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Health care costs
higher in Northeast
   WASHINGTON — Staying healthy is a costly business in the United States, particularly in the Northeast, government statistics show.
   Annual health care spending per person totaled $6,409 in New England and $6,151 in the rest of the Northeast, compared to a national average of $5,283, the Centers for Medicare and Medicaid Services reports in the journal Health Affairs. The totals include spending on individual health care from all sources, including insurance, personal expenses, Medicare, Medicaid and other sources, for 2004.
   Highest per capita spending was recorded in the District of Columbia, $8,295, followed by Massachusetts, $6,683; Maine, $6,540; and New York, $6,535.
   “Most of these states have consistently had the highest spending over time,” said report co-author Anne Martin, an economist with the CMS Office of the Actuary.
   The lowest per person health care spending was $3,972 in Utah.

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Home-health workers deserve better treatment

   What a riot! Hospitals are merging/closing and politicians want people to have quality home care. Since health insurers aren’t willing to pay for home care, what will the sick or infirm do?
   After training, as a rule, home-care aides are paid less that $10 per hour. This is to care for your loved one in a home setting, unsupervised most of the time. We are asked to sign a paper that says we agree to be classified as a part-time worker, whether we work 20 or 60 hours a week. It is legal for our employers to pay us time-and-ahalf for overtime, based on minimum wage, rather than our regular hourly wage. We get no paid time off.
   Home-care aides have been given a raw deal not only in the news, but in the state and federal government (June 12 Gazette). Per all news reports, we are to take up the slack caused by the closing of local hospitals. I’d be happy to do that if our government would back us.
   JEANNE M. LYNCH
   Schenectady

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Home-health workers deserve better treatment

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Home-health workers deserve better treatment

   What a riot! Hospitals are merging/closing and politicians want people to have quality home care. Since health insurers aren’t willing to pay for home care, what will the sick or infirm do?
   After training, as a rule, home-care aides are paid less that $10 per hour. This is to care for your loved one in a home setting, unsupervised most of the time. We are asked to sign a paper that says we agree to be classified as a part-time worker, whether we work 20 or 60 hours a week. It is legal for our employers to pay us time-and-ahalf for overtime, based on minimum wage, rather than our regular hourly wage. We get no paid time off.
   Home-care aides have been given a raw deal not only in the news, but in the state and federal government (June 12 Gazette). Per all news reports, we are to take up the slack caused by the closing of local hospitals. I’d be happy to do that if our government would back us.
   JEANNE M. LYNCH
   Schenectady

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AMSTERDAM
Union: City’s drug savings could grow
Only 25 workers using CanaRX prescription program
BY DANIEL DEVRIES Gazette Reporter

   The city has saved more than $50,000 since implementing a Canadian prescription program for its employees, and that sum could significantly increase with more participation, officials said.
   By the end of 2007, DPW union President Warren Busseno said, the city could save almost $77,000 in prescription drug costs.
   All of Amsterdam’s approximately 200 employees are eligible for the CanaRX prescription program, city Controller Heather Reynicke said Thursday, but only about 25 workers now take advantage of the option.
   Reynicke said program saves money for participating employees and the city, as individuals would need to make only one co-payment for several months of prescriptions.
   Busseno, who provided the savings figures from the city’s insurance broker, said he is pleased that one of the union’s ideas is helping to save money.
   “As far as the guys in my union, they think it’s gone really well. There’s some medications they don’t carry, but this helps with maintenance drugs,” Busseno said. “If it’s something someone needs on a daily basis, it’s helping out.”
   In 2005, Amsterdam paid about $790,000 for prescription drugs, according to figures from the controller’s offi ce.
   Mayor Joseph Emanuele III said any savings is welcome, and as more people opt for the program, the city could end up saving much more.
   “The preliminary numbers from Warren show some positive change. Hopefully this trend will continue,” Emanuele said. “Like any changes, it will take time for people to have confidence in a different system. But I think if it’s monitored correctly, and knowing the controller is doing the best she can to educate the employees, we’re very happy with any savings we can get.”
   Several informational sessions were held when the program fi rst started, to tell retirees and current employees about the opportunity to get maintenance drugs from Canada.
   Reynicke said no recent sessions have been held, but she can get people information if they are interested in starting.
   Some City Hall workers said they prefer sticking with local drug stores. City Clerk Jane Di-Caprio said she favors the hometown shops over mail order.
   “I suppose it’s a good deal, but I like dealing with my local pharmacist,” DiCaprio said.
   Third Ward Alderman Vincenzo Nicosia said he thinks some people have not switched because there is not enough incentive, or because of fears that the medicine will not be of the same quality as found in local retail stores.
   “Some are afraid that they’re not going to get their medications on time, or it will be different,” Nicosia said. “They’re afraid to give it a try, and they shouldn’t be.” He said people who have opted for the prescription program have done well with it.
   CanaRX representatives met with county and city officials in 2006 to explain how the mail-order prescription program works, and to ensure employees that all of the drugs the company sells are name brands and come from the same pharmaceutical factories from which American pharmacies buy.    And while there has been questions of the practice’s legality, Reynicke said, the city has not had any legal challenges to the program.  

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We are our own worst enemy.

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Taking charge of their condition Classes help older patients live healthfully with chronic illnesses
BY KATHY RICKETTS Gazette Reporter

   Karen Revitt has lived with juvenile diabetes for 20 years.
“I definitely try to keep communication open with my doctor and try to be as honest as possible, even when I mess up,” said Revitt, project coordinator for “Healthy Choices New York: Living Healthy.”
   “I also try to take time for myself to help manage the added stress of having to deal with living with a chronic condition.”
   Living Healthy is a six-week workshop series that gives older people and their caregivers the tools they need to take charge of chronic conditions such as arthritis, heart disease, high blood pressure, asthma, osteoporosis and diabetes by learning ways to better manage their ongoing needs.
   Living Healthy was developed and evaluated by the Patient Education Research Center at Stanford University. It is funded by the Administration on Aging, the New York state Office for Aging and the state Department of Health.
   Each class is led by two volunteers, at least one of whom either has a chronic condition or helps care for someone with a chronic condition.
TRAINING PERIOD
   Peer leaders go through a four-day training to learn how to teach the free workshops, which are held weekly for 2 1 /2 hours at various locations throughout the Capital Region. They can also be taught in Spanish.
   Some of the topics include goal-setting, relaxation and breathing techniques, stress reduction techniques, nutrition, exercise, medications and their side effects, pain management, having a positive attitude, and communicating with your family and your doctor.
   “One thing we do during every workshop is have participants set personal goals to work on for a week,” said Revitt.
   Some examples may be to walk every day for 15 minutes, or to spend half an hour a day reading or doing another form of relaxing.
   Although participants have different chronic conditions, they often experience similar symptoms, such as tenseness and anxiety, said Revitt.
   “We teach people ways to relax, like progressive muscle relaxation where you tense a certain part of your body then relax it,” Revitt explained. “We also teach pursed-lip breathing, where you take a deep breath through your nose then slowly breathe out through pursed lips.”
People with asthma or chronic emphysema find that practicing that type of breathing helps release anxiety and calms them down, Revitt said.
Participants also receive a relaxation tape or CD to help them practice.
“We also talk about a safe way to exercise and how to know if you are working hard enough but not too hard” said Revitt, who suggested walking as an excellent form of exercise.
The course suggests eating a wide variety of foods, particularly fruits, vegetables and whole grains to get more fi ber.
“We also tell people, if they can, it’s better to eat the same amount at each meal instead of having one huge meal then very little or nothing, so they can keep their energy consistent throughout the day,” said Revitt.
   When people have a chronic condition, it’s important that they consider themselves to be a partner with their health care provider.
   “Your doctor can tell you about the progression of the illness and make different recommendations. But at the end of the day, you are the one at home managing your disease,” said Revitt. “There’s no magic pill that will make this go away.”
   It’s important to talk to your doctor about what your medication is for, how much you should be taking, side effects and potential drug interactions.
PRACTICE AND PATIENCE
   Participants also practice learning positive thinking techniques by writing down their self-defeating thoughts, then turning them into postive ones.
   “It takes a lot of practice and patience,” said Revitt. “These are ingrained patterns, but people can be open to change at any age.”
   Symptoms such as fatigue, pain, tense muscles, stress and anxiety and depression can actually feed on each other, said Revitt.
   “Sometimes, you may feel like you are trapped,” she explained. “So the idea of the class is to teach these different tools so you can interrupt that symptom cycle.”
   If one participant is having a problem with fatigue, for example, the group will brainstorm and throw out different ideas about what they do to fight fatigue.
   “Then the next week, the person talks about if he or she tried any of the suggestions,” said Revitt.
   Class size is typically between 12 and 16 people.
   “The idea is that you try different techniques and find what works for you at that particular time,” said Revitt.
CONTROLLING LIFE
   Max Kintner of Clifton Park, a peer leader along with his wife, Mary Pliska, said he tries to tell people they have some degree of control over their chronic illness.
   “Maybe they can’t be cured, but we emphasize that they can take charge of their lives, and there are things they can do to control the pain, the emotional trauma and the physical limitations they have to live with,” said Kintner, who has diabetes.
   “It’s empowering when people realize they have power within themselves to improve their conditions,” Pliska said. “It’s something they have to want to do, and nobody can do it for them.”
   Further information is available by contacting Karen Revitt, project coordinator, Healthy Choices New York, University at Albany, Richardson Hall 390, 135 Western Ave., Albany.

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SCHENECTADY COUNTY
Ellis money request at issue Hospital is asked to reduce cost of Bellevue merger
BY MICHAEL LAMENDOLA Gazette Reporter

   The state is asking Ellis Hospital and Bellevue Woman’s Hospital to revise a funding request amounting to $35 million to consolidate the operations under Ellis, saying the amount is too high and could jeopardize the plan.
   State Department of Health spokeswoman Claudia Hutton on Friday said, “That is a really high state investment. At this point, I do not know whether in the end the Bellevue-Ellis agreement can hold together because they are asking for a disproportionate amount of state funding.”
   Bellevue spokeswoman Sue Nigra said Friday that “state health officials have given us no indication they will not give us the money. We have had several meetings with Ellis and the state about this.”
   Ellis spokeswoman Donna Evans said Ellis is asking for $12.5 million from the state. “We feel it is a reasonable request, based on our best judgments and are continuing to talk with state about it.”
   Bellevue is also seeking state assistance to meet its own obligations, which possibly brings the total to $35 million, Evans said.
   “Our first responsibility and duty is to protect Ellis’ substantial services. We have been asked by the state to assume some significant responsibilites at Bellevue and we are willing to do that. We can only take on additional responsibility if we have substantial state support to do so,” Evans said.
   Hutton said the state is working with Ellis to pare down its request. It expects to issue grants to hospitals, including Ellis, in the next few weeks. “We are distributing the money now,” she said.
   The $35 million amount represents Bellevue’s accumulated debt and the cost to consolidate with Ellis, Bellevue officials said. Ellis is to take over Bellevue’s operations on Nov. 1, at which time Bellevue will surrender its operating license.
   The Ellis-Bellevue agreement is expected to satisfy the Berger Commission decision that Bellevue should close. State law, which took effect Jan. 1, puts into effect proposals of a commission headed by Stephen Berger calling for health care changes statewide to make the system more efficient and save public money.
   The state is requiring Ellis to maintain a full range of women’s health and reproductive services, which Ellis plans to do through the Bellevue campus. It also is requiring Ellis to consolidate services with Schenectady County’s other major hospital, St. Clare’s on McClellan Street.
   Ellis is a nonsectarian hospital, while St. Clare’s is a Catholic hospital subject to Roman Catholic canon law, which affects the women’s reproductive health services it offers.
   Hutton said Ellis is also requesting state funds to cover St. Clare’s $34 million unfunded pension obligation, as well as funds either to build a new hospital, estimated at between $300 million and $500 million, or a new women’s and children’s health center for approximately $24 million. The proposed center would replace operations at the Bellevue campus. Such a center could take years to build, officials said.
   “The $35 million does not do anything about St. Clare’s and Ellis [consolidation],” Hutton said. “When you take all the requests, there would be a disproportionate amount of money going to Schenectady County.”
   She said the state has “communicated to Ellis our concerns about the size of the grant. The state and federal money is money of last resort.”
   Hutton cited a grant the state awarded to two Kingston hospitals this week as an example of how it is handling requests under Berger. Kingston Hospital and Benedictine Hospital requested $130 million to build a new hospital; the state gave them $44 million. “They are getting what they truly need to execute Berger,” she said.
   The state has some $550 million to distribute to hospitals and nursing homes across the state to help put the Berger plan into effect. Hutton said the state will use approximately $115 million of this money to develop a statewide interconnected medical system, which would allow hospitals to tap into patient data instantaneously.
   The state also expects to set aside some of the money to help hospitals not targeted by Berger that want to consolidate and to establish primary care and more home-based care services, Hutton said.
   The money is coming from the Health Efficiency and Affordability Law for New Yorkers, also known as HEAL. The state expects to spend $1 billion over four years. The money comes through bond sales and is being allocated through the New York State Dormitory Authority.  

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Hospital pains  
First published: Sunday, September 23, 2007

From the moment the Berger Commission released its recommendations on hospital closings and mergers throughout the state, the cash register began to ring. Now the tab is running up as hospitals on the list face the rising costs of shutting down.
It shouldn't be this way, but it is. Just look at the bills being incurred by Bellevue Hospital in Niskayuna as it prepares to be taken over by Ellis Hospital in Schenectady, and by St. Clare's in Schenectady, which is due to merge with Ellis. The numbers, outlined a week ago by our business writer Alan Wechsler, are troublesome.

To begin with, Bellevue's malpractice insurance premium has skyrocketed from $630,000 a year to $4.3 million. Then there's the $500,000 in legal and consulting fees incurred by St. Clare's, and the $30 million shortfall that has accumulated over time in its pension fund. And that's not to mention the staff turnover at Bellevue, as professionals begin to search for jobs at other hospitals, or the declining occupancy rates at St. Clare's, where patients uncertain about the hospital's future are seeking care elsewhere.

The staff and patient numbers are considered part of the hidden costs of closing or merging a hospital. Even so, they can -- or at least they should -- be estimated ahead of time. And the other costs, such as legal expenses, insurance premiums and the difficulty of a hospital targeted for closure to obtain credit, should have been calculated long ago.

Granted, the state has set aside $550 million to help hospitals through the transition period, but there's no certainty that that is anywhere near the final cost, which by some estimates could reach $2.5 billion if all of the requests submitted by hospitals affected by the Berger Commission report were approved.

The question is, why wasn't there better planning? True, the commission concluded that the hospitals should pay as much of the closing costs as possible. But that is no help to the hospitals. Instead, it continues an infamous tradition of the state trying to save money by passing on the costs of mandates to localities. In this case, the localities are hospitals struggling under the weight of mounting debt.

There's no reason this tradition needs to continue. Gov. Spitzer, who has promised to change the culture of Albany, could set an example by promising the hospitals in transition the help they need to comply with the Berger Commission's goals. For example, that could mean, besides money, providing legal help to the hospitals, and monitoring malpractice costs to prevent carriers from taking advantage of the situation. Thousands of jobs are being lost; thousands of patients will be inconvenienced as a result of the commission's recommendations, and dozens of communities will be dealing with the economic impact of closings for a long time. They deserve better treatment.

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Ellis gets funds for takeover Grant to cover Bellevue consolidation costs
BY KATHLEEN MOORE Gazette Reporter

   Ellis Hospital will receive less than half of what it said it needed to take over services of Bellevue Woman’s Hospital, under a state funding plan announced on Friday.
   Ellis is slated to receive $5.9 million from the state Department of Health and state Dormitory Authority. Bellevue and Ellis Hospital officials had said they needed $12.5 million to run Bellevue, a changeover set to begin on Nov. 1. They said they also needed $22 million to close out Bellevue’s debt, pensions and other expenses.
   They were initially told that figure was too high, with a state DOH spokeswoman saying the request was so disproportionate that it might jeopardize the entire consolidation plan.
   But on Friday, the state agreed to give Bellevue exactly what it asked for — $22 million — while granting Ellis $5.9 million.
   Ellis spokeswoman Donna Evans said the grant is enough to keep the consolidation plan on schedule.
   “It’s not what we asked for but it is a sufficient amount to handle the short-term costs,” she said. “This is certainly sufficient for now. Beyond that, we’re continuing to talk with the state DOH about the longerterm operating needs.”
   The grant does mean that Ellis will stick to its plan, which projects that Bellevue will stay open for only another three to four years, Evans said.
   “There are a lot of puzzle pieces, but three to four years is what we’ve been saying for Bellevue,” she said.
   Anne Saile, Bellevue’s president and chief executive officer, said she was pleased that her hospital received its full $22 million grant request.
   “The good news is that women’s health is here to stay in Schenectady,” Saile said. “It’s clear our services are needed, and we were really victorious in making that point.”
   About $4.3 million of the grant will pay for extended insurance coverage, with $3 million set aside for vendors and another $2 million to be used to supplement an existing pension fund. The money will also be used for legal, auditing and consulting fees, paying off leases and to compensate employees for unused vacation time.
   “We didn’t ask for a penny more than we needed,” Saile said, adding that the money will help make the transition seamless to the public.
   “The staff and services will still be here,” she said. “People won’t feel a difference.”
   The Ellis takeover of Bellevue services followed a recommendation from the Berger Commission that Bellevue should close.
   Ellis and St. Clare’s Hospital also are proposed to merge, but funds have not yet been designated for that plan.
   St. Clare’s CEO Robert Perry said he has been assured that the state will offer grants for that project later. The Department of Health has another $187.7 million to distribute over the next few weeks.
   DOH officials said they started with the most-deserving institutions.
   Health Commissioner Dr. Richard F. Daines said the projects that were funded Friday were the ones that offered a “practical approach” to the changes proposed in the Berger report.
   “I commend these facilities for responding in a constructive manner to the Berger Commission mandates,” Daines said. “Their resourcefulness in reconfiguring their buildings, services and governance will smooth the transition to a more stable and efficient health care system for their communities and for all of New York State.”
   The only other local institution to receive a grant Friday was the Albany County Nursing Home and Ann Lee Infirmary, which received $3 million.  

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SCHENECTADY COUNTY
$1M drug purchase savings forecast
Canadian dollar’s strength fails to cut benefits of discount plan
Gazette Reporter

   Despite a strong Canadian dollar, Schenectady County still expects to see a savings of more than $1 million by the end of the year through its international discount prescription drug program for employees, a county official said.
   The county works with CanaRx of Ontario to obtain long-term prescription drugs cheaply through Canada, Australia and Great Britain. It launched the program in December 2004, becoming the first county in the state to obtain prescription drugs from non-U.S. sources.
   “In the first six months of 2007, the savings are $591,601, with an annualized savings rate of almost $1.2 million,” said County Attorney Chris Gardner.
   He said county savings would have been greater had the Canadian dollar not leveled in value with the U.S. dollar during the year.
   “I had some concerns specifi - cally about the currency weakness of U.S. dollar, that savings would go down. The good news is that our savings are increasing,” Gardner said. “We are always trying to monitor our program and see if we are heading in the right direction.”
   Schenectady County has saved $2.7 million in prescription drugs costs since 2004, Gardner said. This is the amount of money the county would have had to pay out if employees purchased their brand name prescription drugs in the United States. Brand name prescription drugs in the United States are 30 percent to 70 percent higher in cost than those overseas, due to free market conditions.
   Gardner said the county uses the savings to “try to keep tax rate low,” relative to health care costs. “In last four years, the cost of our HMO option, which is not part of the CanaRx program, has gone up 40 percent. Our Blue Cross Matrix program, to which most current and retired employees belong, has gone up only 20 percent.”
   The county spends approximately $5 million annually on prescription drug costs for employees. It spends approximately $1.3 million per year through the CanaRx program, mostly for name-brand drugs, and the rest is spent on generic drugs purchased in the United States, either through local pharmacists or through mail order.
   Under the county’s plan, an employee can directly purchase drugs by mail from a Canadian, British or Australian pharmacy. The county then reimburses the CanaRx.
   The county cannot order prescription drugs for patients in its Glendale Home or inmates in the county Jail, Gardner said, “but each employee has a contract for personal use, for maintenance medication,” usually for 80 to 90 days.
   The arrangement is a legal mechanism that holds the county harmless from federal law that prevents companies or municipalities from importing drugs. However, a long-standing FDA policy allows individuals to import up to 90 days worth of drugs for life-threatening conditions, Gardner said.
   County officials are negotiating with employees this year to increase their participation in the CanaRx program, which would further increase savings, Gardner said. Of the county’s 1,474 employees, both current and retired, eligible to participate in the CanaRx program, only 950 participate, a rate of 64 percent.
   “Our goal is to achieve 90 percent efficiency by getting employees to use the cheapest option, which is to buy their drugs through CanaRx,” Gardner said. The county uses an incentive: Employees pay no copay when they purchase drugs from Canada; otherwise they pay up to $20.
   “As we tweak and adjust our incentive co-pays, we can increase our savings several hundred thousands per year,” Gardner said.
   Selig Corman, a consulting pharmacist and director of professional affairs with the Pharmacists Society of the State of New York, said his organization has several concerns about the importation of prescription drugs into the United States.
   “The drugs are being imported into this country, which is possibly not legal. The drugs may be of doubtful quantity, and the patient profile — a record of the various drugs a patient uses — is split between different pharmacists, which makes consultation difficult to prevent medicine interaction,” Corman said.
   He added, however, that he believes the quality of drugs from CanaRx “appears OK.”  

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“The drugs are being imported into this country, which is possibly not legal. The drugs may be of doubtful quantity, and the patient profile — a record of the various drugs a patient uses — is split between different pharmacists, which makes consultation difficult to prevent medicine interaction,” Corman said.
   He added, however, that he believes the quality of drugs from CanaRx “appears OK.”  

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Do you realize that Mr. Spitzer is not happy with the latest round regarding the State Childs Health Insurance Program (SCHIP)?  It seems that the state of New York will not get any funding for this, as they have not yet got the appropriate percentage of currently eligible children enrolled, therefore making New York State residents ineligible on the most recent level of care.  To further this, as the health care plan progresses, this means that New York State residents will be paying more to help children all over the country, while we will be recieving no additional money.  Is there some way that you can think of to have this rectified?  I would appreciate if you would reply via e-mail as this would be the quickest way for me to receive and the cheapest for all involved.  
Thanks,
Kevin