National News

House call doctors make a comeback

Marketplace - American Public Media - Tue, 2014-05-27 10:16

Back in the day, doctors made house calls and actually got to know their patients. But as times and technology changed, a home visit from your doctor became a luxury for the 1 percent. Dissatisfied doctors and frustrated patients have forced the industry to adjust, and house call doctors are making a comeback. But are they for everyone?

Patients want that personal relationship as well. People who grew up with house call doctor visits remember them fondly.

Dr. Michael Farzam is CEO of House Call Doctor Los Angeles. He's been seeing patients in their homes for 13 years, and almost never has to make a referral. Part of the reason is he speaks with patients on the phone before making the trek in LA traffic to their home, but also, he says, "I can do everything in the home, essentially, a doctor's office or a typical urgent care can do. So, we do x-rays and ultrasounds, we administer IV fluids."

And there are advantages to seeing patients in their homes. Some cases can only be solved by a home visit, like the time he diagnosed a whole family with carbon monoxide poisoning from an old furnace.

"It's just something you had to see visually in the home to be able to make that diagnosis. You know, if they had been in the house one more night, they probably all would have died. And that was a nice day. That makes the job very worthwhile."

During our interview, Dr. Farzam took several calls from patients on his cell phone. It's this personal care and the access his patients have that make them so satisfied. But this kind of service must be for the super-wealthy. Right? At around $400 a visit, Dr. Farzam says he does see the 1 percent here in LA – corporate executives and celebrities who want the privacy and convenience. 

However: "But I'd say 95 percent of my patients are middle income people, who hold average jobs, and any way you look at it, our fee is less expensive than an emergency room visit, even if you have good insurance."

The tech startup Medicast uses a house call model they call "Uber for healthcare". Patients can hail a doctor 24/7 from a mobile app.

"It's really as simple as just clicking a button when you're not feeling well,” CEO Sam Zebarjadi says, “and we find a nearby on-call doctor who will come to your home, your office or hotel in under two hours."

Patients can also summon a doctor from their website or by calling in to the call center. Medicast has been up and running in Miami and South Florida for almost a year and it launches in Los Angeles and Orange Counties in the beginning of June.

Of course, there was a reason house calls all but disappeared in the middle of last century. Medicine became more expensive, having medical insurance became necessary, and dealing with that ate into doctors' profits.

"About 60 to 70 percent of the costs of healthcare are really in the overhead that come with traditional practices," Zebarjadi says -- and to make up for all that overhead, doctors might have to see 30 patients a day. "They spend about 6-8 minutes per patient…so it's a very stressful experience."

The Medicast model is a twist on a relatively new trend. It's called private medicine and it's growing by 25 percent a year. The idea is to eliminate some of the costs associated with billing insurance. That way, doctors can afford to spend more time with patients. These house call practices are a cash business – they don't take insurance. They also don't need nurses, receptionists… they don't even need the office.

But still, these are doctors driving to your homes. How do the non-millionaire patients afford that? Zebarjadi says people are saving money on insurance by choosing policies with high deductibles.

"A lot of people are using healthcare for catastrophic events and actually looking elsewhere to services like ours for basic wellness and urgent care needs."

So when you go to sleep with a high deductible insurance plan and wake up in the middle of the night with an alarming fever, you're faced with a choice: a potential $3,000 in the Emergency Room, or $400 or so for a home visit. That house call might just be the frugal choice, as well as a lot more restful.

Pakistani Woman Stoned To Death By Family Outside Courtroom

NPR News - Tue, 2014-05-27 10:14

The 25-year-old woman, who was three months pregnant, was bludgeoned to death with bricks after she married someone against her family's will.

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Bill Murray Offers Bachelor Party Advice On Love And Life

NPR News - Tue, 2014-05-27 09:36

At a South Carolina steakhouse over Memorial Day weekend, the comic actor told friends of a groom that if they find love themselves, they should test it by going on a trip around the world.

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When Older People Walk Now, They Stay Independent Later

NPR News - Tue, 2014-05-27 09:36

Nobody wants to spend their final years unable to walk, but that sad fate afflicts many people as they age. A little exercise helps a lot, especially if people can do it in social groups.

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Former LulzSec Hacker Turned Informant Avoids Further Jail Time

NPR News - Tue, 2014-05-27 09:24

Hector Xavier Monsegur, or Sabu, was a well-respected hacker in the world of Anonymous. But as an informant, authorities say he helped cripple the hacktivist group. A judge let him off on time served.

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Median CEO Pay Tops $10 Million For The First Time

NPR News - Tue, 2014-05-27 09:20

An Associated Press study shows that most CEOs at S&P 500 companies are now making more than eight figures. Over the past four years, they've received raises topping 50 percent.

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Florida's IQ Limit For Death Penalty Isn't Constitutional, Supreme Court Says

NPR News - Tue, 2014-05-27 07:44

In a reversal of a state court, the justices say Florida's rule ignores norms in the psychiatric profession. The opinion also cites the Eighth Amendment barring cruel and unusual punishment.

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PODCAST: Women and minorities ignored by VC

Marketplace - American Public Media - Tue, 2014-05-27 07:27

This week is Hurricane Awareness Week, which precedes the official start of the hurricane season. While storms like Hurricane Sandy are still unusual, protecting populated coastal areas like New York City is a technological challenge.

Innovation requires brains, but also requires money -- and the early money often comes from venture capitalists. But all too often minority and women innovators miss out on venture capital funding.

Obama Plans To Leave Residual Force Of 9,800 In Afghanistan

NPR News - Tue, 2014-05-27 07:19

The number is in line with what military officials had asked for. The United States will end America's longest-running war in 2014 and expects most of the residual force out of the country by 2016.

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Art In A Jar 2: Details, Details

NPR News - Tue, 2014-05-27 07:13

Can you find the masterpiece in the mass of pieces?

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States Consider Using Medicaid To Pay College Health Plan Premiums

NPR News - Tue, 2014-05-27 06:50

Students who are covered by Medicaid could get access to a wider network of doctors and hospitals, as well as mental health services, if they get care through their school's health plan.

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Supreme Court Rules In Favor Of Secret Service In Free Speech Case

NPR News - Tue, 2014-05-27 06:50

Anti-Bush protesters claimed the Secret Service violated their First Amendment rights because they moved them away from the president. The Court said there was a security reason for doing so.

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With A Heavy Hand, Chinese Authorities Crack Down On Mourners

NPR News - Tue, 2014-05-27 06:20

After a terror attack in northwestern China, mourners left flowers at the scene and citizens took to social media and called for an evening protest. The government saw this as a threat.

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Malaysia Releases Satellite Data From Missing Jetliner

NPR News - Tue, 2014-05-27 05:35

Malaysia Airlines Flight 370 communicated with satellites as it flew across the Indian Ocean. Malaysia, however, is facing criticism for leaving out some information.

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Soldiers Arrest Thai Politician As He Speaks Out Against Coup

NPR News - Tue, 2014-05-27 05:27

A former minister of Thailand's ousted cabinet was detained Tuesday at a news conference. The arrest comes as ousted Prime Minister Yingluck Shinawatra is released.

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A Meaty Offer: Pilgrim's Pride Offers $5.58 Billion For Hillshire Brands

NPR News - Tue, 2014-05-27 05:17

Pilgrim's Pride said the deal would create a "protein-focused company." The offer also puts Hillshire Brands' own intent to buy Pinnacle Foods in limbo.

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Fixing the VC gender gap

Marketplace - American Public Media - Tue, 2014-05-27 04:35

Innovation requires brains, but also requires money -- and the early money often comes from venture capitalists. But all too often minority and women innovators miss out on venture capital funding.

Jules Pieri, found and CEO of the product launch platform, The Grommet, sees a bias in the system, but she also sees a simple, practical solution. Pieri calls her idea “Title IX for business.” In short, remove the lucrative carried interest tax loophole from any venture firms that do not fund women’s businesses proportionate to men's.

Pieri joins Marketplace Morning Report host David Brancaccio to discuss. Click on the audio player above to hear more. 

Book News: U.K. Plan To Cut American Lit From Tests Prompts Fierce Backlash

NPR News - Tue, 2014-05-27 04:31

A push to protect To Kill A Mockingbird. Also: Notable books coming out this week include a wildly original collection of poetry and a terrible, horrible, no good, very bad thriller.

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Heroin, opiate addicts find it tough to get treatment

Marketplace - American Public Media - Tue, 2014-05-27 04:07

Sheryl Santiago's son, Erik, was addicted to pills he'd been prescribed for anxiety and depression.

But when he finally decided to quit, he learned that asking for help and getting it can be two very different things.

"As soon as he contacted [a treatment facility], he thought he could go that night,” Santiago recalled. “He was ready to go and then he just got more and more discouraged."

Erik didn't have health insurance, and neither he nor his parents could afford the private facilities, where a month of treatment can cost as much as $30,000. So the first step for the family was to purchase insurance for Erik.

"When we got the insurance, they only covered a couple places, and they had waiting lists," she said.

A few weeks later, Erik was moved off the waitlist at a local treatment facility in Ocean County, N.J. However, he had been trying to stop using drugs on his own while he waited for help, and the program he was accepted into was the kind of place that helps patients detox with the assistance of medication. Like many facilities of this type, it required potential patients to be active drug users to get treatment -- to actually fail a drug test.

"He told me, he goes, 'Don't be mad at me if I use something because I have to test dirty in order to go into their program,'” said Santiago. “And he did, he must have used whatever he was using prior — the dosage — and it was too much."

Santiago said Erik had been clean for four weeks before he overdosed and died. In that time, his body may have lost some of its tolerance for the drug.

He had just turned 31 when he died, so it's hard not to play a game of “what-ifs?” but Santiago believes her son would still be here today if he'd gotten into a program right away.

"There's not enough beds, there's not enough providers,” confirmed Bruno Silie, a health educator who helps place addicts in treatment facilities at a drop-in center run by the South Jersey AIDS Alliance in Atlantic City, N.J.

"There's options, but the waiting period is ridiculous,” he added. “I've had clients wait for 60-plus days, and by that time they've given up."

"You really have to strike when the iron's hot," said Kimberly Reilly, the alcohol and drug coordinator in Ocean County, N.J. "So if someone comes to us and says I'm motivated for treatment, you really want to get them in, really, within that hour, because the next hour they could be off looking for their next hit of heroin."

There are simply not enough beds to meet New Jersey’s growing demand for substance abuse treatment. Statewide, admissions are up nearly 40 percent since 2006. As the state diverts more nonviolent drug users to treatment over prison, the waiting lists are even more of an issue.

Increasingly, people are seeking treatment for heroin and opiate additions. In Ocean County, half the admissions last year were for heroin. It's cheap and easily accessible, so many users turn to the drug after getting addicted to prescription pills, such as OxyContin.

The situation in New Jersey is mirrored across the country, according to Roseanne Scotti, director of the Drug Policy Alliance in New Jersey.

Scotti noted the Affordable Care Act will eventually add coverage for many people with mental health and substance abuse issues. The Substance Abuse and Mental Health Services Administration estimates that the ACA will eventually extend coverage to approximately 11 million people with behavioral health conditions, which include mental health and substance use issues.

Without significant expansion of treatment options, that expansion may create additional backlogs.

“In some states, like New Jersey, there just isn’t the infrastructure, at this point,” said Scotti. “There’s going to have to be new facilities, new providers, new licensed addiction counselors, and that’s going to take a while to ramp up.”

In addition to expanded access to insurance, other factors – like the aging population, the high turnover of substance abuse counselors, and better medical screening for addition – affect the availability of treatment options, according to Andrea Kopstein, a division director in SAMHSA’s Center for Substance Abuse Treatment.

Kopstein says the Obama administration is making a “significant investment” in both the number of treatments slots and to expand the number of professionals working in the field, SAMHSA was unable to specify how much. The most recent figure available on U.S. spending for substance abuse was $24 billion in 2009. 

Rising risk in mortgage market

Marketplace - American Public Media - Tue, 2014-05-27 03:59

A new report from the American Enterprise Institute suggests that home-buyers are more likely to default on new mortgages.

The mortgages were subjected to a stress test. Under the worst case scenario, an increasing percentage of the loans would fall into foreclosure.

But when considered historically, housing consultant Thomas Lawler says new mortgages are, “Substantially lower in terms of overall risk than any time in 20 plus years.”

Lawler says the risk of another all-out housing crisis is much lower because fewer mortgages are backed with borrowed money.


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