Longer looks: Women caregivers giving up careers; 'Buyers Club' laws; finding a voice for the patient

Every week KHN reporter Marissa Evans finds interesting reads from around the Web.

The New York Times: For Women In Midlife, Career Gains Slip Away
Tracy Murphy was managing a nonprofit agency five years ago when her mother became seriously ill with heart problems. She promptly left her job to care for her, a task that has consumed Ms. Murphy ever since. "For me, it was a no-brainer," said Ms. Murphy, who lives in Syracuse. "When I was growing up she sacrificed for me." Ms. Murphy, 54, set aside her career aspirations, drained her savings account and eventually sold her gold jewelry to help make ends meet while shuttling her mother, who is 85, to doctors' appointments and running errands (Dionne Searcey, 6/23).

The Morning Consult: States, Feds On Collision Course Over 'Dallas Buyers Club' Laws
The argument that the government shouldn't regulate the behavior of a dying patient has sprouted up once again in 2014, and may be setting the stage for a showdown between the states on one side, and the federal government and Congress on the other. In May, Colorado Gov. John Hickenlooper (D) signed into law a controversial measure that allows terminally ill patients to obtain experimental medications before they've been approved by the Food and Drug Administration. Those who favor the law have a ready-made big government bogeyman in the Food and Drug Administration, as well as some Hollywood glitz in the form of Oscar-winning picture "Dallas Buyers Club," in which Matthew McConaughey is an AIDS crusader smuggling non-sanctioned medications to patients in the early days of the virus. They also have a simple and emotionally compelling argument (Jonathan Easley, 6/22).

Modern Healthcare: Credit Agencies Warn Of Troubled Financial Outlook For Hospitals
Some hospital balance sheets are rebounding to pre-recession levels but declining revenue and shrinking margins are causing credit rating agencies to look askance at the sector, according to industry experts. "We're seeing margins coming down as the ability to cut costs is eclipsed by revenue pressures," said Martin Arrick, managing director of Standard & Poor's ratings services, during a Tuesday session at the Healthcare Financial Management Association's 2014 Annual National Institute in Las Vegas. After assigning the healthcare sector a stable outlook for what Arrick called "quite a long time," Standard & Poor's announced in December 2013 that accelerating negative pressures at not-for-profit hospitals and health systems had led the ratings service to a negative outlook for the industry (Rachel Landen, 6/24).

KQED: Coordinated Care For Those Nearing Life's End – But Does It Save Money?
(Bob) Martinez is 81, a long-retired life insurance salesman. In the last few years, he's had more than a dozen surgeries on his right leg, including a foot amputation, a casualty of severe diabetes. His heart disease has warranted almost half a dozen heart procedures. After one of his recent operations, he said he'd had enough. "I'm so sick and tired of being in hospitals," he says shaking his head. "I don't want to go back no more. I said, God, no more. No more" (April Dembosky, 6/25).

Health Affairs: Correcting The Blind Spot In Accountability: The Role Of Pharmacy Care
While reforms to the payment systems are fundamentally transforming incentives for providers, the cost and value of prescription drugs, in control of medical problems and expenses, were omitted. No new payment models, to date, target Part D directly. ACOs and other new payment models do not include the cost of pharmacy services in their measurement of total cost of care. Considering that Part D plans are private firms and manage their own claims, the path to coordination of Part D with ACOs was not immediately clear when the ACO program was initiated. As a result, providers in these models have no meaningful incentive to promote cost-effective medication use (William Shrank, Andrew Sussman, Patrick Gilligan and Troyen Brennan, 6/25).

The New York Times: Who Can Speak For The Patient?
Our patient was never going to wake up. He had an unrecoverable brain injury. The prognosis had become clear over time. As the patient's attending physician in the intensive care unit, I arranged a meeting with his sister, the only visitor we'd seen for days, and explained. She was resolute. "He'll wake up," she said. "He's a fighter. Do everything you can to keep him alive." The next day I told the social worker what the patient's sister had said. "What about the wife?" the social worker asked. That was the first I'd heard of a wife (Dr. Jessica Nutik Zitter, 6/19).

The Visalia Times-Delta: The High Cost Of Childhood Trauma
You might not think that jail is a typical topic of conversation for a 4-year-old. But for many children in Tulare County, the topic is a central part of their young lives. As a therapist in Cutler with Family Services, a nonprofit organization contracted with the county health department to provide mental health services, Zenaida Cruz is faced daily with the challenge of helping young children process adult-level problems. Most of Cruz's patients are referred by Child Welfare Services (Kyle Harvey, 6/23).