Chronic Low Back Pain Eased By Massage

Massage therapy helps ease chronic low back pain and improve function, according to a randomized controlled trial that the Annals of Internal Medicine will publish in its July 5 issue. The first study to compare structural and relaxation (Swedish) massage, the trial found that both types of massage worked well, with few side effects.

“We found that massage helps people with back pain to function even after six months,” said trial leader Daniel C. Cherkin, PhD, a senior investigator at Group Health Research Institute. Better function means they are more able to work, take care of themselves, and be active.

“This is important because chronic back pain is among the most common reasons people see doctors and alternative practitioners, including massage therapists,” Dr. Cherkin added. “It’s also a common cause of disability, absenteeism, and ‘presenteeism,’ when people are at work but can’t perform well.”

The trial enrolled 400 Group Health Cooperative patients who had had low back pain for at least three months. Their pain was “nonspecific,” meaning with no identified cause. They were randomly assigned to one of three treatments: structural massage, relaxation massage, or usual care. Usual care was what they would have received anyway, most often medications. The hour-long massage treatments were given weekly for 10 weeks.

At 10 weeks, more than one in three patients who received either type of massage – but only one in 25 patients who got usual care – said their back pain was much better or gone. Also at 10 weeks, a questionnaire showed nearly twice as many massage patients (around two thirds) as usual-care patients (more than one third) were functioning significantly better than at the trial’s outset. Patients in the massage groups spent fewer days in bed, were more active, and used less anti-inflammatory medication than did those with usual care.

“As expected with most treatments, the benefits of massage declined over time,” Dr. Cherkin said. “But at six months after the trial started, both types of massage were still associated with improved function.” After one year, the benefits of massage were no longer significant.

The bottom line: “We found the benefits of massage are about as strong as those reported for other effective treatments: medications, acupuncture, exercise, and yoga,” Dr. Cherkin said. “And massage is at least as safe as other treatment options. So people who have persistent back pain may want to consider massage as an option.”

Prior studies of massage for back pain had tested only structural forms of massage, not relaxation massage. But relaxation (also called Swedish) massage is the most widely available and is taught in massage schools. It aims to promote a feeling of relaxation throughout the body. By contrast, structural massage involves identifying and focusing on specific pain-related “soft tissues” (like muscles and ligaments). It requires extra training and may be more expensive – but more likely to be covered by health insurance plans – than relaxation massage.

“The massage therapists assumed structural massage would prove more effective than relaxation massage,” said Dr. Cherkin’s colleague Karen J. Sherman, PhD, MPH, a senior investigator at Group Health Research Institute. “They were surprised when patients in the relaxation group got so much relief from their back pain.”

Next steps include figuring out whether the structural and relaxation massages were equally effective for the same – or for different – reasons:

Structural or relaxation massage, or both, might have specific effects, such as stimulating tissue or calming the central nervous system.

Either or both might work through “nonspecific effects” that may promote a person’s ability to play an active role in their own healing. Possible nonspecific effects include: being touched; spending time in a relaxing environment; receiving care from a therapist who seems caring; getting advice on caring for yourself, such as exercises to do on your own; or becoming more aware of your own body, so you’re better able to avoid triggers for your back pain.

Some combination of specific and nonspecific effects might be at play.

Drs. Cherkin and Sherman’s co-authors are Assistant Investigator Andrea J. Cook, PhD, of Group Health Research Institute and the University of Washington; Biostatisticians Robert Wellman, MS, and Eric A. Johnson, MS, Project Manager Janet Erro, RN, MN, and Analyst/Programmer Kristin Delaney, MPH, of Group Health Research Institute; Janet Kahn, PhD, of the University of Vermont School of Medicine in Burlington; and Richard A. Deyo, MD, MPH, of Oregon Health and Science University in Portland, OR.

The National Center for Complementary and Alternative Medicine (NCCAM), part of the National Institutes of Health, funded this study.

 

Recent budget crisis has federally funded clinics asking – how much will health care reform help them?

The Hurtt Family Health Clinic in Tustin had a close call recently. The Federally Qualified Health Center feared the loss of a $667,000 federal grant expected in March. Instead of getting their federal Healthcare for the Homeless grant this spring, they got a notice telling them that the budget impasse in Washington D.C. had locked their funds, along with bit of money to cover operating costs through May.

The federal gridlock didn’t result in disaster for the clinic–- this time. Hurtt and all other Federally Qualified Health Center expecting continuation funding got their funding continued in early June, said the Health Resources and Services Administration’s Director of Communications, Martin Kramer.

But clinics may continue to struggle. The budget cuts resulted in the denial of millions of dollars in new grant requests and saw cuts of over $600 million to the Health Center Appropriations for 2011, said Kramer.

Hurtt and other Community Health Clinics across the state need every dollar they can get, and they are not optimistic that they will have sufficient funds to expand clinics to keep pace with increasing demand.

Their experiences lead them to doubt, too, that increased funds from the coming health care reform will be a balm for their budget troubles.

Responding to increased demands with decreased federal funds

East San Diego County-based Mountain Health operates fives clinics in the rural San Diego communities of Alpine, Escondido and Campo. Mountain Health was hoping for $220,000 under the new Expanded Medical Access grant. They were denied because of budget cuts, said CEO Judith Shaplin. They’d slated the money for everything from hiring additional physicians and case managers to getting a badly needed pharmacy at their Campo facility.

An increasing number of patients have filed into the clinics. The percent of uninsured patients coming to Mountain’s facilities, for instance, went from 20 percent in 2009-10 to 34 percent in 2010-11. The clinic, however, hasn’t seen the needed resources to support the increase.

Instead, Mountain Health has to hold off on planned expansions to ancillary services, and multitasking is a given for the staff. “This amounts to longer waiting times for patients, and our staff wearing multiple hats,” Shaplin said.

Their inability to hire more staff to cope with increasing numbers of uninsured patients base is a daily challenge, Shaplin said.

Like Mountain Health, Hurtt also treats patients regardless of their ability to pay, which is why it largely depends on federal assistance to sustain it. Federal funding, including the Healthcare for the Homeless grant, is one of Hurtt’s vital sources of support.

As director, Amavizca said it is part of her job to continually be on the lookout for other sources of funding. She has tried to be proactive, including a major restructuring of the clinic in 2004. That’s when Hurtt, which until then was operating as the Casa de Salud clinic in Santa Ana, was taken over by the Orange County Rescue Mission where Amavizca is Director of Health Care Clinics & Services.

Together with Amavizca and her staff, OCRM gave Hurtt a strategic makeover, repositioning the clinic to provide for a high volume patient base with minimal resources. OCRM moved the clinic three miles from Santa Ana to Tustin, where it is housed along with the Hurtt Mobile Clinic.

Both administer a full range of primary health care services (including dental) to the community’s homeless, poverty-stricken and uninsured population. Cities covered by Hurtt Mobile clinic include Tustin, Santa Ana, Orange and Garden Grove.

The most significant measure taken in Hurtt’s redesign, however, was obtaining status as a Federally Qualified Health Center. With federal grants as well as support from other donors since the takeover, patient services were expanded to a level that now accommodates a 140 percent patient volume increase since 2004.

“This is the hard part…you get a grant like this, which allows us to provide more all around, and now with more than double the patients, we’re left without it?” Amavizca said.

Will health care reform help?

The Affordable Care Act could provide clinics with a more stable line of funding. However, Shaplin describes herself as “cautiously optimistic” at best about the benefits of health care reform.

The ACA provides increased access to healthcare for patients who are currently uninsured, Shaplin said. But these reforms are very costly, and there are many gray areas in the law about how people qualify, and whether the new structure of the insurance market will be one that can support provider payment, she added.

Simply put, the biggest flaw is that the legislation doesn’t outline the exact mechanism for moving the ever-growing patient population into the program. California is trying to address this problem with their Bridge to Reform program, which will allow patients eligible for insurance under health care reform to begin receiving benefits before the Affordable Care Act begins.

One of Shaplin’s counterparts, Stephen Schilling, CEO of the Central Valley-based Clinica Sierra Vista, doesn’t believe it’s realistic to look toward the act as a source of increased funding. Sierra Vista recently agreed to participate in California’s Bridge to Reform program.

Schilling’s assessment is based on the dismal state of the economy and resulting budget cuts in Washington. Considering the cuts made to the regular budget, provisions under the Affordable Care Act don’t amount to “increased” funds, Schilling said. If anything, they just serve to compensate for the funding that clinics have recently lost.

Sierra Vista is comprised of 16 ambulatory facilities and a mobile health provider, and serves homeless and indigent patient populations across Inyo, Kern and Fresno counties. Increased funds from health care reform will only serve to keep community health centers funded at the same level as other sources of federal money are slashed, Schilling said.

The biggest problem, Schilling said, is that there is nothing being added to the existing budget to facilitate the clinic expansions that there will be a desperate need for after health care reform begins.

“This doesn’t yield the advantages we were hoping for…to get community clinics prepared for the new wave of insured patients under the PPACA with additional health centers,” Schilling said.

The bottom line amounts to continued uncertainty for clinics, directors said. Amavizca, Melgar, Shaplin and Schilling all agreed that there are a number of blind curves on the road ahead. They will operate, they said, with the knowledge that planning ahead is just not an option until there is more economic stability.

“We’re bracing for a lot of different scenarios,” Schilling said.

 

Another ruling on affordable health care

Another ruling on affordable health care! https://jeffschilling.wordpress.com

 

Healthcare Reform Is Ruled Constitutional

Healthcare Reform Is Ruled Constitutional

So yesterday, another court ruling held the Affordable Care Act constitutional…

 The health-care law seeks to extend medical coverage to 30 million uninsured Americans and make major changes in public and private health insurance. By far the most contested provision is the individual mandate, which requires most Americans to purchase at least a minimum level of health insurance starting in 2014 and imposes a tax penalty if they don’t.

 Like other legal challenges, the lawsuit filed by the Thomas More Law Center — a Christian-oriented law firm in Michigan — says Congress overstepped its constitutional authority to regulate commerce.

 A three-judge panel of the 6th Circuit disagreed. The mandate is constitutional, Martin wrote, because “Congress had a rational basis to believe” that the provision would affect interstate commerce and that it was “essential” to the law’s broader goals of reforming the health-care market.

 Judge James Graham, a Republican appointee, dissented, but it was the concurrence of Sutton — a George W. Bush appointee and former law clerk for conservative Supreme Court Justice Antonin Scalia — that was most noteworthy.

 Sutton wrote that “the government has the better of the arguments” and that “Congress . . . did not exceed its power” in passing the individual mandate. But he also appeared to acknowledge that his word would not be final, writing, “The Supreme Court has considerable discretion in resolving this dispute.”

According to Daily Kos, who also links to a copy of the opinion, that makes the latest score 3-2…

 Thus far, five lower-level district court judges have ruled on the merits of the challenges, with three upholding the law’s constitutionality and two striking down all or part of it.

I wish to hell it would just go to the Supreme Court so we all could just move on, one way or another. This treading water is getting old and does nothing to move us forward as a nation toward better healthcare.…

 

Common Sense Loses Another Battle!

Health Care Reform Survives First Appeal Before a Circuit Court

By BARBARA LEONARD

     (CN) – The 6th Circuit on Wednesday affirmed the constitutionality of President Barack Obama’s health care law – the first time a federal appeals court has ruled on the controversial overhaul.

     Appeals stemming from passage of the Patient Protection and Affordable Care Act are currently pending in other federal appeals courts, including most notably in the 11th and 4th Circuits.

     In October 2010, U.S. District Judge George Steeh of Detroit rejected a challenge to a provision of the act that requires most Americans to buy health insurance.

     Following that decision, the Thomas More Law Center and four individuals sought relief from the Cincinnati-based federal appeals court.

     A three-judge panel of the 6th Circuit ruled Wednesday that the minimum coverage provision, also labeled as the individual mandate, is a valid exercise of legislative power by Congress under the Commerce Clause.

     The provision, which is set to take effect in 2014, imposes penalties on eligible citizens who choose not to purchase health insurance.

     “The Act considered as a whole makes clear that Congress was concerned that individuals maintain minimum coverage not as an end in itself, but because of the economic implications on the broader health care market,” Judge Boyce Martin wrote for the court. “Virtually everyone participates in the market for health care delivery, and they finance these services by either purchasing an insurance policy or by self-insuring. Through the practice of self-insuring, individuals make an assessment of their own risk and to what extent they must set aside funds or arrange their affairs to compensate for probable future health care needs. Thus, set against the Act’s broader statutory scheme, the minimum coverage provision reveals itself as a regulation on the activity of participating in the national market for health care delivery, and specifically the activity of self-insuring for the cost of these services.”

     Since Congress has the power to regulate economic activity, and that is the ultimate goal of health care reform, the opponents failed to bring a challenge under the commerce clause of the Constitution, according to the 26-page ruling.

     “Congress found that without the minimum coverage provision, the guaranteed issue and community rating provisions would increase existing incentives for individuals to delay purchasing health insurance until they need care,” Martin wrote. “The legislative record demonstrated that the seven states that had enacted guaranteed issue reforms without minimum coverage provisions suffered detrimental effects to their insurance markets, such as escalating costs and insurance companies exiting the market.”

     The judges also rejected the Thomas Moore Law Center’s claim that health care reform impermissibly regulates inactivity. After first dismissing the notion that the Constitution distinguishes between activity and inactivity, the ruling states that the challenged provision does any such thing.

     “Furthermore, far from regulating inactivity, the minimum coverage provision regulates individuals who are, in the aggregate, active in the health care market,” Martin wrote.

     Try as the might, most Americans are active in the health care market, the ruling states.

     “Virtually everyone will need health care services at some point, including, in the aggregate, those without health insurance,” Martin wrote. “Even dramatic attempts to protect one’s health and minimize the need for health care will not always be successful, and the health care market is characterized by unpredictable and unavoidable needs for care. The ubiquity and unpredictability of the need for medical care is born out by the statistics.”

     More than 80 percent of adults nationwide visited a doctor or other health care professional one or more times in 2009, according to statistics from the Centers for Disease Control and Prevention quoted in the ruling.

     And since federal law requires medical practitioners to treat all patients regardless of whether they can afford the treatment, it is a virtual certainty “that all individuals will require and receive health care at some point,” Martin wrote.

     “Thus, although there is no firm, constitutional bar that prohibits Congress from placing regulations on what could be described as inactivity, even if there were it would not impact this case due to the unique aspects of health care that make all individuals active in this market,” the ruling states.

     Resolving the appeal under the commerce clause, Martin added that the panel did not need to address whether the provision constitutes proper exercise of Congress’s power to tax and spend under the general welfare clause.

     Judge Jeffrey Sutton elaborated on the case in a separate 24-page opinion concurring in part and delivering part of the court’s opinion.

     “That brings me to the lingering intuition – shared by most Americans, I suspect – that Congress should not be able to compel citizens to buy products they do not want,” Sutton wrote. “If Congress can require Americans to buy medical insurance today, what of tomorrow? Could it compel individuals to buy health care itself in the form of an annual check-up or for that matter a health-club membership? … And if Congress can do this in the healthcare field, what of other fields of commerce and other products?

     “These are good questions, but there are some answers. In most respects, a mandate to purchase health insurance does not parallel these other settings or markets. Regulating how citizens pay for what they already receive (health care), never quite know when they will need, and in the case of severe illnesses or emergencies generally will not be able to afford, has few (if any) parallels in modern life. Not every intrusive law is an unconstitutionally intrusive law. And even the most powerful intuition about the meaning of the Constitution must be matched with a textual and enforceable theory of constitutional limits, and the activity/inactivity dichotomy does not work with respect to health insurance in many settings, if any of them.”

     Sutton goes on to note that few question the authority of states to require its residents to have insurance, and such laws are already on the books in Massachusetts and New Jersey.

     “Today’s debate about the individual mandate is just as stirring, no less essential to the appropriate role of the National Government and no less capable of political resolution,” Sutton concluded. “Time assuredly will bring to light the policy strengths and weaknesses of using the individual mandate as part of this national legislation, allowing the peoples’ political representatives, rather than their judges, to have the primary say over its utility.”

     Senior U.S. District Judge James Graham, sitting on the panel by designation from the Southern District of Ohio in Columbus, concurred and dissented in part.

     “If the exercise of power is allowed and the mandate upheld, it is difficult to see what the limits on Congress’s Commerce Clause authority would be,” Graham wrote. “What aspect of human activity would escape federal power? … Such a power feels very much like the general police power that the Tenth Amendment reserves to the States and the people. A structural shift of that magnitude can be accomplished legitimately only through constitutional amendment.”

 

Check out my Health Insurance Matters bl

Check out my Health Insurance Matters blog for the latest posting “Court declares health care reform is constitutional” https://jeffschilling.wordpress.com

 

Court: Healthcare law is constitutional

 

By Sam Baker – 06/29/11 01:25 PM ET

 

A federal appeals court ruled Wednesday that healthcare reform — specifically the provision requiring most people to buy insurance — is constitutional.

 

The 6th Circuit Court of Appeals upheld the coverage mandate in a 2-1 decision that directly validates the federal government’s primary argument. Although the mandate’s supporters thought a procedural ruling might be their best chance for a win in the 6th Circuit, the court said clearly that the mandate falls within Congress’ power to regulate economic activity.

 

 

 

Judge Jeffrey Sutton, one of the two judges on the three-judge panel who ruled in favor of the mandate, was appointed by President George W. Bush. He is the first judge appointed by a Republican president to uphold the healthcare law.

 

The plaintiff in the case, Thomas More Law Center, had argued that the mandate compels economic activity, rather than simply regulating it, and is therefore unconstitutional. The Justice Department argued that the provision does not require people to consume healthcare services — which almost everyone will — but rather governs how they pay for it.

 

The court agreed with the federal government.

 

“The activity of foregoing health insurance and attempting to cover the cost of health care needs by self-insuring is no less economic than the activity of purchasing an insurance plan,” the decision states. “Thus, the financing of health care services, and specifically the practice of self-insuring, is economic activity.”

 

Hospital TeamCare Identifies Physician Hurdles in Healthcare Reform

June 28, 2011 | PR Web Email   Print   Free Newsletter

Pompano Beach, FL (PRWEB) June 28, 2011

 

For many physicians, next year’s healthcare overhaul will mean making that switch from being the boss, to becoming salaried employees of hospitals or larger healthcare organizations, explains James E. McLean, MD, President of Hospital TeamCare West – a leading provider of outsourced physician services.   

 

“Reactions could be described as bittersweet,” McLean said. “Some physicians have commented in news articles, that working for a hospital will provide that sense of stability, while many others have said it will change the way they’ve been practicing medicine for decades.”

 

In a story that ran in The Washington Post, a few days ago, said 56-year-old Dr. Jonathan Plotsky, who, after working for many years as an internist in Rockville, and is in the process of negotiating a possible job with a local hospital, “All the rules are changing.”

 

Some other hurdles that providers of physician services are encountering with changes in healthcare —not included in the healthcare overhaul —reported by the Associated Press are, “rising numbers of uninsured or underinsured patients, Medicare crises, looming doctor shortages, and new physicians shunning primary care to pay off huge medical school debt.”

 

Dr. Cecil Wilson, President of the American Medical Association recently told the Associated Press, that “the nation’s health care system is sick, and that’s why we’ve gone through this agony developing health care reform. We’ve got to make it better.”

 

About Hospital TeamCare

 

Hospital TeamCare is a leading provider of quality hospital-based outsourced physician services. We offer physician outsourcing in emergency medicine, anesthesia, hospital medicine, pediatrics, radiology, and urgent care medicine. For more information about Hospital TeamCare, our hospital services, or healthcare solutions, visit TeamCare.com or call 800/616.8236

 

Read the full story at http://www.prweb.com/releases/2011/6/prweb8598727.htm

 

Check out the new postings on my blog at

Check out the new postings on my blog at https://jeffschilling.wordpress.com

 

Health debate shifts to entitlement cuts

By Sam Baker – 06/27/11 08:23 AM ET

  Congressional Republicans have had some success in shifting the healthcare debate back to the reform law, but speculation about health entitlement cuts in a debt-ceiling deal could thwart their momentum.

After weeks of dominating the healthcare headlines, Rep. Paul Ryan’s (R-Wis.) Medicare proposal has taken a backseat to heightened criticism of the Affordable Care Act. Republicans are renewing their assault on the law’s Independent Payment Advisory Board, which they say will “ration” care.

The GOP also seized on a report that up to 3 million middle-class families could become eligible for Medicaid because of the reform law.

But with negotiations over the debt ceiling and spending cuts reaching a critical phase, the focus is likely to shift away from the reform law and onto entitlements.

Democrats and advocates are fighting potential cuts to Medicaid, while industry groups are bracing for Medicare payment cuts that many of them say they can’t afford. Little information has leaked out so far, even as the talks fell apart and got kicked up to President Obama and the leaders in the House and Senate.

Hospitals have already been making an aggressive case that they took big hits in healthcare reform as well as through recent regulations; they say it’s time for other healthcare sectors to shoulder more of the burden. Medicare’s advisory commission recently suggested paying less for imaging services, which doctors didn’t like.

Congressional Democrats have proposed taking more money out of the pharmaceutical industry through expanded rebates and Medicare price negotiations, but neither of those proposals has ever found much support among Republicans.

The Senate Finance Committee is scheduled to hold a hearing Thursday on “key issues” in deficit reduction, following up on a hearing last week that focused specifically on healthcare programs.

The National Center for Policy Analysis is holding a briefing Tuesday on Capitol Hill about the future of Medicare, and a coalition of provider groups has a hearing the same day on Medicaid.

Also on Tuesday, the American Enterprise Institute will discuss the importance of innovation in vaccine development, and some 125 physicians come to Capitol Hill to lobby members on painkiller legislation. And the Food and Drug Administration starts a two-day public hearing on whether to review its restrictions on the cancer drug Avastin.