Obesity adds more health-care costs than smoking, study finds

Obesity costs the health care system more than smoking does, a new study has found. The annual health costs for someone who is obese average $1,850 more than for a person a normal weight. The excess costs were up to $5,500 per year for people who are morbidly obese. Smokers' health costs averaged $1,275 more than those of nonsmokers.

Researchers studied the additional costs "of smoking and obesity among more than 30,000 Mayo Clinic employees and retirees. All had continuous health insurance coverage between 2001 and 2007," reports research-reporting service Newswise. The findings were published in the Journal of Occupational and Environmental Medicine.

The additional costs associated with obesity appeared to be lower after they were adjusted for other related health problems. "This may lead to underestimation of the true incremental costs, since obesity is a risk factor for developing chronic conditions," said James P. Moriary and his fellow researchers. (Read more)

Managed-care executives acknowledge problems, say they're trying to fix them

Executives of three managed-care companies who run most of the state's Medicaid program told a legislative committee yesterday that they are aware of "significant problems" with their management since they took over in November, and they are "committed to fixing them," reports Deborah Yetter of The Courier-Journal. Health-care providers have complained to lawmakers for months about late payments, claims processing and battles over new rules requiring "pre-authorization" to guarantee payment. The executives said they're meeting with providers to solve the problems.

Health care providers implied last week during testimony that the companies were withholding payments to "maximize their profits," Yetter notes. All three executives denied the claim, saying they have to pay interest on payments delayed more than 30 days. They said some late payments "weren't getting past billing clearinghouses" that many health-care providers use to process Medicaid claims. Claims have been delayed in those facilities for a number of reasons, the executives said, including new billing requirements under managed care. They said they are working to identify and pay those claims. (Read more)

Evidence grows of links between oral health and overall health

"The eyes may be the window to the soul, but the mouth provides an even better view of the body as a whole," The Wall Street Journal's Melinda Beck writes in her Health Journal column. "Some of the earliest signs of diabetes, cancer, pregnancy, immune disorders, hormone imbalances and drug issues show up in the gums, teeth and tongue—sometimes long before a patient knows anything is wrong. There's also growing evidence that oral health problems, particularly gum disease, can harm a patient's general health as well, raising the risk of diabetes, heart disease, stroke, pneumonia and pregnancy complications." (WSJ graphic; click on it for larger version)

Beck adds, "Such findings are fueling a push for dentists to play a greater role in patients' overall health. Some 20 million Americans — including 6 percent of children and 9 percent of adults — saw a dentist but not a doctor in 2008, according to a study in the American Journal of Public Health this month."

Beck urges her readers not to be fooled by shiny white teeth. "In fact, many dentists worry that people who whiten their teeth may have a false sense of complacency, since their teeth can still be harboring tooth decay and serious gum disease," she writs. "Even people who have no cavities can still have inflamed and infected gums." She quotes Mark Wolff, an associate dean at the New York University College of Dentistry: "Whiteness and the health of your teeth are totally unrelated." (Read more)

Smokers should pay more for health insurance, but obese should not, national poll finds

Nearly 60 percent of people in October's Thomson Reuters-NPR Health Poll said smokers should pay more for their health insurance than those who don't smoke, but 69 percent said "no" when asked if people who are overweight or obese should pay more.

Support for punishing smokers was greatest among groups less likely to smoke. Almost three-fourths of people in households with an annual income of $100,000 or more felt smokers should pay more than nonsmokers, Sarah Kliff of The Washington Post reports. There was nearly as much support — 70 percent — among people asked with at least a college degree.

But when it came to the weight-related question, the majority of people, regardless of education or household income, did not support having people who are overweight or obese pay more. Just 31 percent supported the idea.

Overwhelmingly, nearly 85 percent of respondents felt people who eat right and do not smoke should receive a discount on their health insurance premiums.

Each month, the poll surveys 3,000 Americans to gauge opinions on a variety of health-care topics. The poll, which is independently funded, has a margin of error of 1.8 percent. (Read more)

The poll results were released at a time when many mid- and large-scale companies are asking their smoking, obese employees to pay higher premiums than their more healthy colleagues. In 2012, almost 40 percent of these companies, including Walmart, will start using penalties to control unhealthy behavior. That's up from 19 percent this year and just 8 percent in 2009. (Read more)

Haven't quit smoking, lost weight? Pay more for health insurance, more companies say

In an effort to keep health-care costs down, companies across the country, including Walmart, are opting to charge workers who smoke or are obese higher premiums than their more healthy colleagues. (Reuters photo by Lucas Jackson)

The move is the follow-up to a strategy many companies have already tried: to encourage workers to take better care of their health by offering benefits like weight-loss programs or smoking-cessation classes. But with few signs of the health-care landscape changing, "They're replacing the carrot with a stick and raising costs for workers who can't seem to lower their cholesterol or tackle obesity," reports Jillian Mincer of Reuters.

One example is Walmart, which in 2012 will start charging its smoking workers higher premiums. It will also offer cessation classes. A company spokesman said people who use tobacco use about 25 percent more health-care services than people who don't: "These decisions aren't easy, but we need to balance costs and provide quality coverage."

Critics say the move will limiting people's freedoms, create employee resentment and hut the lowest-paid workers hardest. "It's not inherently wrong to hold people responsible," said Lewis Maltby, president of the National Workrights Institute. "But it's a dangerous precedent."

Though well-intentioned, these policies can create bitterness. Mark A. Rothstein, a lawyer and professor at the University of Louisville School of Medicine, said having a colleague call to ask about a person's weight loss can be seen as intrusive. That's part of the reason why the janitors at the school participate, but "the professors on campus consider it a privacy tax, so we don't get some stranger calling us about how much we weigh."

Nevertheless, many companies are moving forward with the option. In 2012, almost 40 percent of large and mid-size companies will start using penalties to control unhealthy behavior. That's up from 19 percent this year and just 8 percent in 2009, an October survey by consulting firm Towers Watson and the National Business Group on Health shows. "Nothing else has worked to control health trends," said NBGH Vice President LuAnn Heinen. "A financial incentive reduces that procrastination."

Cleveland Clinic, with a staff of 40,000, has implemented a comprehensive program and seen its health-care costs grown just 2 percent this year. "The effort began several years ago when it banned smoking at the medical center and then refused to hire smokers," Mincer writes. "It later recognized that having a gym and weight -oss classes wasn't enough to get people to participate. It made these facilities and programs free and provided lower premiums to workers who maintained their health or improved it." Paul Terpeluk, medical director of occupational health at the clinic, said employers have to develop a program and change the culture: "You don't do this overnight." (Read more)

U of L physicians' group drops open-records appeal, but C-J may still not get records

An organization representing University of Louisville doctors who were trying to keep their financial records private dropped its lawsuit appealing an adverse open-records decision Tuesday. In April, Attorney General Jack Conway ruled that University of Louisville Physicians Inc. is a public agency and, as such, is subject to the Kentucky Open Records Act. Conway's opinion was requested by The Courier-Journal.



Last November, state auditor Crit Luallen released a scathing audit against Passport, which provides managed care for 165,000 Medicaid patients in Jefferson and 15 surrounding counties. The audit accused the organization of "wasteful spending, conflicts of interest and the questionable transfer of $30 million in Medicaid funds to organizations represented on Passport's board, including University Physician Associates," The Courier-Journal's Tom Loftus reports. Because of the audit, the newspaper asked for financial records from University Physicians Associates and University of Louisville Physicians Inc., which is the successor to University Physicians Associates. They refused to hand over the records, and Conway's decision followed.



Though the attorney general determined the organization should be subject to the open-records law, and the doctors' lawsuit has been dismissed, giving Conway's opinion the force of law, The Courier-Journal may not receive the records it has asked for. In its notice of dismissal, University of Louisville Physicians stated it could change "its structure and function in the future which it believes may alter its status as a public agency."



"We are still forming our final structure and function," Diane Patridge, ULP's vice president for marketing and communications, told Loftus. "Once we're up and fully established we may appeal this current determination." Curiously, "Partridge also said that ULP has no records to release to the newspaper as a result of the dismissal of the case," because it has no employees -- even though it was incorporated in March 2010. "She said University Physicians Associates . . . has handled all financial matters and paperwork for ULP to date," Loftus reports.



“This case is another piece of a puzzle,” Courier-Journal attorney Jon Fleischaker said. “It’s another step to try to make sure there’s more transparency at the University of Louisville School of Medicine and University Medical Center.” (Read more) "Sounds like a shell game with shell corporations," said Al Cross, director of the Institute for Rural Journalism and Community Issues and associate extension professor of journalism at the University of Kentucky.

Conference for Kentuckians who get, give health care Aug. 24

A gathering intended to bring Kentuckians together who get care, give care, purchase care and pay for care will be Wednesday, Aug. 24 at the Capital Plaza in Frankfort.

The Kentucky Health Quality collaborative conference will focus on current quality improvement efforts in Kentucky and will address changes that are happening through health reform and national efforts to improve health care. The keynote address will look at the national quality strategy that drives reporting and payment incentives.

Conference co-hosts are the Foundation for a Healthy Kentucky; Friedell Committe for Health System Transformation; Health Care Excel; Humana; Kentucky Hospital Association; Kentucky Primary Care Association; Kentucky Voices for Health; Norton Healthcare; UAW/Ford Community Health; and UK HealthCare.

To register, click here. Cost is $40 for attendees. The conference is from 9 a.m. to 4 p.m.