IGH - ROCH 163 March 19

PRICELESS

Meet Your Doctor Julie Riccio, the new chief of pediatric medicine at Highland, is working to improve the care given to the tiniest and most vulnerable newborns

HOW CONTENT ARE YOU?

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Taking Antibiotics?

MARCH 2019 • ISSUE 163

You may not need to. Study shows a quarter of antibiotics prescriptions unnecessary. See what local doctors say about it. Story on page 13

ALSO INSIDE: The measles outbreak and the ‘anti-vax’ movement Page 7

What health questions people ask Google the most

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Worldwide, More Die After Surgery Than From HIV, Malaria: Study

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bout 4.2 million people worldwide die every year within 30 days of surgery — more than from HIV, tuberculosis and malaria combined, a new study reports.

The findings show that 7.7 percent of all deaths worldwide occur within a month of surgery, a rate higher than that from any other cause except ischemic heart disease and stroke.

About 313 million surgical procedures a year are performed worldwide, according to The Lancet Commission on Global Surgery, but little is known about the quality of surgery around the world. That’s what this study set out to explore, using available data on volume and type of procedures and death rates.

“Surgery has been the ‘neglected stepchild’ of global health and has received a fraction of the investment put in to treating infectious diseases such as malaria,” said lead author, physician Dmitri Nepogodiev. He’s a research fellow at the University of Birmingham in England.

Along with finding that 4.2 million people a year die within a month of having surgery, his team discovered that half of those deaths occur in

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THAN THE NATIONAL AVERAGE In 2017, the uninsured rate across upstate New York averaged just 4.0 percent. This maintains our region’s historically low uninsured rate. It compares with a New York state average of 5.7 percent and a national average of 8.7 percent.

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • March 2019

low- and middle-income countries.

Researchers from Birmingham’s NIHR Global Health Research Unit on Global Surgery said 4.8 billion people worldwide lack timely access to safe and affordable surgery. They estimated that there is an unmet need for 143 million surgical procedures a year in low- and middle-income countries.

But answering unmet needs those countries would increase the worldwide number of postoperative deaths to 6.1 million a year, the investigators said.

“Although not all postoperative deaths are avoidable, many can be prevented by increasing investment in research, staff training, equipment and better hospital facilities,” Nepogodiev said in a university news release.

“To avoid millions more people dying after surgery, planned expansion of access to surgery must be complemented by investment in to improving the quality of surgery around the world,” he noted.

The findings were published Feb. 2 in a research letter to The Lancet medical journal.

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INVEST IN YOUR HEALTH.

Keto Diet, ALS Top Google Search in 2018

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Toastmasters was started in 1924 by Dr.Ralph Smedely in Anaheim California. Toastmasters is a nonprofit organization that helps its members develop Leadership and Communication skills. We need your passionate impactful stories that can and have changed lives. Words with positive intent are powerful! District 65 is one of 106 Districts in the International Toastmasters organization and has approximately 2,000 members and 108 clubs In Western and Central New York including Buffalo, Syracuse and Binghamton.

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oogle it —and Google we did. On the eve of 2019, CNN reported that the “Dr. Google” spat out more information on health-related questions regarding a fad diet and ALS more than any other ailment in 2018.

Along with other health concerns — including endometriosis, the flu, how long marijuana stays in system, implantation bleeding, heartburn and high blood pressure — the Ketogenic Diet and ALS were the top two health-related searches.

Keto, the high-fat low-carb diet, may be proven to shed weight, but it is not a way of life, according to nutritionist Lisa Drayer. “It doesn’t teach you how to acquire healthy eating habits,” Drayer said. “It’s good for a quick fix, but most people I know can hardly give up pasta and bread, let alone beans and fruit,” she said.

Whether or not the death of world-renowned physicist Stephen Hawking in March 2018 death contributed to the spike in searches about ALS — also called Lou Gehrig’s Disease — is unknown, just like ALS itself, of which “little is known about the causes of the disease, and there is no cure,” reported CNN. Lupus topped the list in 2017 as the top searched disease, along with mental illness, both of which have a direct link to singer Selena Gomez.

As the producer of “13 Reasons Why,” a Netflix series dealing with mental health and suicide and as a Lupus sufferer herself, Gomez brought her creative direction and

health concerns to masses, especially since the Netflix series reportedly sparked an interest in suicide ideology.

Unlike the last year, opioid addiction did not dominate the search engine questions as it did in 2017 after it was declared a national public health emergency by President Donald Trump. However, three health related questions that did remain the same in 2017 and 2018 concerned the flu, blood pressure and lethargy.

Speaking of the flu, Marie Claire magazine points out that Googling the illness can literally leave you feeling worse than when you clicked search. “We’ve all typed in flu symptoms only to have the internet suggest that it’s anything from pregnancy to ebola,” reports the magazine. “Which, unsurprisingly, leaves you feeling anxious, upset and confused.”

The reason why “a whopping 1 in 4 people,” Google their illnesses, according to Marie Claire, is because of doctor availability and work schedule conflicts; however, that is still no excuse for not “being seen by a trained professional, rather than, well y’know, your own imagination and a bunch of random web searches.”

Only time will tell what Dr. Google who tracks health-related questions annually from January to mid-December will report the top 2019 health concerns are, so until then, maybe go to the doctor rather than the search engine for the answer to what ails you.

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onprofit organizations in Upstate New York can apply for Excellus BlueCross BlueShield Community Health Award grants that add up to a total of $100,000, which the company is offering to help fund health and wellness programs in Upstate New York.

Nonprofit, 501(c)(3) organizations in Excellus BlueCross BlueShield’s 31-county Upstate New York region are invited to apply for an award of up to $4,000 each.

The award can be used for programs that have clear goals to improve the health or health care of a specific population. Programs that improve the health status of the community, reduce the incidence of specific diseases, promote health education and further overall wellness will be considered.

The deadline to submit an application to be considered for an Excellus BlueCross BlueShield Community Health Award is Tuesday, March 5. For additional information and the online application, go to www.excellusbcbs.com/wps/ portal/xl/news/company-information/corporate-giving. Award winners will be announced in the spring.

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • March 2019

ty Health Awards demonstrate a corporate commitment to support local organizations that share our mission as a nonprofit health plan,” said Holly Snow, director, community engagement, Excellus BlueCross BlueShield. “These awards complement our existing grants and sponsorships with agencies that work to enhance quality of life, including health status, in Upstate New York.”

Earlier this year, 13 Rochester area organizations received Excellus BlueCross BlueShield Community Health Awards from last fall, when more than 50 applications were submitted by organizations in the six-county Rochester region.

The winning organizations were 13thirty Cancer Connect, Bishop Sheen Ecumenical Housing Foundation, Inc., Coalition to Prevent Lead Poisoning, Family Promise of Ontario County Inc., Finger Lakes Migrant Health Care Project, Inc., Foundation for Dansville Education, GiGi’s Playhouse Rochester, Heritage Christian Services Inc., NAMI Rochester, RESOLVE of Greater Rochester, Inc., S2AY Rural Health Network, The Children’s Agenda and Veterans Outreach Center Inc.

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Page 5

Meet

Your Doctor

By Chris Motola

Julie Riccio, M.D. New chief of pediatric medicine is working to improve care given to the tiniest and most vulnerable newborns at Highland

Emergency Rooms the Destination for Many Electric Scooter Users

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ented electric scooters have become all the rage in getting around larger cities, but they are also accidents waiting to happen, a new study reveals.

In two Southern California emergency departments, nearly 250 people were seen for injuries linked to electric scooters in a single year, researchers found.

“Riders of electric scooters share roads with fast-moving vehicular traffic and share sidewalks with lots of pedestrian traffic and uneven curbs, and riders seem to underestimate hazards,” said senior study author Joann Elmore, a physician and professor of medicine at UCLA’s David Geffen School of Medicine.

Injuries associated with these electric scooters are a new phenomenon, she noted. “While the injuries vary in severity, some are serious, including fractures and head injuries,” Elmore said.

These data are likely a conservative estimate because the researchers only included patients seen in emergency rooms. “Our findings do not cover the many patients seen in our outpatient clinics,” Elmore added.

“Electric scooters are an innovative and inexpensive method of transportation for short distances,” she pointed out.

The companies offering these electric scooters are rapidly expanding in the United States and internationally. “This is now a billion dollar market, with ride-sharing companies like Uber and Lyft recently entering the market,” Elmore explained.

For the study, Elmore and her colleagues used medical records from University of California, Los Angeles-affiliated hospital emergency departments to look at accidents associated with standup electric scooters over one year. In all, 228 patients were injured as riders and 21 as non-riders.

Q: How long have you been working as chief of pediatric medicine at Highland Hospital?

A: I have for about a month.

Q: What are your duties?

A: I oversee mostly the newborn nursery at Highland and policies and procedures that apply to any child who comes into the hospital.

But at Highland that mostly means newborn medicine, because we don’t necessarily have inpatient pediatrics except for newborns and infants that need special care. So, I oversee the administrative aspects, credentialing and physician management, with the medical director helping me with some of the HR aspects of that unit.

Q: What got you interested in the role?

A: I actually have an administrative role at Unity Hospital as well, so it started because both of the hospitals have what are known as Level 1 nurseries, so they take care of somewhat sick babies. And that’s in addition to the normal newborn care that they do. In my job and clinical role at Strong, I actually spend a lot of time taking care of babies that are a little bit ill, and I also overlapped with some of the newborn care as well. So, when the role opened up at Unity, I was a good fit because I was one of the neonatologists who did the less acute medicine and took care of healthy babies as well.

That’s how I became interested in that administrative role at Unity, and then that kind of blossomed being a good fit for a similar role at Highland.

It just seemed kind of

logical.

Q: What kind of impact do you want to make at Highland?

A: I think it’s important to really hone in on newborn medicine and standardize it across the Rochester area, and just to continue to create best-practice medicine in some of the smaller hospitals. Given the neonatology background I have and some of the quality improvement initiatives we have at Strong, I want to bring them out to smaller community hospitals like Highland and really enhancing the care that newborns are getting and really working with the community.

Q: And your own medical background is pediatrics, correct?

A: I did a three-year pediatric residency in neonatology, so my background is really in newborns and sick newborns.

Q: What kind of care do newborns usually need?

A: Highland has the biggest delivery service in the Rochester area, and they do take care of many, many healthy babies. Really, for healthy newborns, it just making sure they have normal heart and lung functions, and the fingers and toes, making sure they’re feeding well. Watching for jaundice, making sure they transition to being outside their mother in an appropriate manner in terms of their breathing.

So, most of the care we provide is making sure that transition is happening.

That’s why they have us there as pediatricians, along with advanced practice providers to provide that need to newborns who do

The report was published online Jan. 25 in JAMA Network Open.

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • March 2019

need that extra little bit of help. And, usually, with a little bit of help in terms of breathing, most newborns will turn the corner and be just fine in terms of birth. We do provide respiratory help for newborns who have a little trouble breathing. We can also provide fluids, antibiotics, phototherapy for jaundice.

Q: How do you divide your time between administration and practice?

A: A fair portion of my time is clinical. Fortunately or unfortunately, administration has taken a little bit of my time away from clinical.

Q: What qualities do you think make for a good medical director?

A: I think, obviously, someone well-versed in the medicine that’s happening and the needs within the hospital. That’s why at a hospital like Highland, where most of the pediatric population are newborns, a neonatologist has been in that role.

Outside of that, I think a person who is easily approachable, who can implement changes with the group and be able to manage people as well.

Q: Do you practice at Highland?

A: My clinical practice is all through Strong and some time at Rochester General Hospital as well.

The one clinical piece at Highland would be doing consultation to providers there. I act more in a consultant role there for providers in the unit.

Q: With child delivery, patients can afford to be a bit more discretionary about where they seek medical services. What does Highland Hospital offer above other options?

A: I think the care there is very family-centered. Their recent reconstruction of the special care nursery and labor and delivery unit is designed to help keep mothers and babies together. And that’s something that I think they do very well. I think the environment there is very warm and inviting, and they do a great job. I think the community knows that, and Highland has grown to accommodate that.

Q: How’s your first month been?

A: It’s been exciting. It’s been nice to see how different places do things. I’m kind of coming in at a time where things are in place. It’s not in a period of active change, so it’s a good time to meet people and assess where we’re going in the future. It’s been a nice transition, and I’m getting the lay of the land.

Everyone’s very friendly. It’s a great environment.

Lifelines

Name: Julie Riccio, M.D. Position: Chief of pediatric medicine at Highland Hospital Hometown: Lyndhurst, Ohio Education: SUNY Upstate Medical Center, Syracuse; residency in pediatrics at SUNY Syracuse Office of Graduate Medical Education; fellowship in neonatology at University of Rochester Medical Center Awards: Excellence as a Teacher Award, residency, SUNY Upstate Medical University (2005 and 2006) Affiliations: University of Rochester Medical System Organizations: American Academy of Pediatrics Family: Husband, Dustin and two school-aged boys Hobbies: Tennis; jigsaw puzzles

As U.S. Measles Outbreaks Spread, Why Does ‘Anti-Vax’ Movement Persist?

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easles outbreaks across the United States — including one in Washington state where 50 cases have now been identified — have again shone the spotlight on parents who resist getting kids vaccinated.

These outbreaks are a clear sign of the fraying of “herd immunity,” the overall protection found when a large majority of a population has become immune to a disease, said physician Paul Offit. He is director of the Vaccine Education Center at the Children’s Hospital of Philadelphia.

“Measles is the most conta-

gious of the vaccine-preventable diseases, so it’s always the first to come back when you see a drop in herd immunity,” Offit said.

The World Health Organization has taken notice, and recently declared the anti-vaxxer movement a major threat to public health.

Given this, why does anti-vaccine sentiment continue to thrive in certain locales throughout America?

Offit suspects it’s because people have forgotten just how bad diseases like measles, chickenpox and whooping cough can be.

“It’s happening because people March 2019 •

aren’t scared of the diseases,” Offit said. “I think vaccines in some ways are victims of their own success.”

But other factors come into play, including a reluctance to give a slew of vaccines to a young child so early in life, now-debunked fears of a link to autism, a feeling that diseases are a natural part of childhood, and a deep-seated distrust of the medical community.

Measles outbreaks were “inevitable,” said physician Dawn Nolt, an associate professor of pediatric infectious disease at OHSU Doernbecher Children’s Hospital in Portland, Ore. She lives close to the Washington border, where the biggest current measles outbreak rages.

“Pockets of communities where there are low vaccine rates are ripe to be ground zero for an outbreak,” Nolt said. “All you need is one person in that community. We knew this was going to happen.”

That’s particularly true of measles, which is incredibly virulent.

Offit explained that “you don’t have to have face-to-face contact with someone who has measles.

You just have to be within their air space within two hours of their being there.”

According to Nolt, despite its power to spread, there are three questions that typically come up with parents who are hesitant about having their children vaccinated against measles: Is the vaccine safe? Is the vaccine needed? Why shouldn’t I have freedom of choice regarding my child’s vaccinations?

“I think what’s important is to really understand that families have certain concerns and we need to understand those concerns,” Nolt said.

“We can’t lump them all together and think that that one conversation serves all of their concerns.”

Parents’ concerns regarding vaccination are often first sparked by the recommended vaccine schedule, Offit said.

“What’s happened is we ask parents of young children in this country to get vaccines to prevent 14 different diseases,” Offit said. “That can mean as many as 26 inoculations during those first few years of life, as many

as five shots at one time, to prevent diseases most people don’t see, using biological fluids most people don’t understand.”

So, it’s important that doctors explain to parents that these vaccines are “literally a drop in the ocean” compared to the myriad immune system triggers a child encounters each day, Offit said.

“Very quickly after birth, you have living on the surface of your body trillions of bacteria, to which you make an immune response,” Offit explained. “The food you eat isn’t sterile. The dust you inhale isn’t sterile. The water you drink isn’t sterile. You’re constantly being exposed to bacteria to which you make an immune response.”

Vaccine and autism Doctors also still have to deal with an erroneous 1998 study that linked vaccinations and autism, said physician Talia Swartz, an assistant professor of infectious diseases with the Icahn School of Medicine at Mount Sinai, in New York City.

The study was later found to be fraudulent and withdrawn, but “significant press has continued to raise concern about this, even though these concerns have been refuted based on large-scale population studies,” Swartz said.

It’s important to emphasize that these vaccines are heavily tested for safety, said Lori Freeman, CEO of the National Association of County and City Health Officials.

As to whether vaccines are needed, outbreaks provide a powerful argument in favor of that premise, experts said.

However, some parents still greet outbreaks with a shrug.

Nolt said that “some people think vaccines aren’t needed because the disease is more ‘natural’ than the vaccine.”

And arguments based on altruism — vaccinating your child to protect the rest of the community, especially kids who can’t be vaccinated — only go so far, she added.

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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Page 7

Hospital-Acquired Conditions Declined

By Nearly 1 Million

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ew data released in January by the Agency for Healthcare Research and Quality (AHRQ) and Centers for Medicare & Medicaid Services (CMS) show reductions in hospital-acquired conditions such as adverse drug events and healthcare-associated infections helped prevent 20,500 hospital deaths and save $7.7 billion in health care costs from 2014 to 2017.

AHRQ’s preliminary analysis estimates that hospital-acquired conditions were reduced by 910,000 from 2014 to 2017. The estimated rate of hospital-acquired conditions dropped 13 percent; from 99 per 1,000 acute care discharges to 86 per 1,000 during the same timeframe.

AHRQ’s new report quantifies trends for several hospital-acquired conditions, including adverse drug events, catheter-associated urinary

tract infections, central-line associated bloodstream infections, Clostridioides difficile infections, pressure injuries (pressure ulcers), and surgical site infections.

The report showed that harms decreased in several categories, such as adverse drug events, which dropped 28 percent from 2014 to 2017. However, opportunities for improvement exist in other harm categories, such as pressure ulcers.

“CMS is delivering on improving quality and safety at America’s hospitals,” said CMS Administrator Seema Verma. “Our work isn’t done and we will continue our efforts to hold providers accountable for delivering results.”

AHRQ Director Gopal Khanna, MBA, added, “The updated estimates are a testament to the successes we’ve seen in continuing to reduce

hospital-acquired conditions. There’s no question that challenges still remain in addressing the problem of hospital-acquired conditions, such as pressure ulcers. But the gains highlighted today were made thanks to the persistent work of many stakeholders’ ongoing efforts to improve care for all patients.”

The continued decline in hospital-acquired conditions is a signal that patient safety initiatives led by CMS are helping to make the nation’s health care safer, federal officials said. AHRQ, CMS, the Centers for Disease Control and Prevention, and

other federal and private partners throughout the field support ongoing improvements in health care and are establishing a growing foundation of knowledge about how to keep patients safe.

CMS has set a goal of reducing hospital-acquired conditions by 20 percent between 2014 and 2019. If achieved, AHRQ projects the 20 percent reduction would result in 1.8 million fewer hospital-acquired conditions over this period, potentially resulting in 53,000 fewer deaths and saving $19.1 billion in hospital costs.

Healthcare in a Minute

By George W. Chapman

State of the Union — Five Major Healthcare Initiatives

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resident Trump delivered his SOTU address on Feb. 5. Here are some of his plans. 1) Obliterate the “HIV epidemic” within 10 years by focusing on geographic hotspots; funding an HIV health force; improving access to testing and proper medication. 2) Cure childhood cancer by providing $500 million of research over the next 10 years. 3) Produce a plan for a national paid family leave act, which has been the pet project of Ivanka Trump.

4) Pass legislation to prohibit late

term abortions. 5) Continue to focus on lowering drug prices and mandating pricing transparency among drug manufacturers, hospitals and physicians. Surprisingly, there was little mention of how he would lower overall healthcare costs, making premiums more affordable. Trump also promised to protect pre-existing conditions. Ironically, he has systematically dismantled the Affordable Care Act, which protected pre-existing conditions.

Opioid epidemic

Anthem insurance. Anthem includes rides as a benefit to Advantage members. Ninety percent of Anthem’s non-emergent patient transportation is booked with Lyft. As a result, Anthem’s ride costs have decreased 39 percent and wait times for a ride have decreased 40 percent. This clever benefit could benefit physicians by reducing patient no-show rates.

Thirty-five states are suing opioid manufactures. Recently, the state of Massachusetts attorney general filed a lawsuit against Purdue Pharmaceutical and its owner family, the Sacklers, for knowing their pain killer OxyContin was highly addictive and for deceiving physicians and consumers alike. Several incriminating internal emails and documents from Purdue have been subpoenaed.

Roughly 130 people per day, or about 47,000 people per year, die from opioid addiction. The worse states for opioid-related deaths per 1,000 are: West Virginia 50; Ohio 39; District of Columbia 35; New Hampshire 34; Maryland and Oregon 32. New York ranks 24th with 16/1,000. The state with the least opioid deaths per 1,000 is Nebraska at 3.

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Fewer People Have EmployerSponsored Insurance

Twenty years ago, 67 percent of us received health insurance through our employer —Today, the percentage has dropped to 58 percent, according to research conducted by the Kaiser Family Foundation. Some experts surmise the gradual decline over 20 years could be due to retiring baby boomers and employees of small businesses purchasing their insurance on the exchange. Recently, the Trump administration struck down the individual mandate to have insurance which may fuel the downward trend going forward.

About 156 million people, or slightly less than half of the US population, were covered by employers in 2017.

The other half of us were covered by Medicare, Medicaid, the VA, federal employment, co-ops, the Bureau of Indian Affairs and the exchanges.

Smaller Hospitals Seek Affiliations

In order to enhance their reputations, remain independent and provide their communities access to the best care, let alone survive, smaller community hospitals are affiliating (versus merger or acquisition) with larger, more prestigious hospitals. In return, the larger hospital increases its market for the specialized services that most smaller hospitals can’t provide. Most of these affiliations have eventually resulted in a complete merger or acquisition of the smaller by the larger. Because today’s consumers are far more savvy and demanding, smaller hospitals need to shed their local or “community” reputation and rebrand as part of a larger more comprehensive health system.

Drug Costs

Uncontrolled, skyrocketing and mysterious drug costs are a bipartisan issue. Trump mentioned this in his State of the Union. But few of the invited drug CEOs bothered to show up, voluntarily, at a Senate Finance Committee meeting to discuss drug costs. The CEOs who failed to show told committee chairman Chuck Grassley they would prefer to meet in private versus in public. (Talk about transparency.) The committee is threatening to force the CEOs to testify if they continue to balk. There have been several suggestions on controlling drug costs. But most are convoluted and difficult to monitor and enforce. The best solution for controlling drug costs would be to

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • March 2019

allow CMS (Medicare/Medicaid) to use its massive purchasing power to negotiate drug costs. This solution is not favored by the powerful drug lobby. Bowing to pressure from the lobby, Congress is still dancing around the real solution.

Artificial Intelligence in Healthcare

The healthcare industry is slowly incorporating artificial intelligence — AI — when it comes to assisting physicians in determining a diagnosis or treatment plan. AI is already being used in radiology, pathology and dermatology. It assists physicians with faster and highly accurate diagnoses. Combining AI with physician experience and judgment results in higher diagnostic confidence. Telehealth continues to be perfected and more widely accepted. Robots and 3-D printers are being used in operating rooms. AI in psychotherapy is becoming more prevalent due to the limited availability of psychiatrists, the cost of treatment and the greater willingness of patients to be honest about themselves, especially when it comes to socially deviant behavior, with a computer versus a human.

The integration of AI in healthcare will lessen, if not negate, the impact of the projected physician shortage.

George W. Chapman is a healthcare business consultant who works exclusively with physicians, hospitals and healthcare organizations. He operates GW Chapman Consulting based in Syracuse. Email him at gwc@gwchapmanconsulting.com.

Insulin Price More Than Doubles in U.S.

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ome Americans with Type 1 diabetes have cut back on their insulin usage as the cost of the lifesaving drug nearly doubled over a five-year period.

The annual amount that people with Type 1 diabetes spent on the drug rose from about $2,900 in 2012 to about $5,700 in 2016, according to a new analysis from the nonprofit Health Care Cost Institute (HCCI), CBS News reported.

Those are gross amounts and don’t factor in the use of rebates or coupons, which can reduce costs for some people.

The cost of living rose 6.5 percent between 2012 and 2016.

A study published last year found that more than one-quarter of people with diabetes said they reduced their use of insulin due to the rising cost. Doctors warn against cutting back on insulin usage, CBS News reported.

“There has been a flurry of news reports sharing stories of individuals with diabetes rationing their insulin because they cannot afford higher and higher prices,” according to HCCI.

MS Drug Costs Skyrocket After Medicare Rule

M

edicare rule changes could trigger a spike in out-ofpocket drug costs for patients with multiple sclerosis (MS).

Due to rules that restrict access and require patients to cover more of the cost, those without low-income subsidies can expect to spend almost $6,900 a year out of pocket for MS medicines, researchers reported.

“It’s a dysfunctional market that lacks the typical incentives for most other consumer products,” said lead author Daniel Hartung. “Aside from the public optics, there are few incentives for companies not to raise prices. Most intermediaries in the drug distribution channel, including drug companies, benefit from higher prices.”

MS is an unpredictable disease of the central nervous system, resulting in symptoms that include vision problems, muscle weakness, tremors and difficulty with balance and coordination.

Out-of-pocket drug costs are often tied to undiscounted list prices, and there appears to be a link between rising prices for MS drugs and more use of restrictive policies

by Medicare drug plans, according to the researchers.

For example, they found that patients who are prescribed the only generic drug in one class — glatiramer acetate — will pay more out of pocket than patients using any brand-name drugs in the same class.

Medicare rule changes last year were meant to reduce patients’ outof-pocket costs through increased discounts from brand-name drug manufacturers. But the change resulted in higher out-of-pocket costs for users of certain generic products.

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Don’t Miss the April Issue of In Good Health Special issue highlighting Women’s Health, Autism, Gardening, Health Careers, Mental Health and much more. To advertise and reach nearly 1000,000 readers, please call 585-421-8109 or send an email to editor@GVhealthnews.com March 2019 •

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

•

Page 9

Live Alone & Thrive

YOUR SCORECARD

By Gwenn Voelckers

Practical tips, advice and hope for those who live alone

Quiz Time: How Content Are You? M erriam-Webster defines contentment as “the state of being happy and satisfied.”

This dictionary definition sounds like a nice way to feel, doesn’t it? Oh, if we could just snap our fingers and be happy with who we are and what we have.

Wouldn’t life be grand?

I’ve had the privilege of meeting and talking with a lot of women and men who live alone, and our conversations often turn to the subject of contentment: how to find it, how to keep it and how to find it again once it has been lost.

Those on their own often feel a lack of something in their lives, and many have trouble letting go of a craving for things to be different.

I know. I’ve been there.

For years after my divorce, I had trouble seeing the good in myself and in my life. But with time, intention and practice, I was able to stop yearning for what I didn’t have and start appreciating what existed right in front of me.

It all began with an important first step — taking a hard look at myself.

While I’m no expert in survey design, I created the simple quiz be-

Calculate your total points using this scale:

low to help you assess where you are on the road to contentment.

Your results may light a new and hopeful way forward.

How Content Are You?

Circle the choice that best answers the questions below:

If asked, how many positive personal qualities come immediately to mind?

A. 5 or more B. 1 to 4 C. Nothing really comes to mind

1.

How would you describe your home?

2.own!

A. Very “me” — I’ve made it my

B. It’s fine. I keep meaning to redecorate, but just haven’t gotten around to it C. It’s a place to sleep

How would you describe your suc3. cess in letting go of old ways of thinking and of negative thoughts or behaviors

that keep you anchored in the past?

A. I live in the present; it’s full steam ahead!

B. I still go “back there” from time to time C. I can’t let go, I obsess about the past

Could you imagine planning a trip 4. by yourself and traveling alone to a favorite destination?

A. In a heartbeat!

B. Maybe someday C. I can’t imagine that

Does the thought of going alone to a 5. cafe for a cup of coffee, or grabbing a bite to eat in a local restaurant, feel perfectly comfortable — even enjoyable?

A. I do it all the time B. Occasionally, but I’m not at ease C. I’m just not ready you exercise, get enough sleep, 6.A. Doand stay on top of health screenings?

Of course B. I know I should, but I don’t always take care of myself C. I’m too preoccupied to think about my health

How often do you pamper or reward 7. yourself by taking some time just for you or by purchasing that little something

special you’ve had your eye on?

A. As often as I can!

B. More often than not, I put others’ needs first C. I can’t remember the last time I pampered myself

you imagine your life without a 8.A. Can special someone on your arm?

I would enjoy sharing my life with someone special, but could also find contentment with my “family of friends” B. Maybe, but not for long; I feel incomplete without a “one and only” C. Life doesn’t feel worth living when I’m not in love

3 points for each A answer 2 points for each B answer 1 point for each C answer 8 points: Contentment may feel elusive at the moment — beyond your grasp. But it can be found.

You may benefit from talking with a professional or your pastor. Help and encouragement might also be found in grief support groups and other gatherings that offer emotional support.

9-15 points: You experience feelings of contentment, but you know there’s more to be found. Continue to stretch yourself. Reach out to others. And “try on” healthy pursuits outside your comfort zone. Success and achievement breed contentment.

You might also find inspiration and a needed jump-start in workshops, classes, and lectures devoted to personal growth and development.

16 points: Good for you — what you have is precious. Being content with yourself opens up all kinds of possibilities. It enables you to feel peace and joy, whether you are alone or with others. It is an invaluable inner springboard on which you can launch all things imaginable!

Gwenn Voelckers is the founder and facilitator of Live Alone and Thrive, empowerment workshops for women held throughout the year in Mendon.

She is also the author of “Alone and Content: Inspiring, empowering essays to help divorced and widowed women feel whole and complete on their own.” To purchase her book, learn about workshops, or invite her to speak call 585-624-7887, email gvoelckers@rochester.rr.com, or visit www.aloneandcontent.com.

s d i K Corner

Almost All U.S. Teens Falling Short on Sleep, Exercise

T

oo little sleep. Not enough exercise. Far too much “screen time.” That is the unhealthy lifestyle of nearly all U.S. high school students, new research finds.

The study, of almost 60,000 teenagers nationwide, found that only 5 percent were meeting experts’ recommendations on three critical health habits: sleep; exercise; and time spent gazing at digital media and television.

It’s no secret that many teenagers are attached to their cellphones, or stay up late, or spend a lot of time being sedentary. But even researchers were struck by how extensive those issues are among high school students.

“Five percent is a really low proportion,” said study leader Gregory Page 10

•

Knell, a research fellow at University of Texas School of Public Health, in Dallas. “We were a bit surprised by that.”

In general, medical experts say teenagers should get eight to 10 hours of sleep at night, and at least one hour of moderate to vigorous exercise every day. They should also limit their screen time — TV and digital media — to less than two hours per day.

The new findings show how few kids manage to meet all three recommendations, Knell said.

It’s easy to see how sleep, exercise and screen time are intertwined, he pointed out.

“Here’s one example: If kids are viewing a screen at night — staring at that blue light — that may affect

their ability to sleep,” Knell said.

“And if you’re not getting enough sleep at night, you’re going to be more tired during the day,” he added, “and you’re not going to be as physically active.”

The report was published online Feb.4 in the journal JAMA Pediatrics.

Ariella Silver is an assistant professor of pediatrics and adolescent medicine at Icahn School of Medicine at Mount Sinai in New York City. She offered some advice for parents: • Instead of telling kids to “get off the phone,” steer them toward alternatives, like extracurricular activities, community programs or family time. “Their screen time will go down by default,” she noted.

• Be a good role model. Get off

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • March 2019

your phone and demonstrate healthy habits, including spending time being physically active with your kids.

• Talk to teenagers about the importance of healthy habits. “Ask them, ‘How do you feel when you don’t get enough sleep?’” Silver suggested. “Ask, ‘How do you feel when you don’t get outside in the sun and get some exercise?’” It’s important, she said, that kids notice how their bodies feel when they do or don’t engage in healthy habits.

• Set some clear rules around screen time, such as no devices in the two hours before bedtime. “Make sure your kids realize these devices are a privilege, and not a necessity to living,” Silver said.

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5

of the Hottest Health Apps

By Angela Underwood

I

n a day and age when “there’s an app for that,” there is no excuse not to be fit and healthy. That is why it is important to point out the five of the hottest health apps to start using. So if you used the excuse that there were too many apps, we’ll try to narrow it down for you.

MyFitnessPal

It’s as simple as it sounds. It’s a fitness friend in the form of an app. Ranked as the No. 1 health and fitness app on iTunes, reports Men’s Health of the Under Armour-sponsored service. “This app pushes users to keep tabs on their diet programs through an easy-to-use database that offers nutrition information for over 5 million different foods,” according to Men’s Health magazine.

Available on Android and Apple, MyFitnessPal is like having your best friend nudge you to go to the gym or put down that candy bar when bikini season is right around the corner.

“There are about 5 million foods in their database to choose from so you’re not just typing in ‘chicken’ — which means you can determine how many calories you’re actually taking in and burning off,” reports Marie Claire. The app costs $9.99 monthly or $49.99 for the year.

Fooducate

Calories, fat grams, carbohydrates and protein are key items to track when maintaining a healthy lifestyle but standing in the grocery store aisle adding and subtracting said numbers on the side of packages just doesn’t cut it anymore. That is where Fooducate comes in. Simply type in the product of your picking and moments later you will know what the best brand is to buy. “As the app’s name suggests, its goal is to teach you about the products you buy at the grocery store,” reports Men’s Health. And the advice is free, unless you want the ad-free version or allergy-related health ad-

vice. In that case, it will respectively cost $3.99 or 4.99 monthly.

Couch to 5K

Don’t let the app’s title intimidate you. No one says you have to run a 5K, but this app will set you up for success if you so choose. “It only requires sweating for 30 minutes per day, three days a week for nine weeks,” according to Marie Claire. Breaking down each day with a personal avatar trainer, users can track their time and distance during their warm up, jog and walk or cool down. The app is free at first, but after a couple of runs, it costs $4.99 to continue the service.

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Charity Miles

The app works like it reads.

Sponsors like Johnson & Johnson, Chobani, and Humanity donate a few cents for every mile you move biking, running or even walking to charities, according to Marie Claire.

Needless to say, when you are not in the mood to work out, this app helps the hungry, homeless, veterans or other nonprofits. So, if you don’t want to work out for yourself, do it for someone else at no cost a month.

Now that’s charity.

Headspace

Can’t sleep, stressed out or just out of the groove? Then Headspace will put you right back where you need to be. The initial free 10-day program promotes mindfulness, proven to ramp up work productivity. And be warned, it really works.

“Look out for improved mental acuity, patience, productivity and sleep with daily use,” according to New Jersey-based physician Chirag Shah as quoted in Men’s Health.

After the free 10-day trial, Headspace costs anywhere from $7.99 to $19.99 monthly depending on the level of meditation you choose to access.

March 2019 •

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

•

Page 11

SmartBites

The skinny on healthy eating

Whole-grain Millet: Good for Hearts (and More!)

F

luffy like couscous or creamy like polenta, millet has many things going for it: it’s gluten-free (appealing for those trying to avoid gluten), a good source of protein, and loaded with health benefits.

So why aren’t we consuming more millet on a regular basis? Especially when it’s so versatile, inexpensive, and easy to prepare?

One word: birdseed.

Most people equate this delicious whole grain with birdseed, even though the millet for human consumption differs from what our feathered friends eat.

Like other whole grains that retain all parts of the seed (bran, germ and endosperm), millet helps protect the heart and it does so in more ways than one. Millet’s fiber helps prevent heart disease by lowering both blood pressure and bad cholesterol. Hearts also benefit from millet’s rich supply of magnesium, an essential mineral for maintaining a steady heartbeat and normal blood pressure. And because millet is relatively low in calories (only 200 per cooked cup), this satisfying grain helps hearts by assisting us with weight loss and

maintenance. Extra pounds, as many know, put significant strain on your heart and worsen several heart-disease risk factors.

Millet may reduce your risk of developing Type 2 diabetes, thanks to its healthy concentration of two minerals that regulate blood sugar: magnesium and manganese.

According to the Centers for Disease Control, nearly 10 percent of the U.S. population has diabetes, and the majority have Type 2. Studies have shown that low blood levels of both minerals can increase insulin resistance, which leads to diabetes.

Of course, millet’s overall nutritional profile — high in filling fiber; low in fat, sugar and salt — is just as important in keeping diabetes at bay.

One cup of cooked millet serves up six grams of protein, an important building block of bones, muscles, cartilage, skin and blood. You also use protein to make enzymes, hormones and other body chemicals. Millet, however, is not a complete protein because it lacks the amino acid lysine. The addition of lysine-rich beans to any millet dish easily creates a complete protein.

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Lemony Millet Salad with Fresh Asparagus, Mini Peppers and Black Beans 3/4 cup millet 1 1/2 cups water 1/2 bunch asparagus 8 mini peppers 1 can black beans, rinsed and drained 3 tablespoons olive oil juice and zest from 1 lemon 1 large garlic clove, minced salt and pepper to taste 1 cup flat-leaf parsley, rinsed, dried and roughly chopped 1/2 cup slivered almonds, toasted Combine millet with water in a medium saucepan. Bring to a boil, reduce to a simmer, cover, and cook until water is absorbed (about 20 minutes). Remove from heat and let it sit, covered, for 10 minutes, before fluffing it with a fork.

While millet is cooking, cut the asparagus, including the tips, into

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • March 2019

thin slices, crosswise, and place in a medium bowl. To prep the mini peppers, cut off the end, cut out the seeds, and then slice the peppers into rings, about 1/8-inch thick. Add black beans, millet and chopped parsley to vegetables; lightly toss.

Make the dressing by whisking together olive oil, lemon juice and zest, minced garlic, and salt and pepper. Drizzle over millet mixture, mix well, adjust seasonings, and top with toasted almonds.

Anne Palumbo is a lifestyle colum-

nist, food guru, and seasoned cook, who has perfected the art of preparing nutritious, calorie-conscious dishes. She is hungry for your questions and comments about SmartBites, so be in touch with Anne at avpalumbo@aol.com.

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By Deborah Jeanne Sergeant

T

he Centers for Disease Control and Prevention recently stated that 25 percent of antibiotic prescriptions aren’t necessary. But it’s more than simply wasting medication for a case where it cannot help.

Over-prescribing antibiotics contributes to a major health issue: antibiotic resistance.

“Bacteria are everywhere, good and bad,” said Emil Lesho, an infectious disease physician at Rochester General Hospital. “When exposed to antibiotics, they want to survive.

They tend to mutate and survive. It triggers them to be resistant.”

This can cause both individual resistance, when a particular person discovers antibiotics don’t work as well as they used to, and universal resistance, when bacteria mutate to the point where no antibiotics can treat them, regardless of a person’s history of taking antibiotics.

Dubbed “super bugs,” these more aggressive bacteria “have become a public health crisis,” Lesho said, and can even cause fatal complications “We are running out of antibiotics,” he said. “If nothing is done to slow down the spread of resistance, and no new antibiotics are developed, we can come to the point where we have infections we can’t treat. People could die of minor infections. That’s the opinion of the World Health Organization, Infectious Diseases Society of America, and the Centers for Disease Control.”

Because antibiotics kill both good bacteria and bad, patients are more susceptible to yeast infections, diarrhea and stomach upset. The natural flora of the gut and, in women, vagina, are negatively affected. Some say it takes weeks to restore that balance.

So why are doctors prescribing antibiotics to patients who don’t need them? Undue patient pressure on physicians represents one reason, according to Lesho. He said that electronic medical records tend to focus

on patient satisfaction, as does media feedback.

“Doctors know that they’ll be evaluated based on patient experience and if they don’t provide a good patient experience, that could be another driver of over-prescribing,” Lesho said.

Sometimes, it’s for dental procedures, where some providers routinely recommend antibiotics. Lesho said that as many as 80 percent of antibiotic prescriptions are unnecessary in this setting.

Pediatricians often face upset parents who want something they think will help their sick, crying children.

Edward Lewis, pediatrician at Lewis Pediatrics in Rochester, has also observed a rise in antibiotic resistance.

He said that for the past decade, his office has been practicing “antibiotic stewardship” to reduce antibiotic use only to cases where it’s necessary, and then for a shorter duration if possible.

“We realized we have to use antibiotics more carefully,” he said. “If you as a pediatrician spent time with parents to explain why they don’t need it — and it does take a little more time — it works.”

Parents are beginning to understand why it’s not routine for children. Lewis said it helps to give out a handout on what to expect with their child’s viral illness and planning to follow-up call or, as needed, visit.

Antibiotics cannot help viral infections. Anti-viral drugs can help for rare, serious viral illnesses for people prone to complications, but are not prescribed for routine cases.

For those, Mary L. Beer, RN and public health director for Ontario Co Public Health, recommends treating symptoms.

“If you have a fever, take Tylenol,” she said. “Get plenty of fluids and rest. Over-the-counter medication can help with decongestion.”

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Serving Monroe and Ontario Counties in good A monthly newspaper published

Health Rochester–GV Healthcare Newspaper

by Local News, Inc. Distribution: 33,500 copies throughout more than 1,500 high-traffic locations.

In Good Health is published 12 times a year by Local News, Inc. © 2019 by Local News, Inc. All rights reserved.

154 Cobblestone Court Dr., Suite 121 – P.O. Box 525, Victor NY 14564.

• Phone: 585-421-8109 • Email: Editor@GVhealthnews.com

Editor & Publisher: Wagner Dotto • Associate Editor: Lou Sorendo Writers: Jim Miller, Deborah J. Sergeant, Gwenn Voelckers, Anne Palumbo, Chris Motola, George W. Chapman, Payne Horning, Sharon Osborne, Brian Potvin, Travis Heider, Angela Underwood • Advertising: Anne Westcott, Linda Covington • Layout & Design: Dylon Clew-Thomas • Office Assistant: Kimberley Tyler No material may be reproduced in whole or in part from this publication without the express written permission of the publisher. The information in this publication is intended to complement—not to take the place of—the recommendations of your health provider. Consult your physician before making major changes in your lifestyle or health care regimen.

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

•

Page 13

Things to Ask When Checking Out Chiropractors certain times, you’ll likely have better results.

• “Go online and read reviews.

People tend to post pretty honest things about their experience.”

By Deborah Jeanne Sergeant

If you’re shopping for a chiropractor, here’s what to ask Bill Ferris, chiropractor and owner of Modern Chiropractic & Pain Relief, Victor • ”Does the office offer a free consultation?

• ”Ask if they have digital x-ray available onsite, because they’re dealing with the spine.

• ”Ask how long the doctor has been in practice, as experience is important. Ask if the doctor participates regularly in continuing education.

• ”Does the office or doctor use any advanced technology like Class IV laser? Cold laser is the antiquated laser.

• ”Some of them use only one tool. If all you have a hammer, every thing looks like a nail. That happens a lot in our profession.

Does the doctor use one technique or a more comprehensive, holistic list of tools? Is the doctor certified in any soft tissue modaliFerris ties, which complement the skeletal modalities.

Typically, muscular/skeletal mean you treat all of that.

• ”Do they offer a reduced fee membership model? That’s the wave of the future.

• “Have they treated your specific condition before, if you know what it is?”

-------v-------

Joshua Rittenberg, chiropractor, East Avenue Chiropractic, Rochester • “People should find someone who has an affiliation with a larger

-------v-------

Adam Cassel, chiropractor with Rochester Chiropractic Associates, PC, Rochester

corporation like American Chiropractic Association.

• “Look for someone who’s not ordering imaging right away, unless there are certain red flags that indicate you need imaging.

• “You want to find someone who’s goal-oriented for you, someone who will help encourage an active treatment plan, who will help restore you to a normal function not just treat pain.

• “You don’t want someone who encourages the use of lumbar support or braces for long-term prevention of back pain, but will teach you how to learn and exercise so you don’t need a chiropractor.

• “Look for interdisciplinary care. As a chiropractor, I should be part of someone’s healthcare team.

The skills and knowledge I possess and continue to learn should be complementary to what they receive from their physician. If you can’t tell

the difference between the care you receive from a chiropractor and a physical therapist, you’re in the right place, though our study is broader.

• “They should be open to referring people out. If I possess the skills and tools that will help patients the most, I’ll keep them in house, but if I know they can receive better care elsewhere, then I’d send them elsewhere.

• “There’s a formula to Rittenberg care for everyone. Some have intermittent bouts of back problems, but if we can develop a formula such as a frequency of spinal adjusting and exercise, and mindfulness to know what it needs at

• “You want someone who will sit down and explain treatments.

They will use insurance instead of saying it’s a cash-only plan.

• “Read the chiropractor’s biography online to see if that will be a good fit. They might say what they’re into and that can help.

It’s a good way to take a look.

Cassel You can see the certifications that can include if they do taping, soft tissues, ultrasound and other modalities. You can gauge a lot about a chiropractor through their website.

• “A lot of times, they have tours.

You can see how their office looks.

You want to be comfortable with the provider, like with any provider.

• “A lot of people, when they call here and ask to speak with the doctor, that’s not a bad thing. The doctor may not be able to speak with you that minute, but you know it will be a good fit if they’ll call you back before you come into the office. It should be all about the patient.”

• “If it’s a worker’s compensation injury, you’ll have to see if they accept those. Some don’t.

• “If it’s a cash or general insurance basis, the best way is by wordof-mouth. Talk with family members and friends. See who keeps them moving.

Your Personality Could Put You at Greater Risk for Diabetes

I

t has been said that a good personality can help one succeed in life. But can it also guard against disease risk?

A new study based on data from the Women’s Health Initiative (WHI) shows that positive personality traits, such as optimism, actually may help to reduce the risk of developing Type 2 diabetes. Results were published online in January in Menopause, the journal of The North American Menopause Society (NAMS).

More than 30 million Americans, or 9.4 percent of the US population, have diabetes. The prevalence of diabetes increases with age, with a 25.2 percent prevalence in those aged 65 years or older. Type 2 diabetes is the most common type, accounting for 90 to 95 percent of all diagnosed cases in adults. Obesity, a family history of diabetes, race/ethnicity, and physical Page 14

•

inactivity are major risk factors for diabetes. But these are not the only determinants.

Accumulating evidence supports the fact that depression and cynicism also are associated with an increased risk of diabetes. In addition, high levels of hostility have been associated with high fasting glucose levels, insulin resistance, and prevalent diabetes.

Few studies, however, have investigated the association of potentially protective personality characteristics with diabetes risk.

The objective of this study was to examine whether personality traits, including optimism, negativity, and hostility, were associated with the risk of developing Type 2 diabetes in postmenopausal women. The study went on to explore whether the association could be mediated by behavioral pathways, such as diet, physical

activity, smoking, or high alcohol consumption.

The study followed 139,924 postmenopausal women from the WHI who were without diabetes at baseline. During 14 years of follow-up, 19,240 cases of Type 2 diabetes were identified. Compared with women in the lowest quartile of optimism (least optimistic), women in the highest quartile (most optimistic) had a 12 percent lower risk of incident diabetes. Compared with women in the lowest quartile for negative emotional expressiveness or hostility, women in the highest quartile had a 9 percent and 17 percent higher risk of diabetes, respectively. The association of hostility with the risk of diabetes was stronger in women who were not obese compared with women who were.

As a result of these outcomes, the

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • March 2019

study concluded that low optimism, high negativity, and hostility were associated with increased risk of incident diabetes in postmenopausal women, independent of major health behaviors and depressive symptoms.

Study results appear in the article, “Personality traits and diabetes incidence among postmenopausal women.”

“Personality traits remain stable across one’s lifetime; therefore, women at higher risk for diabetes who have low optimism, high negativity, and hostility could have prevention strategies tailored to their personality types,” says JoAnn Pinkerton, NAMS executive director. “In addition to using personality traits to help us identify women at higher risk for developing diabetes, more individualized education and treatment strategies also should be used.”

5

Things You Should Know to Prevent Colon Cancer

By Ernst Lamothe Jr.

T

he numbers are scary. For those who are diagnosed with late stage colon cancer, the five-year survival rate is 12 percent, according to the American Cancer Society. Colorectal cancer starts in the colon or the rectum and begins as growths in the inner lining. The growth — called polyps — can change into cancer over time, but not all polyps become cancer.

This year, more than 145,000 new colon and rectal cancer cases are expected and more than 51,020 will die from the disease. That figure takes on even more weight considering what medical experts have been telling patients for decades.

“Colon cancer is one of the most preventable cancers when dedicated early on because the polyps are precancerous,” said physician Mohamed Alsalahi, director of gastroenterology and endoscopy for Newark-Wayne County Hospital, which is under the umbrella of Rochester Regional Hospital. “We shouldn’t be having the number of people dying from this disease that we do.”

Alsalahi offers five important elements people need to know about colon cancer.

1.Screening

Screening tests can detect colon and rectal cancer at its earliest, most treatable stage. It is important to consult your doctor if you experience issues related to a change

in bowel habits, such as diarrhea or constipation, a feeling that your bowel is not emptying completely, or a narrowing of the stool. Other feelings include an enlarged abdomen, weight loss for no know reason, nausea or feeling of bloating. But the five-year survival rate for colon cancer found at the early age is 90 percent, according to the Colon Cancer Alliance. Once a person reaches 50 years of age, most routine, preventable screening colonoscopies are covered with no co-pay under the Patient Protection and Affordable Care.

“If you are 50, you should schedule a colonoscopy immediately,” said Alsalahi. “I know people either let the fear or possible discomfort keep them from going to their physician.

But the discomfort of scheduling an appointment [and having a colonoscopy done] is far less painful than having colon cancer.”

2.Pay attention to symptoms

Colorectal cancer is a disease in which abnormal cells in the colon or rectum divide uncontrollably, ultimately forming malignant tumors.

Symptoms of colon cancer include rectal bleeding, stomach pain, weakness, weight loss and low red blood cells.

“Early detection does save lives,” said Alsalahi. “If you are 50 and you haven’t had your colonoscopy, you have a much higher rate of getting

Addiction: How Substance Abuse Affects Older Adults

By Deborah Jeanne Sergeant

A

ngst-ridden teens and anxiety-ridden young adults seem easy examples of typical substance abusers; however, a growing number of older adults turn to alcohol and prescription and illicit drugs.

They’re seldom identified as having a substance abuse problem.

According to the National Institutes of Health (NIH), the rate of people over 50 who abuse substances is expected to top 5.7 million by 2020.

The baby boomer generation grew up in the era of widespread drug experimentation. To those who used drugs recreationally in the ‘60s and ‘70s, the current growing expansion of acceptance of medical and recreational marijuana tacitly condones using substances to self-treat physical and mental health issues.

The NIH also states that alcohol predominates as this age group’s substance of choice, although abuse of illicit and prescription drug has risen in recent years, too.

Ironically, many older people visit a physician for chronic health

issues than healthier younger people, yet a substance abuse issue often goes unnoticed. Even family and friends may not notice — or choose not to say anything if they suspect.

“Often, older adults are on many medications that can mask or mimic substance use and can easily be rationalized,” said Jennie Militello, chemical dependency manager with Rochester Regional Health. “Older adults are often isolated and can easily hide their use.”

Militello added that respect for elders and the generational mindset of minding one’s business may keep substance abuse problems taboo to discuss for either the elder or their children and the peers around them.

Mary L. Beer, public health director with Ontario County Public Health in Canandaigua, has a few ideas as to why so many in this age group have turned to substance abuse.

“The older adult population, in general, experiences a lot of loss,” Beer said. “As time goes on, your enMarch 2019 •

colon cancer. But when we catch it early, the survival rate skyrockets.”

3.Both genders can be affected

Excluding skin cancers, colorectal cancer is the third most common cancer diagnosed in both men and women in the United States.

Both men and women can be diagnosed with colon or rectal cancer.

Even more important, colon cancer is the second leading cause of cancer death in the U.S. behind lung cancer.

“I think there are some patients that confuse pancreatic cancer with colon cancer. Men and women both have colons and can have colon cancer,” he added.

4.Family History is Essential-

There is no way to know for certain if you will develop colon or rectal cancer, but there are a variety of factors that may increase your risk for these cancers. You are at a higher risk if you are over the age of 50. In addition, the risk of cancer of the colon and rectum increases with age and having a diagnosed family history with a close relative including parents, brothers, sisters, or children.

“When we find out that people have a family history, there are completely different rules. If we find out that their family members had colon cancer as early as 40 years old, then we recommend the other family members get checked as early as 30,” said Alsalahi.

ergy, social networks, spouse, family and friends: you lose a lot of these.

That is a part of aging. Sometimes people self-medicate.”

For others, chronic pain from an illness or injury initiated a prescription for pain medication. Once the refills end, alcohol, others’ prescriptions or illicit drugs may stand in for pain control or to ease loneliness, depression or anxiety. Since many families spread out and neighbors aren’t always as close as they used to be decades ago, many older adults continue to abuse substances unnoticed.

Drugs and alcohol may affect older adults differently than when they were younger. For instance, muscle mass declines decade by decade as the body ages. Frail older adults have less muscle mass and cannot process alcohol and drugs as efficiently as they used to. Beer said that substance abuse can contribute to a greater risk for falling and breaking bones, which can trigger loss of independence and many negative health outcomes.

Ann Olin, program manager at Lifespan of Greater Rochester, Inc. geriatric addictions program, said that older people who abuse substances are usually either early onset users, who have been using a substance throughout their lives as a coping mechanism, or late onset users, who perhaps were social drinkers and later in life turned to a

Physician Mohamed Alsalahi, director of gastroenterology and endoscopy for Newark-Wayne County Hospital.

5.Pay attention to risk factors

Smoking contributes to the development of many types of illnesses, including colon cancer.

Smokers not only have a higher risk of developing colon cancer, they also have a higher risk of dying from the disease. Both staying in shape and watching potential risk factors is essential to stay ahead of the trend.

“What people don’t know is that you can be incredibly healthy, exercise and have no family history and there is still a 20 to 25 percent chance that we will find polyps,” said Alsalahi. “So just imagine the odds if you are someone who doesn’t work out, smokes and does other unhealthy actions.”

substance to cope with a tragic event.

Unfortunately, few substance abuse programs exist to help older adults who abuse substances. Olin said that many older adults feel uncomfortable in a typical group setting with mostly younger people.

“Oftentimes, we hear, ‘I don’t want to go to treatment because the person next to me saying they don’t get along with their spouse and I’m grieving for my spouse,’” Olin said.

One-on-one help may be too costly for seniors on fixed income.

For some of these, accessing care is complicated by the expense of copays and transportation three times a week.

Lifespan offers a geriatric addiction program to provide in-home help. The organization operates on a harm reduction model.

“Some say they won’t stop using,” Olin said. “We ask them if they’re willing to cut down on their use so they can be safe and healthy in the environment of their choice. A great deal of the time, they will come to the conclusion they maybe should stop all together.”

Olin wants more providers to offer programs specific to older adults.

“Some of the treatment programs have gone to a walk-in service which isn’t necessarily a good option for an older adult,” Olin said. “That’s not so easy for someone who has to arrange rides three to five days in advance.”

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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Page 15

What’s Behind the Drop in Cancer Rates?

Despite dramatic drop in mortality, cancer rates are on the rise for certain groups of people

By Deborah Jeanne Sergeant

T

he rate of cancer mortality has decreased by about 25 percent for many types of cancer over the past two decades, according to the American Cancer Society.

Today, fewer die from lung, breast, prostate and colorectal cancer.

ACS and local experts agree that the decrease in cancer deaths relates to advances in several areas.

Some of the decrease in cancer incidence has to do with guidelines for cancer screening. If more or fewer receive screening, that affects the statistics.

Physician Jonathan Friedberg, director of Wilmot Cancer Institute and a lymphoma specialist, attributes lung cancer rates plummeting to a decrease in smoking. He added that tobacco use also contributes to “many, many cancers,” including bladder cancer and head and neck cancers.

Occupational exposure harmful to lungs, such as applying pesticides on farms, handling asbestos in construction and welding has also decreased, thanks to more safety standards and material regulations.

Friedberg points to improved screening as a big factor for detecting cancer earlier and more curable, such as mammograms, in some cases, pre-cancerous lesions, such as colon cancer and cervical cancer screenings.

From 1989 to 2015, breast cancer

deaths decreased 39 percent; colorectal cancer went down 52 percent between 1970 and 2015.

Friedberg predicts that HPV vaccine should eventually eliminate cervical cancer “for a whole generation” once providers reach complete compliance among patients.

Though care providers have made great progress in preventing and treating cancer, some areas still need improvement. Friedberg said that an estimated 15 percent of cancers are related to obesity.

“Obesity is a risk for developing cancer, and once you have cancer, treatment is more complicated for those who are obese,” he said.

Physician Rachel David, an hematologist and oncologist with Rochester Regional Health, echoed that thought.

“These obesity-related cancers are actually increasing in some age groups,” she said.

She noted the American Cancer Society suggests that obesity-related cancers such as colorectal, pancreas, uterine, kidney and gallbladder are increasing in people aged 25 to 49, and that the youngest adults, age 25 to 29, are seeing the biggest rise in obesity-related cancers.

“We don’t know why obesity is associated with cancer, and there could be many factors at play that contribute to the increase in cancer

The Problem with Pancreatic Cancer Compared to other cancers, the survival rate is quite poor for those suffering from pancreatic cancer

By Deborah Jeanne Sergeant

D

espite the steady progress in reducing cancer deaths in recent decades, a few types seem stagnant in their rates.

One of these is pancreatic cancer, the nation’s third deadliest cancer, according to the Pancreatic Cancer Association of Western New York in Rochester.

Only 8 percent of patients survive for five years after diagnosis. In the past decades, all other cancers’ survival rates have risen at a rate ranging from 49 to 67 percent and, for a few, even 90-plus percent. More than 40,560 died of pancreatic cancer in 2015.

“It’s elusive as far as early detection,” said physician Jonathan Friedberg, director of Wilmot Cancer Page 16

•

Institute. “We don’t have an easy screening test, so [when] it presents at a very late stage, the ability to definitively treat [it is compromised].”

Breast cancer patients sometimes detect a lump during a home breast exam or even earlier during a routine mammogram. Without this kind of early detection, the cancer has an opportunity to metastasize to other areas.

“Most who have prostate cancer and breast cancer survive,” said physician Leslie Kohman, board chairwoman of the American Cancer Society for Upstate New York and professor of surgery and director of outreach at Upstate Cancer Center.

“Pancreas cancer patients die from it. The differences are great. Early

risk, including a poor diet and sedentary lifestyle,” David said.

Physician Leslie Kohman, board chairwoman of the American Cancer Society for Upstate New York, said that the cancer death rate is increasing for liver cancer, endometrial cancer, brain cancer and head/neck cancers. She is also professor of surgery and director of outreach at Upstate Cancer Center, affiliated with SUNY Upstate University in Syracuse.

“The death rate in the poorest New York counties is far greater than in the wealthiest,” Kohman said.

“Everyone should have health insurance but they don’t. Not everyone has equal access to transportation.

Poverty is a barrier to medical treatment and screening.”

To address these issues, her organization takes an approach of bringing greater availability to health care, including mobile mammography vans, community outreach, and

community education.

“Almost half the cancers can be prevented by what we know now,” Kohman said.

To sum it up, she said that avoiding tobacco, sun exposure and obesity, and minimizing alcohol and red meat, especially cured and processed meat, can greatly reduce cancer incidences. Mothers should breastfeed as long as possible to protect both mom and baby. Discuss screenings with a healthcare provider.

Each New York county is part of the Cancer Services Partnership, which covers screening for colorectal, cervical, and breast cancer for those who are uninsured.

“Everyone can reduce their own risk of developing cancer,” Kohman said. “The good news is if you develop cancer now, your chance is much better than 25 years ago.”

detection improve your chances of surviving cancer.”

That’s why people such as Aimee Lucas, an American Cancer Society-funded researcher, studies the effectiveness of pancreatic cancer screening for people who rated as high risk. This includes people with a first-degree relative with pancreatic cancer and cancers associated with germline mutations, such as BRCA1 and BRCA2 genes which predispose to breast and ovarian cancer.

“Compared to other cancers, the survival rate is quite poor,” said Lucas, who is a physician and an associate professor of gastroenterology at Icahn School of Medicine at Mount Sinai in New York City. “There’s a lot of work being done on all fronts.”

That work includes focusing on high-risk individuals so care providers can know who needs screening, when and how and if earlier screening can improve survival and even, eventually, prevent pancreatic cancer.

Cancer in the pancreas, an organ in the mid-upper posterior, doesn’t offer obvious symptoms.

Weight loss, abdominal pain and changes in urine and feces color could be attributed to any number of causes. Some patients experience jaundice.

“It’s often very difficult to pinpoint,” Lucas said. “There are a lot of groups working on discovering blood markers. CA19-9 is one, but it can be a positive in pancreatic

cancer and also positive in several other conditions, including gallstone disease that are not cancer. The other problem is that not all pancreatic cancer express CA19-9. Sometimes the blood level is normal.”

Clinical screening is important since most patients remain asymptomatic until the cancer has become advanced. Lucas said that 80 percent of patients are diagnosed when the tumor cannot be surgically removed.

Pancreatic cancer doesn’t respond to chemotherapy and radiation like other cancerous tumors.

“My goal and the focus of my group is to improve earlier detection so we can detect more patients earlier so treatments are more effective,” Lucas said. “Or we could pick up a lesion in the pancreas before the development of pancreatic cancer.”

To lower the risk of pancreatic cancer — and especially for those with family history — Lucas advises avoiding tobacco use, obesity and heavy alcohol use. Diabetics need to manage their condition according to their care provider’s orders.

People with family history and who smoke may hasten development of pancreatic cancer by 10 years.

“Nutrition can certainly impact the disease,” Lucas said. “A few studies have shown that certain dietary factors such as diets high in red meat and low in fruits and vegetables can be associated with an increased risk of developing pancreatic cancer.”

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • March 2019

By Jim Miller

Do I Need to File a Tax Return This Year?

Dear Savvy Senior, What are the IRS income tax filing requirements for retirees this tax season? My income dropped way down when I had to retire last year, so I’m wondering if I need to file a tax return this year.

Retired Ron Dear Ron, Whether or not you are required to file a federal income tax return this year actually depends on several factors: how much you earned last year (in 2018); the source of that income; your age; and your filing status.

Here’s a rundown of this tax season’s IRS tax filing requirement thresholds. For most people, this is pretty straightforward. If your 2018 gross income — which includes all taxable income, not counting your Social Security benefits, unless you are married and filing separately — was below the threshold for your filing status and age, you may not have to file. But if it’s over, you will.

• Single: $12,000 ($13,600 if you’re 65 or older by Jan. 1, 2019).

• Married filing jointly: $24,000 ($25,300 if you or your spouse is 65 or older; or $26,600 if you’re both over 65).

• Married filing separately: $5 at any age.

• Head of household: $18,000 ($19,600 if age 65 or older).

• Qualifying widow(er) with dependent child: $24,000 ($25,300 if age 65 or older).

To get a detailed breakdown on federal filing requirements, along with information on taxable and nontaxable income, call the IRS at 800-829-3676 and ask them to mail you a free copy of the “Tax Guide for Seniors” (publication 554) or see IRS. gov/pub/irs-pdf/p554.pdf.

Check Here Too There are, however, some other financial situations that can require you to file a tax return, even if your gross income falls below the IRS filing requirements.

For example, if you earned more than $400 from self-employment in 2018, owe any special taxes like an alternative minimum tax, or get premium tax credits because you, your spouse or a dependent is enrolled in a health insurance marketplace (Obamacare) plan, you’ll need to file.

You’ll also need to file if you’re receiving Social Security benefits, and one-half of your benefits plus your other gross income and any taxexempt interest exceeds $25,000, or $32,000 if you’re married and filing jointly.

To figure all this out, the IRS offers an interactive tax assistant tool on their website that asks a series of questions that will help you determine if you’re required to file, or if you should file because you’re due a refund. It takes less than 15 minutes to complete.

You can access this tool at IRS. gov/filing — click on “Do I Need to File?” Or, you can get assistance over the phone by calling the IRS helpline at 800-829-1040. You can also get faceto-face help at a Taxpayer Assistance Center. See IRS.gov/localcontacts or call 800-829-1040 to locate a center near you.

Check Your State Even if you’re not required to file a federal tax return this year, don’t assume that you’re also excused from filing state income taxes. The rules for your state might be very different. Check with your state tax agency before concluding that you’re entirely in the clear. For links to state tax agencies see Taxadmin.org/statetax-agencies.

Tax Preparation Help If you find that you do need to file a tax return this year, you can get help through the Tax Counseling for the Elderly (or TCE) program.

Sponsored by the IRS, TCE provides free tax preparation and counseling to middle and low-income taxpayers, age 60 and older. Call 800-906-9887 or visit IRS.treasury.gov/freetaxprep to locate a service near you.

Also check with AARP, a participant in the TCE program that provides free tax preparation at around 5,000 sites nationwide, including several in Upstate New York. To locate an AARP Tax-Aide site call 888-227-7669 or visit AARP. org/findtaxhelp. You don’t have to be an AARP member to use this service.

Caring for the Most Important People on Earth.

Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior. org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book.

March 2019 •

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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Page 17

Ask St. Ann’s

Ask The Social

Is Falling a Normal Part of Aging?

By Sharon Osborne

C

old weather brings plenty of ice, sleet and snow, making it a challenge for anyone to get around without falling, especially older adults working hard to maintain their independence.

The Centers for Disease Control & Prevention identifies falls as the most common cause of treatable injury for hospital admissions among older adults.

Learning what you can do to decrease your risk of falling is the first step. The rehabilitation team at St. Ann’s Community recommends doing strength and balance exercises, managing medications correctly, having routine medical and vision checkups and making safety modifications at your home, inside and out.

• Staying on your feet. When you venture outdoors, uneven surfaces, ice, fine gravel, wet leaves and other hidden dangers can cause you to slip and fall fast and hard. Here’s how to stay safe: • Take extra time. Leave a few minutes early to get to your destination.

• Wear appropriate footwear.

Boots with flat bottoms and visible, heavy treads are best. If you have a foot condition, choose a pair that’s easy to get on and provides a comfortable fit. Get used to wearing your boots before venturing outdoors.

• Bundle up. Wear a winter coat, hat, gloves, and scarf to stay warm and help keep your muscles relaxed for better balance.

• Wear sunglasses. Sun glare from the snow can impair your vision, making it difficult to see uneven or icy surface conditions.

• Keep your hands empty. Don’t carry things, so your hands are free for stabilization and balance.

• Clear your driveway, walkways and steps.

• Be careful getting in and out of cars. Steady yourself on the doorframe and have both feet firmly on the ground before moving. Keep the areas around your vehicle clear, so there are no tripping hazards.

• Choose the best route. Stay on cleared sidewalks and roads instead of taking shortcuts or walking between parked cars. Ask someone to help you with slippery or unsafe paths.

• Stay on level ground. Approach sidewalk cutouts head on, not from an angle. Avoid walking on wet or snow-covered slopes. Watch for potholes and broken concrete.

• Move carefully. To help maintain your balance, take short steps and use handrails, where available.

• Watch out for black ice. Ice is often present on concrete and paved surfaces, especially in shaded areas on a sunny day, and when fluctuating temperatures cause the snow to thaw and refreeze at night.

• Enter buildings carefully.

Tracked-in snow and slush can leave floors wet and slippery • Use walking poles. You’ll stay balanced and get cardiac exercise while you walk.

• You don’t have to go it alone!

Support and assistance are right around the corner.

Although one of four older Americans falls each year, less than half tell their doctor.

For safety’s sake, honesty is the best policy, so tell your doctor and your loved ones about a fall. They’re on your side and can help you find ways to avoid injury and maintain your independence as long as possible.

Sharon Osborne is executive director of Transitional Care Center (TCC) and Rehabilitation Services at St. Ann’s, a senior community offering a full continuum of care in Rochester.

Email her at sosborne@MyStAnns.com, call 585-6976483 or visit www.stannscommunity.com.

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Security Office

From the Social Security District Office

Medicare: Rules for Those With Higher Income

I

f you have higher income, the law requires an upward adjustment to your monthly Medicare Part B (medical insurance) and Medicare prescription drug coverage premiums. But if your income has gone down, you may use form SSA-44 to request a reduction in your Medicare income-related monthly adjustment amount.

Medicare Part B helps pay for your doctors’ services and outpatient care. It also covers other medical services, such as physical and occupational therapy, and some home health care. For most beneficiaries, the government pays a substantial portion — about 75 percent — of the Part B premium, and the beneficiary pays the remaining 25 percent.

If you’re a higher-income beneficiary, you’ll pay a larger percentage of the total cost of Medicare Part B, based on the income you report to the Internal Revenue Service (IRS).

You’ll pay monthly Part B premiums equal to 35, 50, 65, 80, or 85 percent of the total cost, depending on the income you report to the IRS. Medicare Part D prescription drug coverage helps pay for your prescription drugs. For most beneficiaries, the government pays a major portion of the total costs for this coverage, and the beneficiary

Q&A

Q: I’m gathering everything I’ll need to file my taxes this month. Do I have to pay taxes on Social Security benefits?

Also, where can I get a replacement 1099?

A: Some people who get Social Security must pay federal income taxes on their benefits. Still, no one pays taxes on more than 85 percent of their Social Security benefits.

You must pay taxes on some portion of your benefits if you file an individual federal tax return and your income exceeds $25,000. If you file a joint return, you must pay taxes if you and your spouse have combined income of more than $32,000.

If you are married and file a separate return, you probably will have to pay taxes on your benefits. You can read more about tax preparation in relation to Social Security at www. socialsecurity.gov/planners/taxes. htm. Social Security benefits include monthly retirement, survivors, and disability benefits. They don’t include Supplemental Security Income (SSI) payments, which are not taxable. You can also get a replacement 1099 or 1042S when you open your own personal my Social Security account at www.socialsecurity.gov/ myaccount.

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • March 2019

pays the rest. Prescription drug plan costs vary depending on the plan, and whether you get Extra Help with your portion of the Medicare prescription drug coverage costs.

If you’re a higher-income beneficiary with Medicare prescription drug coverage, you’ll pay monthly premiums plus an additional amount, which is also based on the income you report to the IRS. Because individual plan premiums vary, the law specifies that the amount is determined using a base premium. Social Security ties the additional amount you pay to the base beneficiary premium, not your own premium amount. If you’re a higher-income beneficiary, we deduct this amount from your monthly Social Security payments regardless of how you usually pay your monthly prescription plan premiums. If the amount is greater than your monthly payment from Social Security, or you don’t get monthly payments, you’ll get a separate bill from another federal agency, such as the Centers for Medicare & Medicaid Services or the Railroad Retirement Board.

You can find Form SSA-44 online at www.socialsecurity.gov/forms/ ssa-44.pdf. You can also read more in the publication “Medicare Premiums: Rules For Higher-Income Beneficiaries” at: www.socialsecurity.gov/ pubs/EN-05-10536.pdf.

Q: I got an email that says it’s from Social Security, but I’m not so sure.

They want me to reply with my Social Security number, date of birth, and mother’s maiden name for “verification.” Did it really come from Social Security?

A: No. Social Security will not send you an email asking you to share your personal information, such as your Social Security number, date of birth, or other private information. Beware of such scams — they’re after your information so they can use it for their own benefit.

When in doubt, or if you have any questions about correspondence you receive from Social Security, contact your local Social Security office or call us at 1-800-772-1213 (TTY 1-800325-0778) to see whether we really need any information from you.

Q: I know that Social Security’s full retirement age is gradually rising to 67. But does this mean the “early” retirement age will also go up by two years, from age 62 to 64?

A: No. While it is true that under current law the full retirement age is gradually rising from 65 to 67, the “early” retirement age remains at 62.

Keep in mind, however, that taking early retirement reduces your benefit amount. For more information about Social Security benefits, visit www. socialsecurity.gov/planners/retire.

Charity Tackles Country’s Massive Medical Debt by Buying It RIP Medical Debt buys medical debt, then eliminates it

By Payne Horning

W

hile most people spend years trying to escape the weight of their medical debt, Craig Antico has made it a career of acquiring it. He spent 30 years working in the financial industry in collections, debt buying and outsourcing. But several years ago he made a change – one that would end up making a change the lives of hundreds of thousands of people.

In 2011, Antico received a phone call while running a collections agency in New Jersey. His former partner Jerry Ashton was in Zuccotti Park in New York City talking with the protesters of the Occupy Wall Street movement. They needed help with their plan to buy and eliminate $1 million worth of medical debt.

Because many hospitals sell medical debt to collections agencies for pennies on the dollar, the group only needed to raise about $50,000. Antico agreed to help and soon began reverse-engineering his company to become a debt-forgiveness outfit.

The results of the experiment exceeded expectations. The group ended up raising $700,000, which abolished just under $40 million in debt. It relieved financial burdens for 20,000 people in all. And Antico says they did much more than forgive medical debt. The money also erased millions in student loans, credit card debt, and payday loans.

When the movement started to fizzle out in 2013, Antico – who had been reluctant to join the operation in the beginning – now found himself partially responsible for keeping it alive. He and his former partner Ashton did just that, helping launch RIP Medical Debt in 2014. The company has spent the past five years buying large portfolios of debt from medical providers and debt sellers on the cheap and wiping it out.

“Those people will get a letter from us that says your debt is abolished,” Antico said. “It’s a no-strings

attached gift from the donors to RIP Medical Debt.”

The team at RIP Medical Debt begins their work by approaching hospitals, doctor’s groups, and debt buyers to tell them about their cause.

Once they get access to the databases of patients with outstanding debt, a data formula Antico created helps identify those who are in the most need of assistance.

“We can pretty much figure out which people are in between a rock and a hard place and are not going to be able to pay,” Antico said.

“We say let us identify the accounts that we know will not pay you and can never pay you and you are just hurting them by continuing to collect on them, and sell them to us for the same amount that you would sell to companies to make money.”

Most hospitals attempt to retrieve outstanding patient debt through the use of collections agencies that receive a share of what’s collected. But many medical providers decide to instead cut their losses, and sell the right to collect on that debt to outside companies for very low percentages of the total amount.

In either system, patients who are incapable of paying what they owe are barraged by phone calls and letters – a process Antico says is unconscionable.

Enter RIP Medical Debt. To date, the charity has abolished $550 million in debt for more than 200,000 people. Most of the donations come from individuals, but there are a variety of donors. According to Antico, the charity was recently able to forgive $20 million in debt for New York residents because of the contributions raised by two women from Ithaca and from NBC Universal in New York City, RXR Realty and its philanthropic owner Scott Rechler.

“I can’t believe the generosity of people to help other people,” He said. “They’ve just never had an

opportunity to make such a multiple of their dollar. Like, $100 will abolish $10,000 in debt. Where can you get that kind of an amplification of your money?”

RIP Medical Debt just celebrated a milestone. It recorded the biggest medical debt abolishment in U.S. history at the end of 2018 by wiping out $250 million thanks to one couple’s generous donation.

But Antico says it’s just the tip of the iceberg. The charity’s records show 1.5 million New Yorkers currently have more than $1.2 billion in medical debt on their credit reports.

Nationwide, it’s $75 billion. And since only 10 percent of medical debt is listed on credit reports, the problem is much costlier than this charity can currently afford.

They don’t turn any kind of profit from it. One hundred percent of the money comes from donors and are applied to eliminate debt.

Antico, Ashton, and Robert Goff another founding member of RIP Medical Debt wrote a book with ideas on how to improve America’s healthcare system called “End Medical Debt.” Proceeds from the book are donated to the charity. Despite its success, Antico doesn’t believe RIP Medical Debt is the solution to this crisis. But he says at least it’s offering a resolution to some of the current hardship until lawmakers find a way to address the larger issues.

“We need to do much more to help people not be in hardship or go insolvent,” Antico said. “For now, it’s a matter of getting more donors to come to the table.”

1.

12 Medical Debt Facts

The United States spends more per capita (per person) on health care than any other nation on earth.

The United States is the only industrialized country reliant on commercial insurance instead of universal healthcare.

At least 20 percent of all working-age Americans with health insurance have trouble paying medical bills.

An unexpected $500 out-ofpocket medical bill is too much for many people to pay or pay in a timely way.

More than 60 percent of all insured Americans will deplete most or all of their savings to pay medical bills.

About 10 percent of adults delay or skip medical care due to costs; worsening health costs more to treat.

At least 43 million Americans have about $75 billion in pastdue medical bills on their credit reports.

Medical debt on a credit report generally prevents people from buying or renting homes and cars.

Medical debt on a credit report can keep people from getting a job to pay off their medical bills.

Only 10 percent of all unpaid medical bills appear on credit reports; at least $1 trillion exists.

Medical debt drives middle class and lower-income families into poverty or homelessness.

Medical debt is the number one cause of personal bankruptcy in the United States.

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Why Do More and More Americans Use Medical Marijuana?

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asing chronic pain is the main reason Americans use medical marijuana, a new study finds.

“We wanted to understand the reasons why people are using cannabis medically, and whether those reasons for use are evidence-based,” said lead author Kevin Boehnke.

He’s an investigator at University of Michigan’s Chronic Pain and Fatigue Research Center.

Boehnke and his colleagues examined data from a 2017 report by the National Academies of Sciences, Engineering and Medicine on medical use of marijuana (cannabis).

That report found conclusive or substantial evidence that marijuana eased chronic pain, nausea and vomiting due to chemotherapy, and muscle spasms of multiple sclerosis.

Though the number of registered U.S. medical marijuana patients rose from more than 641,000 in 2016 to nearly 814,000 in 2017, researchers said that’s likely far lower than the actual number of users.

Of the license holders, 85.5 percent said they were seeking treatment for an evidence-based condition, with chronic pain accounting for 62 percent of qualifying conditions, March 2019 •

according to the study.

Researchers said the finding is consistent with the prevalence of chronic pain, which affects an estimated 100 million Americans.

As of 2018, medical marijuana use is legal in 33 states and the District of Columbia, while recreational use is legal in 10 states. The federal government still classifies pot as a drug, however, with no currently accepted medical use and a high potential for abuse.

The study was published in the February issue of the journal Health Affairs.

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Changing the Stereotype Language is one of the most blatant ways that we show respect for one another

By Brian Potvin

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ost of us in our lifetime have probably used the terms “handicapped” or “wheelchair-bound” to describe someone with a disability. We may have done this without ever realizing that it is offensive to people with disabilities. In fact, most of us were taught throughout most of our lives to use these terms. It was just as acceptable to us as it was to generations before us who were taught that words “lunatic” or “moron” were the proper terms to use to describe people with intellectual disabilities. These words, which are extremely derogatory by nature, became even more derogatory as society turned them into insults.

Take a look at the word handicapped: Its offensive origins are present just by glancing at the term.

At one time, it was used to describe beggars or helpless people who would stretch out their caps and ask for a handout. Is this the best word we can think of describe a person with a disability?

“Our mission is about diversity and inclusion in the community,” explains Lindsey Graser, director of marketing and communications for the Arc of Monroe. “This means using what we call ‘person centered language,’ which puts people first and does not focus on their disability.” For example, a person is not “wheelchair-bound,” but “uses a wheelchair.” A person is not called a “disabled person,” but rather a “person with autism” or a “person with a developmental or intellectual disability.” When you use language that is person centered and specific, your words empower someone instead of allowing them to fall under one of these labels.

The Arc of Monroe was previously known as the Associated for Retarded Citizens (ARC), but due to the derogatory nature of the ‘r’ word, the name was changed in 1992 to the Arc of the United States. Despite decades of advocacy to purge this offensive term from our language, the cam-

paign to end the “r” word continues.

The “Spread the Word to End the Word” campaign began in 2009 with an effort bring awareness to clinical and personal use of this word. This year on March 6, thousands of people will again take the pledge to not use this word. You can join The Arc of Monroe and sign to take the pledge or find out more at www.r-word.org.

People should not be defined by their disability; they are people first with strengths and weaknesses just like everyone else. When you see someone using a wheelchair, do not just assume they need help or that they are not capable of doing things independently. Ask first, and they will tell you if they need help or not.

If you are a waitress or nurse and assisting someone who has a disability, speak directly to the person not to whoever may be accompanying them. It’s also important to remember not to talk down to people and use a tone of voice that is respectful.

Every person is capable in some way

of communicating for themselves, whether verbally, gesturally, or by using a communication device such as a tablet.

Language is one of the most blatant ways that we show respect for one another. If you believe that all people are capable of living an independent and fulfilling life, then we should use language which reflects that. I urge you to take the time and think about the words you use to describe others, and how changing these words can positively impact the way we think about people who have disabilities. If we can change how we think and what we say, we can make the community, or even the world, a better place Brian Potvin is a personal outcome measures interviewer for The Arc of Monroe. He is also a mentor for local advocacy groups The Self-Advocacy Alliance and Roc PrideAbilty. He is passionate about educating people with disabilities to be strong advocates for greater accessibility and inclusion in the Rochester community.

Nursing: Government-mandated Staffing Ratios Are the Wrong Approach State legislation can be devastating to nurses, patients and healthcare systems

By Travis Heider

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urses are the backbone of hospitals and nursing homes.

They have direct contact with patients — implementing doctor’s orders, dispensing medication, using medical equipment and ensuring that patients receive the best possible care. For 15 consecutive years, nursing has been ranked as the No. 1 most-trusted profession, receiving the highest rankings for ethical standards and honesty. Unfortunately, legislation has been reintroduced in the state government that would completely undermine nurses and take away local control over staffing in hospitals and nursing homes.

The legislation, which would impose government-mandated nurse staffing ratios at all New York hospitals and nursing homes (S.1032/A.2954), has been pushed for many years by a New York Citybased labor union that represents a very small percentage of nurses.

Pandion Healthcare: Education & Advocacy, which represents 17 hospitals in Rochester and the Finger Lakes, is strongly opposed to government-mandated staffing ratios because they’re rigid, unfunded mandates that would be devastating to nurses, patients, and our healthcare system as a whole.

It doesn’t make sense for politicians to dictate the same staffing ratios in every hospital and nursing home — regardless of their size or location — especially in a state as Page 20

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diverse as New York. This legislation would not distinguish between a rural facility in Upstate New York or an urban facility in a city of 8.6 million people. All hospitals and nursing homes would be subject to the same staffing ratios at the same time — with no exceptions. This rigid, one-size-fits all approach would be devastating to our local healthcare system, especially to rural hospitals and nursing homes.

There is no scientific evidence that government-mandated staffing ratios would improve the quality of care that patients receive. Instead, it takes a team of experienced healthcare professionals who have the knowledge and the flexibility to respond to their patients’ needs.

Government-mandated ratios would have the unintended consequence of eliminating jobs for other healthcare professionals who assist nurses in patient care, including technicians, respiratory therapists, physical therapists, occupational therapists, and other members of the healthcare team.

Voters in Massachusetts rejected a similar ballot initiative Nov. 6. An independent study by two research groups determined that government-mandated staffing ratios would have cost Massachusetts hospitals $1.3 billion the first year and $1 billion each year after that, with an additional $100 million in state spending. The Massachusetts legisla-

ture would have been forced to significantly raise taxes to comply with the mandate. New York has almost three times the population of Massachusetts. The cost to our healthcare system would be astronomical.

Government-mandated ratios would significantly increase costs for healthcare providers that are already facing significant financial challenges. New York’s hospitals have the second-lowest operating margins in the nation, and some smaller, rural hospitals are struggling to keep their doors open. Many nonprofit nursing homes are in a similar situation. Fortunately, Gov. Cuomo recognized the difficulties that healthcare providers face and directed the NYS Department of Health to study the cost of staffing ratios in his FY 2020 executive budget.

Even if the government-mandated staffing ratios were implemented in New York, hospitals and nursing homes would be unable to meet the requirements due to the nursing shortage. There simply aren’t enough nurses. According to a Workforce Development Study conducted by the University at Albany, certified nursing aids (CNAs) are the most difficult specialty to recruit and retain at long-term care facilities. If facilities are forced to limit the number of patients they can receive due to staffing ratios, patients will be forced to stay in the hospital longer, decreasing the number of beds that are available

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • March 2019

for others. It’s common sense that the state can’t pass legislation that’s impossible to comply with.

Hospitals are the economic drivers of their communities. In Rochester, the top two employers are UR Medicine/The University of Rochester and Rochester Regional Health.

Imposing government-mandated staffing ratios would have a devastating impact on the local economy.

We’re fortunate to have two excellent healthcare systems in Rochester and the Finger Lakes — why would we put it all at risk?

Pandion Healthcare: Education & Advocacy strongly urges state legislators to oppose this legislation.

We don’t need another unfunded mandate that would increase costs for both patients and providers, and we don’t need politicians in Albany telling nurses how to do their jobs.

Travis Heider, President & CEO of Pandion Healthcare: Education & Advocacy, a nonprofit organization that represents 17 hospitals in Rochester and the Finger Lakes.

H ealth News URMC, St. Joe’s to focus on population health Extending prior strategic partnerships, and following more than 18 months of development work, leaders of St. Joseph’s Health in Syracuse and the University of Rochester Medical Center (URMC) reently announced formation of a new organization to work with health systems across the state.

Concordia Healthcare Network LLC is a super-clinically integrated network (CIN) created to help other health systems, hospitals and provider groups transition to value-based care, an increasingly common payment approach that requires systems to comprehensively monitor and manage the overall health of their population in addition to billing for services.

Concordia is jointly operated by Accountable Health Partners (AHP) — the CIN that serves URMC faculty members, affiliated hospitals and other providers in the Finger Lakes and surrounding areas — and St. Joseph’s Health, a regional nonprofit health care system based in Syracuse that offers primary, specialty and home care, a magnet-recognized hospital, and collaboration with community partners.

The formation of Concordia does not change the structure of either network or its services to providers. Instead, it will serve as a “super CIN” that shares collective expertise and resources with health systems in other parts of Upstate New York, helping all members to increase patient access to services and improve the quality of clinical care, while keeping costs as affordable as possible.

“We believe the whole of Concordia Healthcare Network will be greater than the sum of its parts,” said physician Robert M. McCann, chairman of the 10-member Concordia Healthcare Network board.

McCann is also the CEO of Accountable Health Partners and chief of medicine at Highland Hospital in Rochester, a URMC affiliate. “The Concordia name will not be widely known to patients, but they will see benefits from their local health systems through expanded access to providers, improved preventive care, better clinical integration and more affordable health-plan options.”

“This alliance of CINs—known as a ‘super CIN’—is motivated by our common desire to expand our value proposition to larger populations and further strengthen our population health management capabilities while retaining healthy system independence. This complex collaboration is only achievable as a result of the mission and leadership congruence of Concordia Healthcare Network’s providers,” said physician Paul Fiacco, Concordia vice-chairman and president of CNY Accountable Integrated Medicine, a CIN operated

by St. Joseph’s Health.

Three health systems have already committed to participation in Concordia — Family Health Network of Central New York, a federally funded community health center serving residents of Cortland and

contiguous counties; Lourdes Hospital and its physician network, serving Binghamton and the Southern Tier; and Innovative Health Alliance of New York (IHANY), serving Albany and the Capital Region.

Thompson opens its advanced Surgical Services All three of the general surgeons employed by UR Medicine Thompson Health are now under one roof, in a new location.

Effective Feb. 18, Advanced Surgical Services will open in suite 305 on the third floor of the Thompson Professional Building, located at 395 West St. on Peter

Thompson’s main campus in Canandaigua. Seeing patients there will be surgeons A. David Peter, Joseph Talarico and Thomas Wormer.

Peter and Wormer previously practiced at the Canandaigua Medical Group, which became part of Thompson Health last year. The new suite shared with Talarico offers a second procedure room, allowing for more office Talarico procedures. In addition, its proximity to Thompson’s operating room and ambulatory procedures center in the adjacent Thompson Hospital will mean enhanced availability of the surgeons. The move is expected to make for more convenient, streamlined scheduling as well.

As a result of the move, the three surgeons are increasing the availabil-

ity of screening and diagnostic endoscopy for their patients.

Other procedures include: robotic hernia repair, robotic and laparoscopic gallbladder, stomach, bowel and colon surgery, hemorrhoid and fissure treatment, Wormer breast surgery for cancer and benign diseases, temporal artery biopsy, wound care, abscess and soft tissue foreign body care, advanced abdominal wall reconstruction, vasectomy, skin cancer lesions, pilonidal disease treatment and port placement Paul Whitehead, a general surgeon in private practice and member of Thompson’s medical staff, remains in his current location on West Street in Canandaigua.

Thompson Names Staff Member ‘Health Hero of the Year’

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he associate wellness committee at UR Medicine Thompson Health hosted a Jan. 15 ceremony to celebrate staff members recognized throughout 2018 as the organization’s “Health Heroes,” surprising Kurt Taylor of Honeoye with the news that he was chosen, among all the 2018 honorees, to be the health hero of the year.

Taylor, who works in the health system’s facility services department, has lost approximately 40 pounds while taking part in fitness activities and improving muscle tone. As health hero of the year, he received a Fitbit as well as 50 points to use toward purchasing items on an internal, online recognition site. His name is now featured on a plaque at the hospital.

The other 2018 health heroes each received 20 points. They were: Bani Aello of Victor, Jennifer Dane of Victor, Kate Meighan of Canandaigua, Howard Morgan of Naples, Erin Mowry of Penn Yan, Jen Muscato of Canandaigua, Elizabeth Potter of Stanley, Julie Snyder of Geneva, Bill Vaughn of Rushville and Nicki Zimmerman of Canandaigua Health heroes are named quarterly at Thompson, in recognition of lifestyle changes for better health.

Each receives their choice of logo apparel and their story is featured in Thompson’s internal newsletter.

Thompson Health President/ CEO Michael F. Stapleton Jr., FACHE, told those at the ceremony they are excellent role models for coworkers. By contributing to a healthier workforce, he said, Thompson can provide better service, inspire others to make healthy changes, improve employee retention, and offer its employees lower health insurance premiums.

March 2019 •

Thompson Health President/CEO Michael F. Stapleton, Jr. with Kurt Taylor, who was recently chosen as Thompson’s health hero of the year.

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • March 2019

H ealth News Excellus Awards Hospitals $25.7 Million for Quality Improvements Thirty-six upstate New York hospitals and health centers, including eight in the Finger Lakes region, last year shared $25.7 million in quality improvement incentives from Excellus BlueCross BlueShield. The nonprofit health insurer’s performance incentive program was established in 2005. Thus far, it has paid out more than $282 million in quality improvement incentives.

“When a health insurer collaborates with health care providers, as we are doing with this hospital quality program, health outcomes improve,” said Carrie Whitcher, Excellus BCBS Vice President Health Care Improvement.

Eight hospitals in the Finger Lakes region participated in the program in 2018, sharing $12.3 million in quality improvement incentive payments. Participating hospitals were Clifton Springs Hospital, F.F. Thompson Hospital, Highland Hospital, Newark-Wayne Community Hospital, Nicholas H. Noyes Memorial Hospital, Rochester General Hospital, Strong Memorial Hospital and Unity Hospital.

“In 2018, our hospital performance incentive program evaluated participating hospitals on 59 unique performance measures,” said phy-

55

sician LouAnne Giangreco, Excellus BCBS vice president and chief medical officer for health care improvement.

“We credit our hospital partners for their continuous commitment to quality improvement, and for achieving 77 percent of all quality improvement targets.”

In addition to achieving required clinical and patient safety measures in 2018, other nationally endorsed measures and target outcomes were jointly agreed upon by each hospital and the health insurer using benchmarks established by the Centers for Medicare & Medicaid Services, the Institute for Healthcare Improvement, and others.

Areas targeted for 2018 improvement included: • Clinical processes of care — Focused on improvements in diabetes, chronic obstructive pulmonary disease (COPD), pneumonia, and surgical care, and other measures that may be unique to each participating hospital • Patient safety — Centered on reductions in hospital-acquired infections, readmissions, and other adverse events or errors that affect patient care • Patient satisfaction — Used the

Hospital Consumer Assessment of Healthcare Providers and Systems survey, which is a national, standardized, publicly-reported survey of patients’ perspectives of hospital care “We fully appreciate the partnership we’ve developed with providers for the last several years in the spirit of optimizing patient care and influencing overall outcomes. It is through these types of collaborations that we can mutually seek to improve the quality of care across upstate New York,” Whitcher said.

Chiropractic college, association to collaborate New York Chiropractic College (NYCC) and the New York State Chiropractic Association (NYSCA) announced the first-ever joint NYCC homecoming and NYSCA Fall Convention to be held Sept. 20-22 at NYCC’s Seneca Falls campus.

The college’s homecoming — known this year as the Centennial Celebration in honor of NYCC celebrating the 100th year of its founding — and the NYSCA convention will feature continuing education opportunities for healthcare professionals, guest speakers, networking and social events, exhibitors, and more.

Its innovative format will include plenary sessions, panel discussions, and breakout sessions with panelists, promising a rich and varied educa-

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tional experience for attendees.

Among the speakers and presenters at this event are chiropractors Jack Barnathan, who will give the keynote speech on Sunday morning (Sept. 22); Christine Foss, who will present on sports medicine; David Seaman, who will address nutrition; and Don Murphy, who will discuss primary spine care.

Other topics to be addressed during the celebration will be acupuncture and integrative health systems. Additionally, as the college has played an influential role in chiropractic and other healthcare professions from 1919 to the present day, some of the school’s educational, research, evidentiary, and historical contributions to healthcare will be examined.

NYCC President Michael Mestan explains that the collaborative nature of this event will enable healthcare practitioners to take advantage of a one-stop continuing education opportunity featuring some of the country’s top researchers and educators. “The two organizations have worked closely together in the past, and we see this confluence of our Centennial Celebration with NYSCA’s Fall Convention as a natural outgrowth of our mutual educational goals and commitment to excellence in the provision of healthcare services,” he says.

For more information, visit www. nycc.edu/centennial.

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • March 2019