate around the facilities is likely to be construed as an illegal act, since we are in a campaign currently and Commissioners are clearly taking sides outside of their public meetings to assist candidates. I’ve not found out whether management or staff wearing campaign buttons on site during their working hours could be a firing offense, or could be construed as engaging in illegal activity, but if you are staff, you might want to consult human resources for clarification. 

Now we know…

The Republicans have just floored their health care reform bill. You can read the details all over the internet. But it’s a disaster for rural hospital districts like ours. We have the oldest population of any county in the State and  rely heavily on Medicare reimbursement. We also have a huge poor population, which relies on Medicaid. Let’s just set aside the number of people who come to the food bank weekly.

Our reliance on  Medicare and Medicaid patients being reimbursed from the federal government at rates that make it worthwhile to do the work of caring for them, make it important not to lose what ground has been gained. Before Obamacare we were running a deficit that the taxpayers of this county paid for. Since Obamacare we are running a surplus. Not much, but not in the red. Now this. Who’s going to pay?The general attitude that I hear all the time from acquaintances and on the Internet is that they don’t want more taxes. The poor will come into the emergency rooms regardless if they are covered or not. But if the Feds don’t pay for them, it will be on us. You and I. Or the hospital could eventually close. Just ponder the words of a Kaiser Family Foundation study published in 2016 (JHC is  a 25 bed hospital):

In 2012-2013, rural hospitals had an average of 50 beds and a median of 25 beds. They had an average daily census of 7 patients and 321 employees, and they were 10 years old on average. Compared to urban hospitals, rural hospitals are more likely to be in counties with an elderly and poor population.9 According to The North Carolina Rural Health Research Program (NC RHRP) at the Cecil G. Sheps Center for Health Services Research, which tracks rural hospital closures, there were 72 rural hospital closures between January 2010 and April 2016, compared to 42 closures between 2005 and 2009, and since the 2008-2009 recession, the annual number of closures has increased each year.10 More than half of all rural hospital closures since 2010 were in the South and few Southern states have expanded Medicaid under the ACA.

http://www.kff.org/report-section/a-look-at-rural-hospital-closures-and-implications-for-access-to-care-three-case-studies-issue-brief/

The expectations are that we are in for some very hard times in the years ahead. It will take a lot of effort to keep our hospital running efficiently and staffed appropriately. Even now, we are having a hard time retaining quality medical staff even though we offer competitive salaries to Seattle, according to the hospital administration. Unfortunately, we have not done a great job at looking at foreign trained medical professionals, which are in wide spread use at Harrison and other nearby medical facilities. We also are behind the curve in the use of less expensive mid-levels, ARNPs and PAs. To the hospital district’s credit, the number of those mid-levels is up recently, probably due more to federal requirements and an inability to retain physicians, more  than anything else.

Perhaps if the Democrats win back the House and Senate and eventually the Presidency we can hope for fixes to this awful proposal which was created by a cabal of men behind closed doors. No women, even of their own party, were asked to work with them. It was despicable back room politics of the worse kind. They have even screwed their own constituents in places like Spokane and Wenatchee, as rural hospitals there are even farther from urban centers.  You have to wonder just who they represent? Or maybe we already know and this next four years will finally drive that home to their supporters in places throughout the rural west and south. Or maybe those voters and non-voters are so tuned into Fox News that they can’t connect the dots anymore.

We can only hope that we will get through the next four years without seeing a collapse of our hospital and the services it is offering, even though prices are already causing people who are aware of the high charges to drive closer into Seattle to seek competitive rates for services.

Now more than ever we need engaged, knowledgeable people in the role of Hospital District Commissioner, which is an election that is happening now. We don’t need a rubber stamp for the hospital district administration, we need deeply knowledgeable people who can roll up their sleeves and help, challenge the administration when needed and go advocate for the hospital district in the State and Federal arenas.

We need leadership from skilled medical professionals who have spent time in the trenches, understanding  both the issues of health care administration and the needs of our neighbors because they have sat in the rooms with these patients as they poured out their hearts to them about their medical conditions and their ability to pay for treatment or drugs. People who held them as they cried. Who may have given them free treatment rather than walked away. Who might have sometimes given them hard news. People who know what we have to fight for and can help guide the hospital district administration and our elected officials forward through this coming dark night.

American Cancer Society Journal Promotes Quackery

This article will no doubt shock some, especially in Port Townsend. Some thoughts first to help put context to it.

Dr. Stephen Barrett has been a tireless advocate for exposing fraud and quackery in the medical field. I have read his newsletter for years and have never found myself at odds with his opinions. I’m reposting this here not because I necessarily agree with his opinion on the ACS running this article, but because he points out some very valid questions. While I have witnessed cancer patients, including terminally ill ones, having alternative treatments and “feeling better” none of them that I witnessed ever changed the outcome from terminal to remission. And unfortunately, some of the people promoting these “therapies” are making very good money from promoting them. It is sad but true.

I personally agree with Dr. Barrett’s thoughts that if the therapy ‘makes the patient feel better’ and is not a burden on their families financial situation, then there seems to be no ‘harm’ done. But all too often these are presented as cures.

With that said, here’s the analysis by Dr. Barrett. I am underling what I believe are the key thoughts here.

The American Cancer Society (ACS) has published the Society for Integrative Oncology’s Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment in the May/June 2017 issue of CA: A Cancer Journal for Clinicians. The monograph, whose co-authors include three naturopaths and an acupuncturist, states that its “recommendations” should not be regarded as the standard of care but are warranted as “viable but not singular options for the management of a specific symptom or side effect.” (In other words, they have no effect on the course of cancer but might help some patients feel better.) The “therapies” include acetyl-l-carnitine; acupuncture; acupressure; aloe vera; ginger; ginseng; glutamine; guarana; healing touch; hyaluronic acid cream; hypnosis; laser therapy; manual lymphatic drainage and compression bandaging; massage; meditation; mistletoe; music therapy; reflexology; relaxation techniques; qigong; stress management; soy; and yoga.


In 2014, in response to an earlier edition of the guidelines, David Gorski, M.D., Ph.D., noted:

Treatments that are truly effective and safe do not need the training wheels of a title like “alternative,” “complementary,” or “integrative.” They will stand on their own to scientific testing and should not be used until they have.

The real purpose of the guidelines is to use an ostensibly critical analysis buying into the false dichotomy of “integrative oncology” in order to rebrand potentially science-based modalities as “alternative” or “integrative” and to provide ammunition for advocates of “integrative oncology” to start “integrating” quackery with science-based medicine. [Gorski D. Selling “integrative oncology” as a monograph in JNCI. Science-Based Medicine, Dec 1, 2014]