Jim Burress, WABE, Author at ��ϳԹ�� News

Some Insured Patients Still Skip Care Because Of High Costs

Jim Burress, WABE — Wed, 10 Jun 2015 21:39:22 +0000

A key goal of the Affordable Care Act is to help people get health insurance who may have not been able to pay for it before. But the most popular plans – those with low monthly premiums – also have high deductibles and copays. And that can leave medical care still out of reach for some.

Renee Mitchell of Stone Mountain, Georgia is one of those people. She previously put off a medical procedure because of the expense. But as the threat of losing part of her vision became a real possibility, she sought an eye specialist at Emory University, who told her she needed surgery to correct an earlier cataract procedure gone wrong.

Renee Mitchell says even though she has health insurance she’ll have trouble paying for the eye surgery she needs to save her vision. (Photo by Jim Burress/WABE)

The eye surgery is not the scariest part, she said. Cost is: “further copays [and] more out-of-pocket expenses.”

Mitchell is generally pleased with her insurance — a silver-level Obamacare plan. It’s the most popular type of plan with consumers because of the benefits it provides for the money. But she still struggles to keep up with her part of the bills. She is not alone.

“One in four adults who were fully insured for the whole year still reported they went without some needed medical care because they couldn’t afford it,” said , a senior policy analyst with the health care advocacy group, Families USA.

Mitchell still owes more than $20,000 for several years of medical expenses, with more debt accruing in interest each month. “If not for having availability on my credit card, we’d probably be in the poorhouse,” Mitchell said.

If she undergoes that eye surgery, she said, she’ll owe another $4,000 – the deductible for the operation.

“It’s a very big burden,” Mitchell said.

A recent by Families USA shows that a lot of people with coverage like Mitchell’s feel a similar burden, and a from the Kaiser Family Foundation finds the same thing. The majority of people who buy insurance on state or federal exchanges pick silver-level plans, which often carry a lower monthly premium, but may still have a high annual deductible – $1,500 or more.

“Consumers are still struggling with unaffordable, out-of-pocket costs,” says

Many people skip follow-up care and don’t fill prescriptions. Mitts said that only adds to long-term complications and costs.

But it doesn’t have to be that way, she said. Plans in some states, including Pennsylvania, Texas, Florida and Arizona, have recently with deductibles on some silver-level insurance plans. And for certain , including doctors’ visits and generic prescriptions, other plans are requiring only a small copay.

Still, while copays, deductibles and co-insurance weigh heavy on Renee Mitchell’s mind, they’re not her only insurance concern. Her monthly premium is also getting more expensive. This year, she said, it jumped by about $100 a month.

Mitchell wants to be clear, though: She’s not looking for a handout.

“People seem to think that we just want something for nothing,” she said. “I worked a lot of years. I took an early retirement to take care of my family. It’s not my fault, so to speak, that I’m here.”

This story is part of a reporting partnership with , and .

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With Good Hospital Practices, Emory Rises To Ebola Challenge

Jim Burress, WABE — Wed, 29 Oct 2014 11:56:35 +0000

It was July 30th when Atlanta’s Emory University Hospital got the first call. An American doctor who’d been treating Ebola in Liberia was now, himself, terribly sick with the virus. In just 72 hours, �� . Then, almost immediately, the staff learned a second Ebola patient was on the way. first thought was, “What do we need today, in order to care for these patients tomorrow?”

In the three months since, Emory has treated four Ebola patients. All survived. Dallas nurse spent more than a week at a special treatment unit at Emory before being discharged in good health and good spirits Tuesday.

Amber Vinson (2nd R), a Texas nurse who contracted Ebola after treating an infected patient, stands with her nursing team during a press conference after being released from care at Emory University Hospital on August 1, 2014 in Atlanta, Georgia. (Photo by Daniel Shirey/Getty Images)

“The general dogma in our industry in July was that if patients got so ill they required dialysis or ventilator support, there was no purpose in doing those interventions because they would invariably die,” Dr. Bruce Ribner, who heads Emory’s Ebola team, told reporters at a hospital press conference Tuesday.

But in this case, Emory proved otherwise, he said — aggressively treating the illness can be effective.

Emory’s plan to treat patients who have diseases like Ebola actually began 12 years ago. That’s when the Atlanta-based Centers for Disease Control and Prevention started working with the hospital to create a special isolation unit.

Since then, Varkey says, a core team of health workers has trained yearly. They’ve held practice drills every six months to stay sharp, ready for whatever infectious disease comes their way. Once, in 2005, the unit was used for a suspected SARS case that turned out to be negative.

But in July, with two patients on the way, it quickly became clear that Emory’s specially-trained team was too small, says , the hospital’s chief of nursing.

Critical care nurses volunteered to help fill in the gaps, but weren’t part of the core group that had long practiced for this day. The expanded team had to quickly train — and not everybody made the cut.

Once the team was in place, they focused on supportive care of these patients — administering IV fluids and preventing infections.

“The true cure for Ebola virus is keeping the patient alive long enough to develop the antibodies that will cause them to get over the infection,” Varkey says.

Emory learned lessons, big and small, from each patient, he says.

For example, just increasing the amount of working space around a patient sick with Ebola helped a lot, he says. So does “having a hand sanitizer dispenser available, [one] that wouldn’t require us to actually touch it with a gloved hand.”

In Emory’s experience, nurses on the Ebola unit who started out on 8-hour shifts preferred 12-hour rotations instead. And caring for the emotional health of patients in isolation is as important as promoting physical well-being, the staff learned.

Team members also worked hard to coordinate their efforts. From top administration to waste management crews, pharmacists to lab technicians — every department played a role.

“Every morning the team meets to discuss what worked well, what might be refined,” Feistritzer says, looking for lessons that might be put into practice the next shift, or the next day.

The Emory team doesn’t claim to have all the right answers, Varkey says. But what they do know, they’re sharing.

“Our entire , in terms of our protocols,” he says, “is now available to any person who wants to access that on the web.”

Those protocols went live a week ago. So far, more than 11,300 people have registered to get access to them.

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Stigma Is A Side-Effect Of HIV-Prevention Medicine

Jim Burress, WABE — Fri, 08 Aug 2014 14:14:42 +0000

This story is part of a partnership that includes , and Kaiser Health News. It can be republished for free. (details)

In order to slow the spread of HIV, certain people who do not have the virus but are at risk should take medication to becoming infected. That’s the recommendation of the , and just recently, the .

Bottles of antiretroviral drug Truvada are displayed at Jack’s Pharmacy in November 2010 in San Anselmo, California. (Photo Illustration by Justin Sullivan/Getty Images)

The preventive treatment includes a drug called Truvada, and it is known as PrEP, for pre-exposure prophylaxis.

Eric McCulley made the decision to start PrEP. He’s 40, he’s gay and he’s HIV-negative. Outside an Atlanta coffee shop, he pulls out a plastic baggy with a few blue pills.

“They’re a decent size, actually,” he says. “Some people might call them a horse pill.”

The treatment is a combination of two drugs that are also used to treat HIV.

Eric McCulley of Atlanta says taking Truvada to prevent HIV has helped him feel like he is taking responsibility for his health. (Photo by Jim Burress/WABE)

After hearing about the treatment and doing extensive research on his own, McCulley consulted with his primary care doctor.

“He was very supportive about it. He encouraged me to do it,” he says. “He gave me a lot of stuff to read, gave me a lot of stuff to think about, and told me I was a good candidate for it. So off we went.”

A few months into treatment, McCulley says the only change has been is in his attitude.

“I have what I was looking for. I have peace of mind. I feel like I’ve taken responsibility for my health,” he says.

But some PrEP users worry that not everybody in the medical community is up to speed. Although Truvada has been on the market for a decade, have prescribing guidelines been available.

Listen to this story

Click below to listen to the accompanying NPR story:

Preventing HIV With Medicine Can Carry A Stigma

Dylan West is a 25-year-old Atlanta resident and works in international aid. He is also gay and recently found out first-hand that not every doctor is as familiar with PrEP as McCulley’s.

Some gastro-intestinal issues recently landed West in the emergency department. He’d started PrEP after beginning a relationship with someone who’s HIV-positive. One of the doctors in the emergency room noticed West listed Truvada as a medication he regularly takes.

“She immediately, without asking any questions, just said ‘Well, we should probably test for gonorrhea, syphilis, HIV/AIDS — the list,’ ” he says.

West feels that physician made a “rash assumption” about his sexual practices because he was on Truvada. West knew stigma was something he might face.

“The assumption being, you’re on Truvada, so you probably run around having sex with whoever you can,” he explains.

Some health advocates and activists within the lesbian, gay, bisexual and transgender communities have gone as far as to label those on PrEP as “Truvada whores.”

Dr. Melanie Thompson says she’s heard that before. She’s the principal investigator of the and has long worked in HIV research. She has encountered reluctance from some to prescribe PrEP because of lack of knowledge about it.

“This is an interesting thing to me,” she says, “because doctors who say, ‘I don’t want to prescribe PrEP to somebody who might be at risk for HIV because they might not use condoms.’ You know, it’s an approach we wouldn’t take in other areas of medicine. “

Thompson says no doctor would refuse to prescribe cholesterol-lowering statins to patients because they’re overweight. Somehow, the conversation around PrEP is different.

“So I think it’s a very interesting moralistic attitude that soon will be outdated. But I do think that this is a barrier for some patients,” Thompson says. “They feel stigmatized. And honestly, health care providers need to step up their game and do better than that.”

A CDC spokeswoman said that lack of awareness and knowledge among health care providers is one of the primary challenges to PrEP’s success.

But both Dr. Thompson and CDC officials hope the newly issued treatment guidelines will help overcome any barriers.

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Obamacare Giving Big Boost To Georgia’s Health IT Industry

Jim Burress, WABE — Thu, 09 Jan 2014 17:01:00 +0000

Politically, Georgia is fighting the health law at every turn.

Gov. Nathan Deal, a Republican, has chosen not to expand Medicaid, and the state’s insurance commissioner publically vowed to obstruct the Affordable Care Act. But that doesn’t mean Georgia isn’t seeing a financial benefit from the law.

Mark Gilreath heads the medical device company, EndoChoice, based in Alpharetta, Georgia. The business is part of a health tech boom in the state (Photo by Jim Burress/WABE).

Take the company called . Founder and president Van Willis knows that just a few years ago, a company like his would’ve been a hard sell — impossible, even. The two-year-old company contracts with hospitals and doctors’ offices to call patients after they’re discharged. Under the Affordable Care Act, hospitals are penalized if Medicare patients are within a month for several specific illnesses.

“From a hospital standpoint, there was very little, if any, communication with patients once they leave,” Willis explains. “A logical way to communicate with patients if you can’t be in their homes is, of course, through the telephone.”

Scattered around a half-dozen office cubicles, PreMedex employees don telephone headsets on a recent morning and sit down in front of computers that automatically dial patients. After telling patients they are calling on behalf of doctors and hospitals, the workers ask some simple but important health questions: Have you had any fever? Are you in any pain?

How patients answer could mean the difference between a hospital’s profit and loss. Private insurers will probably follow Medicare’s lead on punishing readmissions. Willis says that’s creating a new market for companies like PreMedex.

“We’ve got clients across the country – small clients, large clients – they all feel the same pressures,” he says.

PreMedex started with five employees. It’s up to 25 and growing. It’s a story told over and over across Georgia, according to Tino Mantella, who heads the .

“We like to say it’s the health IT capital of the nation,” Mantella says. “There are 20,000 technology companies in the state. We did an economic assessment and that came out to be $113.1-billion impact.”

Mantella says that’s about 17 percent of Georgia’s industry, and the health IT part of it is growing fast. Jobs pay an average of $81,000 a year. He says the Atlanta suburb of Alpharetta actually has as many tech companies as startup mecca Austin, Texas.

From Basement To Big Business

Medical device company is one company that calls Alpharetta home. It manufactures equipment like flexible cameras used to check for colon polyps.

, EndoChoice’s founder and CEO, says the company’s workforce has grown exponentially in almost no time. “We were in my basement a few years ago with an idea, to adding a few here and a few there. Today, we’re approaching 400” employees, he says.

Gilreath says the company’s technology helps doctors perform procedures more effectively, reduce infections and give better care to patients. Those are all things encouraged by the Affordable Care Act.

Despite EndoChoice’s success, Gilreath is concerned a provision in the health law will stifle innovation and kill medical device startups before they get off the ground.

The law imposes a 2.3 percent tax on medical device company revenues. “It’s shaking the investment community,” he says. “It’s shaking the device industry. It’s forcing companies to do dramatic things, and it’s just not healthy for the United States.”

Gilreath says he’s cut back on research and development as a direct result of the tax. Even so, his company is on track for more than $100 million in revenue this year.

EndoChoice is a textbook example of the type of tech venture Georgia wants. A recent projects that in 2022, the state will spent about $1.3 billion to attract such companies.

This story is part of a partnership that includes , and Kaiser Health News.

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Health Law Fosters A New Kind Of Business Partnership In Georgia

Jim Burress, WABE — Tue, 16 Jul 2013 10:14:25 +0000

Medical equipment manufacturers operate largely on a “supply and demand” model: Hospitals buy their multi-million dollar machines, use them for a few years, and then the process starts again.

But Philips Healthcare and a hospital system in Georgia are betting on a new business model, one that has risks and rewards for both the hospital and the manufacturer.

Philips is now going to provide the with everything from equipment and training to maintenance — potentially even light bulbs and tooth brushes. But as part of the 15-year, $300 million agreement, Philips also gets something it hasn’t had before: complete access.

“We believe there’s true value in understanding more of the workflow of the institution,” says , president for Philips Healthcare Americas.

The partnership is on view in a radiology lab at Georgia Regents Medical Center in Augusta where doctors have just finished performing a heart procedure on a child. Radiology tech Scott Stevens is among a half-dozen folks prepping the room for the next patient, someone who needs followup care after treatment for an aneurism.

“We’re going to make sure things have gotten better,” Stevens says.

All of this is happening in a huge, new suite with all kinds of diagnostic machinery, a monitor as big as a refrigerator and even mood lighting. And they’re all Philips products.

Under the partnership, about a dozen Philips employees will work in-house at Georgia Regents. They’ll sit in on meetings, offer ideas and develop systems based on one goal: improving patient outcomes.

Philips sees opportunity in the new federal health care law. The law ties some hospital payments to keeping patients healthier. So if more patients get better, in less time and at lower cost, the hospital pays Philips a bonus.

That’s what’s in it for Philips.

What’s in it for Georgia Regents is one answer to a complex puzzle, says hospital CEO .

“Our problem is we have to deliver health care better, faster, and less expensive. What I wanted was a vendor or manufacturer that actually was that kind of partner that would stand in our shoes and think from our point of view, not just sell me more equipment,” Hefner says.

If Philips is successful, it hopes to make this deal with other hospitals.

“I know you’ll see more of these alliances form, because it’s where health care needs to go,” says Laczynski of Philips.

Because the concept behind the partnership is so new, both parties have asked regulators to weigh in on the deal. That should happen within the next 18 months.

This story is part of a collaboration that includes , , and Kaiser Health News.

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New Funds Could Shorten AIDS Drug Waiting Lists

Jim Burress, WABE — Sat, 28 Jul 2012 17:30:00 +0000

The Obama administration nearly $80 million in grants to increase access to HIV/AIDS care across the United States last week – but will it be enough to eliminate waiting lists for the AIDS Drug Assistance Program?

Advocates aren’t sure. The program, known as ADAP, provides a safety net for people with HIV who cannot afford the drugs they need to fight the virus.

For the past few years, ADAP . Nationwide, 1,800 people are now on a waitlist, with Georgia and Virginia accounting for more than half of those cases.

Murray Penner of the says it is hard to tell if the new funding will be enough to handle states’ waitlists. He thinks they will disappear, but only for a year or two.

“It’s very difficult to predict these things because there are so many variables that go into the serving of individuals that need medications,” Penner said.

Atlanta resident James Lark is one of those individuals. Now 47 years old, Lark was 30 when he learned he was HIV-positive. He has gone in and out of phases where he takes care of his condition.

“I’ve been positive now for over 17 years. But when I first found out I just went with it and haven’t done anything about it,” Lark says. “My brother had passed away with AIDS. I was dead within and just kept living my life and wasn’t taking my life seriously.”

Three years ago, Lark was homeless when he decided it was time to get a handle on his health. He qualified for Georgia’s AIDS Drug Assistance Program, which paid for his medications—nearly $20,000 a year.

Lark has qualified for other government programs and doesn’t have to depend on ADAP. But he says his Social Security benefits will end in September. “And that means I’ll have to go back on ADAP. And I’ll be on the waiting list.”

Shifts in state and federal funding, drug costs and rebates, and how many people seek treatment are constantly changing — and all of those affect how many people are on the wait list.

For example, Georgia recently adopted a policy of treating people as soon as they are diagnosed. Research indicates that means a longer, better life for many with HIV. But it also adds a cost burden to a state that can’t support current demand.

The pharmacy at Atlanta’s provides drugs and other services for more than 5,200 HIV/AIDS patients. But with the potential for hundreds of new patients, the Center’s Jacque Muther isn’t sure how they’ll accommodate them.

“It’s going to be a big challenge,” Muther says. “I don’t know how they’re going to meet it. This new money is not going to resolve that.”

This story is part of a collaboration with NPR, WABE, and .

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Dropping Legal Barriers Doesn’t Guarantee Interstate Insurance Sales

Jim Burress, WABE — Mon, 25 Jun 2012 14:24:00 +0000

This story is part of a reporting partnership that includes , and Kaiser Health News.

Starting next week, any health insurer licensed in Georgia can sell policies it offers in other states to Georgians. That includes policies that don’t meet minimum standards for coverage in Georgia.

Small business owner Brian Mayfield has been eager for less expensive health insurance options. It looks like he’ll have to wait a little longer (Photo by Jim Burress/Georgia Public Broadcasting).

They’ll be OK for sale under a new state law that aims to increase competition and lower prices for health insurance in the state.

The idea appeals to Brian Mayfield who runs a in the Atlanta suburb of Woodstock that repairs and refurbishes cash registers and related equipment. Business at his firm is good, but not good enough for Mayfield to offer employees health insurance.

But it doesn’t look like Mayfield, or any other Georgian, will be able to take advantage of the new law. While its cross-state insurance provision is scheduled to go into effect next week, not one insurance company has taken the state up on its offer to sell here.

Some have national ambitions for the idea behind the Georgia experiment. Interstate sales of insurance is a key part of the Republican effort to “repeal and replace” the 2010 health care overhaul. Republicans such as House Speaker of Ohio, from Texas, from Georgia, and even presidential candidate , have touted it as a way to reduce consumer costs for health insurance.

In Georgia, state representative sponsored the legislation, bringing this national Republican concept to Georgia. Ramsey speculates that no insurer has signed up because they are paralyzed by the Supreme Court’s pending ruling on the Affordable Care Act.

“Rightfully, everyone’s kind of preserving the status quo until they see what direction our nation’s health insurance marketplace is going to go.”

It’s not like insurers don’t want the business, he says.

To find out why no company has signed on, NPR asked Georgia’s biggest health insurers: Blue Cross Blue Shield, Aetna, Humana, United Healthcare and Kaiser Permanente. All declined to comment.

Georgetown University professor says insurers’ lack of action is a good thing for consumers. She says cheap plans are cheap for a reason — they don’t offer good services. Insurance premiums are expensive because health care is expensive.

“I’m a little surprised, but frankly, it’s a big relief,” she says, “When you think about health insurance premiums, really the only way that out-of-state companies could sell products that are cheap is if they cut corners — if the product doesn’t cover what the Georgia regulated products cover.”

That doesn’t bother Ramsey, who says, “If an individual wants to buy a more bare-bones policy because that’s all they can afford [or] that’s all they need, that’s a heck of a lot better than not buying insurance.”

Ramsey predicts that if the Supreme Court throws out the Affordable Care Act, insurers will jump at the chance to sell more policies here.

In the meantime, the only thing Georgia has to offer is a new law — and no takers.

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