By EVE TAHMINCIOGLU
NY TIMES

Entrepreneurs have plenty of things to keep them awake at night worrying: payroll, inventory, pricing, competition. For Jere Smith and her husband, Don Lueders, the main thing is health insurance.

Many small-business owners struggle with the high cost of health insurance, but it is even more critical for entrepreneurs with ventures less than five years old, the time when a business tries to build its clientele and profits. And because many start-ups typically include few employees, if any, they cannot always take advantage of discounted insurance rates that groups enjoy.

The cost of buying health insurance, experts say, is increasingly rattling start-ups that never anticipated the escalating price tag, and in some cases the expense keeps would-be entrepreneurs on the sidelines, especially those with pre-existing medical conditions.

“If Bill Gates had to worry about health insurance would he have started Microsoft? Who knows,” said Katherine Swartz, an economist at the Harvard School of Public Health and the author of “Reinsuring Health: Why More Middle-Class People Are Uninsured and What Government Can Do.”

“I worry about whether these small businesses will be able to survive, and I worry about what the U.S. economy is going to produce, the types of products and services small businesses will be able to produce in the next decade or so,” Ms. Swartz said. (more…)

By Matt Viser,
Boston Globe Staff

The City of Boston’s healthcare costs have nearly doubled in six years and now require the property tax bills of five families to pay the premium of one city employee’s family healthcare plan, according to a report by the Boston Municipal Research Bureau.

In order to bring the costs under control, the city must take difficult actions, including shifting some of its healthcare policies and joining the state’s healthcare plan, according to the report.

“This is the biggest issue facing cities and towns today,” said Samuel R. Tyler , president of the Boston Municipal Research Bureau, which is releasing the report today . “It’s affecting services, some of which are quality-of-life issues that has an effect on people and businesses choosing to stay in Boston.” (more…)

By NATASHA SINGER
NY TIMES

In her three years as an obstetrician and gynecologist in Brooklyn, Dr. Ngozi Nwankpa-Keshinro delivered several hundred babies, conducted several thousand pelvic exams and diagnosed everything from infections to infertility. But this year, with a little additional training, she has entered a new field: cosmetic medicine.

As one of the owners of a medical spa in Brooklyn that opened in January, she has given dozens of clients Botox injections to relax their wrinkles and Restylane injections to fill out their smile lines and plump their lips.

“The two fields are as alike as an apple and an orange,” Dr. Nwankpa-Keshinro said. “One can be lifesaving, while the other is not. But when you clear up someone’s acne or facial hair, they are as grateful as if you delivered their baby.”

Cosmetic medicine also provides a more relaxing lifestyle, she said. “And it’s very satisfying.”

Five years ago, cosmetic medicine was primarily the domain of plastic surgeons, facial surgeons and dermatologists — medical school graduates who undergo several years of training in facial skin and its underlying anatomy. But now obstetricians, family practitioners and emergency room physicians are gravitating to the beauty business, lured by lucrative cosmetic treatments that require same-day payments because they are not covered by insurance and by a medical practice without bothersome midnight emergency calls. (more…)

By Clea Benson – Bee Capitol Bureau
http://www.sacbee.com

The physicians at Roseville Pediatrics say they almost stopped seeing Medi-Cal patients this year out of frustration.

It took a year and a half for state workers to issue the practice a new Medi-Cal billing number after a move, said Dr. Ravinder Khaira, one of the two pediatricians at the clinic. During the wait, Khaira said, the clinic was forced to float about $100,000 the state owed for services to low-income patients enrolled in the government health insurance program for the poor.

On top of that, workers handling the application were unreachable by telephone, Khaira said. The only way to communicate was via regular mail.

“The only reason I would even consider remaining with Medi-Cal is because we want to take care of the kids,” Khaira said. “The sheer volume of paperwork that needs to be done is at least triple what would be necessary for commercial insurance.”

State officials dispute some details of Khaira’s account, saying they have computer records showing the delay was only about a year. They say some of that delay occurred because the clinic filled out the forms incorrectly.

But Khaira’s story illustrates one of the hurdles the state faces in trying to attract and retain doctors in the program, which covers more than 6 million poor Californians. According to the California Health Care Foundation, Medi-Cal has about 46 primary care doctors for every 100,000 patients. The standard for Medicaid, the federal program that funds Medi-Cal, is about 60 to 80 doctors per 100,000 patients.

The strains on the system could grow if the number of people receiving Medi-Cal continues to increase. Gov. Arnold Schwarzenegger has said he wants to ensure all children eligible for the program are enrolled, which could add hundreds of thousands of new patients to the system. (more…)

By CZERNE M. REID
http://www.thestate.com

Little Jesus Crespo was hurting. As he lay in his hospital bed recovering from foot surgery, he needed relief. But to treat his pain effectively, nurses and doctors needed to know how much pain he was in.

They made observations. They talked with Jesus’ mother, Marian Crespo. And they listened to 9-year-old Jesus.

He told them how he was feeling with the help of a simple drawing that hospitals and doctors offices use to communicate with children about pain. The drawing, called a pain scale, is simple, but gives young patients a chance to express themselves. That’s important since caregivers can’t always tell by looking how a child is feeling.

“We have an understanding here that pain is the perception of the patient,” said Jane Lukshis, a nurse at Palmetto Health Children’s Hospital, who specializes in pain management. “Basically, pain is whatever the patient tells us … and we believe them.” (more…)