ACP Internist

Friday, November 20, 2009

QD: News Every Day--Santa's take on H1N1 influenza, part II

ACP Internist's daily digest of news and events continues with the contentious issues the senate faces for health care reform and Medicare reimbursement, as well as the pecking order for H1N1 flu prioritization

Health care reform
The Senate will vote Saturday whether to proceed with its bill. The issues are contentious: abortion, affluence and affordability, among others. According to ACP Advocate, the Senate likely won't vote on its bill until December, and even after that happens, the two versions will still need to be reconciled with each other and passed again by both chambers. (New York Times, Los Angeles Times, AP, Christian Science Monitor, ACP Advocate)

The House voted to cancel the pending 21% cut to Medicare reimbursement. Now the issue moves to the Senate, which didn't get that accomplished as a single issue when it came up in October. They'll reconsider it as part of overall health care reform legislation.

In case you missed it ...
As we reported yesterday, organizations representing mall Santas want their members added to the priority list for H1N1 influenza vaccination. Now, hog farmers are saying their proximity to pigs trumps the Santa's contact with children. They first want to protect their herd from humans carrying H1N1 influenza. The Santas respond that they should fall in the pecking order when pigs fly, not reindeer.

Labels: H1N1, health care reform, QD, reimbursement

QD: News Every Day--Santa's take on H1N1 influenza

ACP Internist's daily digest of news and events continues with the latest progress on health care reform measures in the Senate, and a caution that Santa is looking at who's naughty, nice and vaccinated this year.

Health care reform
After a few quiet days, Senate Majority Leader Harry Reid set up a potential Saturday vote to take the legislation to the Senate floor. According to the Congressional Budget Office:
--the bill would cost $848 billion over the next decade
--the bill would reduce the federal deficit by $127 billion over the first decade and $650 billion over the second decade,
--it would cover more than 94% of Americans, and
--it would reduce the number of uninsured Americans by 31 million.

A wrap-up digests the breaking news from multiple sources. (Washington Post, Kaiser Health News)

In case you missed it ...
The Amalgamated Order of Real Bearded Santas wants its members to be added to the priority list for H1N1 influenza vaccination, both because of their contact with children and their (likely) obesity. Meanwhile, states' attorneys general are investigating why liquid Tamiflu doses range in price from $43 to $130. That will put some retailers on the naughty list for sure. (New York Daily News, ABC News)

Labels: H1N1, health care reform, QD

QD: News Every Day--when evidence and politics collide

ACP Internist's daily digest of news and events continues with health care reform and how it intersects with the primary care shortage.

Health care reform
As far as the poll numbers are concerned, the public wants improvements to the healthcare system. (Who wouldn't want improvement, to anything?) But they don't want to pay for it themselves. (Los Angeles Times)

Primary care shortage
While waiting for the Senate to pick up the health care debate, newspapers' opinion sections are humming with analysis. ACP President Joseph Stubbs, FACP, and former ACP chapter governor for Massachusetts, Allan Goroll, MACP, say that health care reform is essentially a discussion of a primary care shortage. ACP's Tennessee chapter governor, Kenneth Olive, FACP, watches as his chapter's members struggle with the issues of cost, access to care, and inadequate numbers of primary care physicians on a daily basis. Sabitha Vasireddy, ACP Member, agrees. For the patients at her free clinic in Danbury, Pa., health care access is just as important as reform. It can't be worse than Oklahoma, which ranks 50th of the states in terms of active medical doctors per 100,000 population and last in primary care doctors. (The Hill, Kingsport Times-News, Danville News, Oklahoma City Journal Record)

H1N1 influenza
Despite an increase in deaths in Canada, official believe flu season may peak there earlier than predicted; 20% of the population has been vaccinated. (Reuters)

In case you missed it ...
Politicians are using evidence-based medicine as political fodder. Monday's announcement in the Annals of Internal Medicine stated that breast cancer screening recommendations should change. Now, opponents of health care reform are using it as evidence of government interference in health decisions--one slim step away from "death panels" and other easily disproven myths. (ACP Internist, Los Angeles Times)

Labels: health care reform, primary care shortage, QD

QD: News Every Day--payment fix inches forward (for this year, anyway)

ACP Internist's daily digest of news and events continues with incremental progress on fixing physician payments, and a double-take on Twitter during surgery.

Health care reform
Health care reform is increasingly unlikely to fix the annual threat of Medicare reimbursement cuts. For this year, at least, the U.S. House is expected to pass its part of the fix on Thursday. (Politico, New York Times)

Instead of a legislative solution, fixing health care will require a profound shift in what patients expect from a doctor's visit. And, the patient-centered medical home has to be at the center of any future health-care system, says one doctor. (WBUR FM of Boston, Indianapolis Star)

There won't be enough doctors to handle the uninsured, said one editorial. But, without health insurance, there are more deaths, said one survey that linked lack of insurance to ED mortality. (Wall Street Journal, AP)

In case you missed it ...
One article questions whether surgeons who broadcast procedures in- step-by-step detail using social media outlets such as Twitter are going too far. When patients do it, too, then maybe it's too much. (Biz Report, ACP Internist)

Labels: health care reform, primary care shortage, QD, social media

QD: News Every Day--not the intended effect

ACP Internist's daily digest of news and events continues with backlash from an analysis of proposed health care reform legislation, voices from middle American and an ACP Fellow's controversial stance on just how much money is wasted in our current health care system.

Health care reform
Medicare's chief actuary reports that legislation in the U.S. House would raise health care costs by $289 billion over the next 10 years and reduce benefits and access to services. (The Hill, Washington Post)

Meanwhile, 43% of Americans oppose the health care plans underway in Congress, 41% approve, 15% are undecided, the latest poll figures show. But opponents are more strongly against it than supporters are in favor, say numbers provided in a study by Stanford University and the Robert Wood Johnson Foundation. (AP/Washington Post)

Peter Reiter, FACP of Ottumwa, Iowa, describes the need for health care in his community, while Robert Vautrain, ACP Member, of Springfield Il., asks for a public option specifically. (Ottumwa Courier of Iowa, State Journal-Register of Illinois)

H1N1 influenza
Airlines are chafing at CDC recommendations that they filter air for H1N1 influenza even while at the terminals. They say it's costly, but just 20 minutes on the ground is long enough to spread the virus. (CBS 11 of Dallas-Forth Worth)

Primary care shortage
Concierge medicine rankles some in communities already stretched by a lack of primary care providers. Read how the controversy is playing out in Waco, Texas. (Waco Tribune-Herald)

Medical education
To accommodate the arrival of the first baby boomers, the American Geriatrics Society is proposing that elder care be added to the list of medical education's six core areas. (Boston Globe)

In case you missed it ...
Richard A. Cooper, FACP, blasts the vaunted Dartmouth Atlas for its statement that one-third of the nation's health care goes toward wasted expenses. He counters that the analysis is unfair toward urban hospitals, which treat more poor who lack primary care. His critics are just as harsh. But Dr. Cooper is not afraid of taking strong, pro-primary care position. He's taken on concierge medicine (opens as 1-hour video) and The Mayo Clinic. (Kaiser Health News)

Is Medicare fraud getting worse, or are the documentation requirements just becoming more onerous? (Washington Post)

Labels: concierge medicine, geriatrics, H1N1, health care reform, medicare, primary care shortage, QD

QD: News Every Day--flu's growing tally

ACP Internist's daily digest of news and events continues with the latest numbers on H1N1 infections, more respect for primary care and a boot-strap approach to health care reform in Kentucky.

H1N1 influenza
Swine flu has killed 4,000 people and sickened 22 million, according to new estimates released this week. More vaccine is on the way; the Food and Drug Administration approved GlaxoSmithKline's vaccines and the drugmaker expects to deliver 7.6 million doses by the end of the year. (Philadelphia Inquirer, AP/The Washington Post)

Evidence-based medicine
One path to less expensive health care is to look at the common tests and procedures that really don't work, or may have adverse effects in patient care. Meanwhile, drugs that were shown to reduce some forms of cancer go largely unused. (Forbes, New York Times)

Primary care shortage
Pauline Chen, MD, (a surgeon) writes that the first way to cure the primary care shortage is to improve its image problem. (New York Times)

In case you missed it ...
Rural Kentucky has high rates of some of the worst health in America. But it also has leading facilities and residents who took a boot-strap approach to health care reform. (Kaiser Health News)

Smoking rates are (slightly) rising again. (Philadelphia Inquirer)

Labels: evidence-based medicine, H1N1, primary care shortage, QD, rural medicine, smoking cessation

QD: News Every Day--no holidays for Congress

ACP Internist's daily digest of news and events continues with Congress' newfound work ethic and how the U.S. kept extra chickens on hand to help with H1N1 vaccine preparations.

Health care reform
Following its Veterans Day break this week, Congress may not make it home for any more holidays. The Senate may work right up until Thanksgiving to work on health care reform, said Majority Leader Harry Reid. Representatives in the House will be kept in session until Christmas, says House Majority Leader Steny Hoyer. (Roll Call, The Hill)

Having trouble keeping track of different versions of legislation in both chambers of Congress? This article breaks down the differences between bills in the House and Senate. (St. Petersburg Times of Florida)

H1N1 influenza
Special flocks of chickens were ready and waiting to prepare more eggs for flu vaccines, if needed. Seriously! Margaret Hamburg, FACP, Commissioner of the Food and Drug Administration, revealed this in a letter to America's health care professionals providing information on the safety of the 2009 H1N1 vaccines.

"Some of your patients may be asking how the FDA, the manufacturers and the scientific community can have confidence in vaccines that were available just six months after the 2009 H1N1 virus emerged," Dr. Hamburg wrote. "Understanding more about the manufacturing and approval process for these vaccines should help you to answer their questions." But why wait for the post office? The letter can be viewed at the FDA's Web site.

More than 41 million doses have been delivered for distribution, but layoffs and furloughs among public health workers have further delayed distribution, Anne Schuchat, FACP, told a Senate health subcommittee hearing. (Reuters)

Globally, China's authoritarian measures--quarantining villages or medically isolating entire planeloads of passengers--worked, officials there said. In contrast, the European Union saw its deaths doubled in three of the last four weeks. (New York Times, Washington Post)

Primary care shortage
In Davenport, Iowa local health officials are trying to encourage more doctors into rural practice, but face hurdles from physicians who fear low pay, lack of training and lack of technology at smaller hospitals. But they try to counter with low cost of living, reimbursement for education and a community lifestyle. (KWQC.com)

Labels: H1N1, health care reform, primary care shortage, QD

QD: News Every Day--dry, boring health care reform? Think again.

ACP Internist's daily digest of news and events continues with how health care reform issues play out in real life, how the next generation of doctors view primary care careers, and how hospitalists are changing primary care.

Health care reform
Health care reform debates might at times seem esoteric, appealing only to economists and actuaries. For political wonks, the issue is about balancing what's possible vs. what's achievable. But the impact of reform plays out in real life and upon real lives, as profiles in Maine show. There, the need for health care reform has never been more acute. (New York Times, CBS News)

H1N1 influenza
Just in time for Christmas: flu vaccines. Drugmaker Sanofi-Aventis expects to ship 75 million doses to the U.S. market by late December, their CEO told reporters. (Reuters)

If a smartphone made its way onto your holiday gift list, an app in development could diagnose colds and flus by how the user sounds when coughing into it. (Daily Telegraph)

Primary care shortage
An internal medicine resident in San Francisco relates his eyewitness accounts of how a lack of primary care plays out in multiple care settings. A University of Alaska Anchorage student chooses to answer the call. (Los Angeles Times, The Northern Light)

Hospital medicine
Winneshiek Medical Center finished its first year with a hospitalist program. The results:
--$72,000 profit,
--decreased emergency room transfers to other facilities of 15%,
--decreased patient length of stays and an increase in observation stays by 65%,
--steady patient satisfaction of 88%, with better discharge timing,
--happier inpatient nurses, and
--approval from primary care doctors and emergency room staff.

But hospitalists aren't universally appreciated. Marcy Zwelling-Aamot, ACP Member in Los Angeles, calls them a "substitute" brought in when patients most need their existing primary care doctor. Her editorial decries all the barriers that create a wall between patients and doctors. (Decorah Newspapers of Winneshiek County, Iowa, Press-Telegram of Long Beach, Calif.)

In case you missed it ...
Do we need health care reform or health insurance reform? More than health care politics, doctors are fed up with insurance companies--paperwork, arguing on the phone, fights for what patients need. Some say they'd take pay cuts if there was a model that let them practice medical care differently. In Connecticut, internists discuss the issue in terms of health insurance reform, not health care reform. (Philadelphia Inquirer, Greenwich Time)

An Indiana health clinic is letting those who can't afford care pay for treatments by volunteering elsewhere in the community. (NPR)

Labels: H1N1, health care reform, health insurance, hospital medicine, primary care shortage, QD

QD: News Every Day--more time, more patients, more quality

ACP Internist's daily digest of news and events continues with a snapshot of health care reform, as well as a look at an ACP member's findings that doctors are spending more time with more patients, and still providing better care across nine quality measures.

Health care reform
The focus has now shifted to the Democrats for health care reform.
--Some Democrats don't think it slows health spending enough.
--Some Democrats think it pits young constituents against elderly ones.
--It's either pragmatic and flexible or just as good as it gets.

As the debate moves back to the Senate next week, there's five "flash points" to consider. (New York Times, Wall Street Journal, Politico, The Hill, Cristian Science Monitor)

Patient encounter
Doctors are spending more time with their patients--21 minutes in 2005 compared to 18 minutes in 1997, reports Lena Chen, ACP Member. And, primary care visits increased 10%, from about 273 million visits in 1997 to 338 million in 2005. Yet, quality is improving across nine performance measures. The population is aging, which requires more time, but also health care in general is more complex now. And, patients are better informed and more engaged. (U.S. News & World Report)

In case you missed it ...
Medical education is changing to focus on health care reform, the patient-centered medical home and patient communication, and leaving anatomy for later. Genetics, demography and the environment are being included. Students are helping design the curriculum, too. What's going on? (Washington Post)

Kaiser Health News looks back to 1977 for a familiar scenario--politicizing living wills that might lower unneeded or unwanted health care use at the end of life.

Labels: health care reform, living wills, medical education, patient communication, patient-centered medical home, QD

QD: News Every Day--health reform ready to reconcile

ACP Internist's daily digest of news and events continues with updates from the weekend's passage of health reform in the U.S. House, a global look at H1N1 influenza, and a look at a local hospitals attempt to make a profit by hiring an internist.

Health care reform
Health care passed in the U.S. House over the weekend, and now pressure is on to reconcile it all in the Senate and with the White House. (Kaiser Health News, New York Times, Los Angeles Times)

H1N1 influenza
It hasn't been just H1N1 influenza vaccines in short supply. Hand sanitizers are also evaporating in the face of increased demand. One manufacturer is running its plants around the clock with increased workers, and has asked customers not to stockpile. (CNN)

Globally, an Amazon tribe faces hundreds of infected members and possibly seven deaths from H1N1. Meanwhile, Saudi Arabia's health minister received the H1N1 vaccination on television to calm fears and encourage vaccination among those participating in the Hajj, the once-a-lifetime pilgrimage required of Muslims. (BBC, CNN International)

New Scientist examines H1N1's impact throughout history.

Smoking cessation
America's new "anti-smoking czar" lays out his goals as head of the FDA's new agency, the Center for Tobacco Products: reduce youth smoking rates, reduce tobacco-related disease, and inform the public about tobacco products' ingredients. (Courier-Journal, Louisville, Ky.)

In case you missed it ...
Unicoi County Memorial Hospital in Tennessee was losing money. The hospital's auditor helpfully suggested, "We'd always like to see the hospital have an income." So board members hired an internist and a surgeon to join the staff. Read about their gamble to break even. (The Erwin Record)

Labels: H1N1, health care reform, hospital medicine, QD, smoking cessation

QD: News Every Day--waiting for the weekend

ACP Internist's daily digest of news and events continues with this weekend's expected vote on health care reform, H1N1 influenza's ascendance as the dominant strain, and Texas' look at doctor-owned hospitals.

Health care reform
Everyone is gearing up for the expected weekend vote in the U.S. House on health care reform. ACP President Joseph W. Stubbs, FACP, said while the legislation doesn't have every proposal the organiation wants, it "... would represent an historic step forward to achieving ACP's desired future of a U.S. health care delivery system that provides access, best quality care and health insurance coverage for 100% of its people." The American Medical Association is supporting it, with its president saying in a press release that while the legislation is not perfect, "It goes a long way toward expanding access to high-quality affordable health coverage for all Americans, and it would make the system better for patients and physicians."

While the Congressional Budget Office estimates the legislation will cost $894 billion over 10 years and reduce the national deficit by $30 billion, the actuary for the Centers for Medicare and Medicaid Services said he may not have an estimate ready by the weekend vote. While Congress is bound to budget office estimates, CMS figures may sway some votes. (The Hill)

H1N1 influenza
H1N1 influenza is now the dominant strain globally. Obesity may be a factor for complications. More on this will be reported in ACP InternistWeekly on Tuesday. (CNN, CBS News)

In case you missed it ...
This weekend's New York Times Magazine features the debate about evidence-based medicine--clinical judgment squares off against the scientific method, and what happens when doctors at Intermountain Healthcare create their own evidence base.

In Texas, legislators are debating how to treat doctor-owned hospitals. Texas has 67 physician-owned hospitals with about 50 more expected to open, state Rep. Sam Johnson told the Dallas Morning News. While pending legislation would severely curtail existing facilities and prohibit new ones, amendments may grandfather the existing ones. At is issue is whether these facilities cherry-pick the wealthiest patients.

Labels: evidence-based medicine, H1N1, health care reform, QD

QD: News Every Day--health care reform's eerie repeat history

ACP Internist's daily digest of news and events continues with updates on health care reform, "swine" flu in a cat, and two views on fixing the shortage of primary care doctors.

Health care reform
Health care reform is streaking toward a vote in the U.S. House Saturday, but is it just a case of history repeating itself--specifically, the Clintons' 1994 effort? A New England Journal of Medicine paper analyzed 30 public opinion surveys and compared the shift in public opinion, both then and now. (AP, Boston Globe, NEJM)

Waiting in the wings, the Senate's legislation is facing opposition from surgeons and other specialists. (The Hill)

One aspect of health care that needs reform is the practice of defensive medicine. One doctor was profiled about why he encourages patients not to get unneeded tests, and then capitulates if the patients insist. (AP)

Primary care shortage
Op-eds in two major dailies agree that fixing the shortage of primary care doctors is an important component of health care reform. You wouldn't normally expect the Los Angeles Times and Wall Street Journal to agree on anything but the rising cost of newsprint.

H1N1 influenza
Swine flu has jumped from a cat owner to the pet, ABC News reports.

In case you missed it ...
In case the mainstream media misses something, there's always a blogger who digs a little deeper and finds it. Hats off to the person who found this outlier right in the middle of the U.S. House legislation on health care reform--a tax credit for second generation biofuels. (FireDogLake.com)

And, an economist offers "vaguely heretical" musings on the proposed legislations floating around Congress. His social conscience doesn't override his desire to balance the books. (The New Yorker)

Labels: H1N1, health care reform, primary care shortage, QD

QD: News Every Day--health care reform's 'sunshine provision'

ACP Internist's daily digest of news and events continues with findings that N95 respirators weren't all they were cracked up to be, and a look at disclosing more about doctors' financial ties with industry.

H1N1 influenza
Authors retracted findings that N95 respirators were better than surgical masks at preventing flu, causing a stir at the Infectious Diseases Society of America meeting, where the retraction was announced. Reviewers questioned the study, and re-analysis resulted in the findings being no longer significant. The original study spurred guidance from the Centers for Disease Control and Prevention and the Institute of Medicine on using the masks.

Blogger Gerald O'Malley, DO, says that he's not getting vaccinated. Hospital administrators are pressuring him, he sees flu patients in emergency wards and his two kids have it. But he's not budging. Neither are college students. (Physicians Practice, The Washington Post)

"Presenteeism" could exacerbate flu's spread, public health leaders said, since 39% of all private-sector workers do not receive paid sick days, (Bureau of Labor Statistics figure). They also send their sick kids to school because they have to work. (New York Times)

Health care reform
Legislation in the U.S. House could get a vote as early as Friday night, But in the senate, Majority Leader Harry Reid isn't making any promises to pass legislation this year, which could frustrate the White House if it delays health care reform until 2010. (The Hill, CBS News, AP)

One aspect of health care reform legislation includes "sunshine provisions" intended to disclose the financial relationships between the medical industry and doctors and hospitals. It's been tried before, though, and bioethicist Bernard Lo, FACP, argues that sunshine provisions don't go far enough. It needs to include other health professionals, and academic research. A survey in Health Affairs found that 53% of academic research faculty in the life sciences at top schools reported financial ties to industry. (New York Times, Wall Street Journal)

Labels: ethics, H1N1, health care reform, QD

QD: News Every Day--health care reform splits urban, rural hospitals

ACP Internist's daily digest of news and events continues with the focus of health care reform shifting toward the U.S. House of Representatives. Also, urban and rural hospitals eye each other for the lion's share of reimbursement.

Health care reform
Legislation released in the House faces opposition from abortion and immigration. The $1.2 trillion price tag over 10 years made many take a second look at what Americans would get for their money. Meanwhile, the deadline for potentially passing legislation is slipping into next year. (AP, Politico)

Rural and urban hospitals would fare differently under health care reform. For example, New York City facilities are worried about losing money to Iowa; Iowa, in turn, is already worried about subsidizing urban areas. (New York Times, WQAD.com)

H1N1 influenza
Pregnant women and children ages 10-17 need only one dose to inoculate against H1N1 influenza. But children ages 6 months to nine years still need two doses for best efficacy. Anne Schuchat, FACP, reports that half of all vaccinations have gone to minors. While the World Health Organization is recommending one dose for all kids and the use of adjuvanted vaccines to stretch supplies, U.S. officials are still recommending two doses. Adjuvanted doses have not been cleared for use in the U.S. Research on them was reported in the Sept. 15 ACP InternistWeekly. (Washington Post, Washington Times, New York Times)

Scientists have used a supercomputer to predict a third wave of H1N1 coming this spring. But others want to use handheld devices to predict which individuals might get sick before they actually do. (Wall Street Journal)

Labels: flu, H1N1, health care reform, hospital medicine, QD

QD: News Every Day--the public option as a Straw Man

ACP Internist's daily digest of news and events catches up with newly appointed Surgeon General Regina Benjamin, MD, fears about adverse reactions to H1N1 vaccinations, and why one ACP member says hope for recovery isn't always the best for a patient.

Surgeon General confirmed
Newly confirmed Surgeon General Regina Benjamin said preventive medicine will be her priority, following her confirmation by a unanimous Senate vote late last week. Month before, during a press conference announcing her nomination, she had spoken about losing relatives to lung cancer, diabetes and other lifestyle-related illnesses. (al.com)

Health care reform
For all the fuss over the public option, the Congressional Budget office estimates that 2% of the nation, 6 million in all, would enroll in it. (AP/The Washington Post)

Barry Izenstein, FACP, Governor of ACP's Massachusetts Chapter, writes that health care reform should cover all Americans, create more primary care doctors and reform medical liability. (The Springfield Republican)

Meanwhile, Peter Boling, ACP Member, is undertaking his own effort at health care reform by falling back on the old-fashioned house call. The House and Senate are considering such measures as part of the "Independence at Home" provision of current legislation. (AP)

H1N1 influenza
Independent experts started today tracking adverse events from the H1N1 vaccine to spot any real problems quickly, explain false alarms and separate normal disease rates from potential yet real risks. (AP/Boston Globe) There's a basis to the fear of H1N1 vaccination, and it's generational, says one psychologist. (Psychology Today)

In case you missed it ...
Sometimes, it's better to lose hope for recovery, University of Michigan researchers said.

Peter Ubel, ACP Member, teamed up on a study that noted while it's important not to lose hope, it's also important to realize that hope might make some people unhappier because they fall into a holding pattern of sorts, waiting for their condition or chronic pain to wane before moving on with their lives. They compared outlook among patients who'd just had colostomies. Some were told the procedure would be reversible, and some were told the procedures were permanent. He explains more about hope's "dark side."

Labels: H1N1, health care reform, patient communication, QD

QD: News Every Day--the Halloween edition

Doctors who are ghostwriting has recently come to the fore recently, so now we're writing about ghosts for our doctors. Enjoy ACP Internist's Halloween edition of QD: News Every Day.

First, physicians are looking at near-death experiences and trying to come up with answers about them--the bright light at the end of the tunnel, for example. It may have a neurological cause, but why do so many people all report a common experience? If a near-death experience has left you terrified, then it's not entirely a myth that your hair could turn white overnight.

For those of you trying to stave off death one more day through exercise, here's one fitness trainer's fun idea: use pumpkins for your workout instead of for pies. This one is worth the click-through just for the photos (putrid pushups, devilish diagonal chops and more).

Next on this haunted tour, Dr. Justina Ford, the first black woman to practice west of the Mississippi, is said to still haunt her office and home. Further west and further back in time comes this folklore about a physician who gets help from beyond the grave in making the correct diagnosis.

Coming back into a more modern concern, A Happy Hospitalist writes about spooky contact lenses being commonly available, even though they require a prescription. Finally, hospitalist Jamie Newman, FACP, tells his tale of working the graveyard shift at locum tenens facility that's off the beaten path.

Labels: QD

QD: News Every Day--public option in da House!

ACP Internist's daily digest of news and events covers how health care reform is being reconciled in Congress, how the primary care shortage impacts local emergency rooms, and how community doctors in Bermuda are reacting to the introduction of hospitalists.

Health care reform
While the Senate stares down a threatened filibuster of legislation that includes a public option, the House introduced its version, which includes it. As the House and Senate reconcile their respective bills into one per each chamber,
Cecil B. Wilson, MACP, who is also the American Medical Association's president-elect, told Floridians at a union-sponsored rally that the majority of Americans, including physicians and AMA members, want reform. (Washington Post, Miami Herald)

Primary care shortage
A column in The Olympian (Olympia, Wash.) points out that the community already has universal health care. Unfortunately, it's the local emergency room. In Palm Beach, Fla., county commissioners are considering whether to build a public hospital for just that purpose. Jose Arrascue, ACP Member, representing the Palm Beach County Medical Society, told commissioners, "We believe the health care delivery system in Palm Beach County is in critical condition. We have escalating numbers of uninsured, diminished access to care, an aging physician population and a lack of specialty care." (Palm Beach Post)

University of Pennsylvania bioethicist Arthur Caplan told an audience in Bakersfield, Calif., that one way to alleviate the primary care shortage is to forgive medical school loans. (Bakersfield.com)

H1N1 influenza
Now, there's an app for that. Harvard Medical School has launched an iPhone application that includes information on the pandemic's spread, practical steps people can take to mitigate their risk of infection, key symptoms to watch for, and what to do in case of infection. The application includes text, video and links to government databases. It also provides information to businesses for managing through the pandemic. People need all the help they can get. Richard Wenzel, MACP, reports that half of all outpatient H1N1 influenza cases don't develop a fever, so the patients don't take precautions. Even among hospitalized patients, 15% don't get a fever. (Minnesota Public Radio)

In case you missed it ...
Family doctors claim that the switch to hospitalists has shut them out of their community hospital ... in Bermuda. The chief of staff at King Edward VII Memorial Hospital feared being hanged in effigy outside his office after general practitioners lost their hospital privileges and communication suffered between community and hospital doctors. But, the chief said outcomes have improved and the move is needed as his facility moves from being a rural provider to a modern metropolitan facility. (Bermuda Sun)

Labels: flu, H1N1, health care reform, hospital medicine, primary care shortage, QD

QD: News Every Day--public option unsettles Senators

ACP Internist's daily digest of news and events wraps up how the public option has shifted the balance of opinion in the Senate, how the public itself has shifted on H1N1 vaccination, and the economic impact of a rural physician.

Health care reform
The introduction of a public option has precariously shifted Senators' support. Democrats are divided. What bi-partisan support there was has evaporated. Liberals are happy, but that won't carry the day. (AP, Los Angeles Times, Boston Globe)

H1N1 influenza
Some hospitals are seeing their emergency department patient volumes double from H1N1 influenza as doctors are being recruited as the flu police, trying to prioritize who gets vaccinated. To ease the crunch, more than 22 million doses of H1N1 flu vaccine are now available now, and health officials are still saying better late than never. (USA Today, New York Times, AP/MSBNC.com)

Data produced by a supercomputer shows that there could be a third wave of the H1N1 virus in the spring. The University of Texas is using
the "Ranger" supercomputer to make its predictions. (KXAN-TV)

Handshaking was out, and now so is the simple fist bump. Here's some humorous ways to greet people. (NPR)

In case you missed it ...
Doctors' economic contributions are as important to rural communities as their medical ones. The National Center for Rural Health Works estimates that a rural hospital loses $236,565 from clinic visits and $451,169 net revenue for every half-a-physician they are short. When extrapolated to include services purchased by the physician, the clinic and employees, the shortage translates to 13.8 jobs and $533,493 in income. (Iowa Independent)

Irving Harper, ACP Member, discusses how he handles his patients with e-mail, cell phone and video chat. Ahhh, but it's good to practice in Hawaii. (U.S. News & World Report).

Labels: H1N1, health care reform, health information technology, QD, telemedicine, vaccination

QD: News Every Day--the need for health reform

ACP Internist's daily digest of news and events continues with more on how the need for health care reform plays out across the country, as well as the uneven distribution of H1N1 vaccines.

Health care reform
Sen. Reid's announcement of a public option in Senate legislation follows statements by legislators who said they'd oppose any bill without it. He still doesn't have 60 Senators on board to prevent filibuster. (AP/The Washington Post)

ACP Fellows continue to vent about the need for health care reform. In the latest op-ed, Rod Hochman, FACP, CEO of Swedish Medical Center in Seattle, talks about how the patient-centered medical home plays out in what he calls "the other Washington." (The Seattle Times)

The largest private group practice in Kansas City, Mo. has stopped accepting walk-in Medicare patients. At Kansas City Internal Medicine, 65% of its nearly 70,000 active patients are 65 or older. Keith Jantz, ACP Member, says that it's a harbinger of things to come if Medicare reimbursement is cut by 21%. (CNN) It's a situation that one patient experienced in Grand Junction, Colo. (KJCT8.com )

A Thomson Reuters piles on the blame, finding the health care system wastes between $505 billion and $850 billion every year, about a third of the overall bill. (Reuters)
--antibiotic overuse and lab tests to protect against malpractice are 37% of the wasteful spending, or $200 to $300 billion a year,
--fraud is 22% of waste,
--administrative inefficiency and redundant paperwork are 18%, and
--mistakes are 11%.

H1N1 influenza
Despite shortages and some tales of uneven or nonsensical distribution, the vaccine is worth getting late rather than never, said Health and Human Services Secretary Kathleen Sebelius. (ABC News; Los Angeles Times; GetBetterhealth.com; AP/The Washington Times) Also, USA Today breaks down H1N1 flu incidence by region.

In case you missed it ...
One medical student prefers primary care, despite the financial shortfalls he'll face. His profile is here. (Minneapolis Star Tribune)

Labels: flu, H1N1, health care reform, primary care shortage, QD

QD: News Every Day--H1N1 'emergency' and vaccine shortage

ACP Internist's daily digest of news and events continues with H1N1 updates, and physicians speaking out about health care reform.

H1N1 influenza
The weekend's health news had one theme: President Obama declared a national emergency, coupled together with pictures of long lines of people waiting for vaccines. Lines formed despite the large numbers of people refusing to get inoculated. (Half of all Canadians!)

Health insurance
Health care reform may have to start at the (medical) home. Eleven percent of health care workers are uninsured. Ambulatory care workers are three times as likely as hospital employees to not have insurance; residential care workers are four times as likely; and service workers are 50% more likely to be uninsured than those involved in treatment. Meanwhile, Blue Cross Blue Shield of Florida, that state's largest insurer, is moving its 5,000 employees to a high-deductible insurance plan linked to health savings accounts.

In case you missed it ...
Internist Randy Silverstine, MD, turned his solo office into a concierge practice but only charges $600 a year, a fraction of what others have charged. He joins the ranks of the 12% of internists who no longer accept health insurance. "This was the only way I knew how to keep practicing the kind of medicine I loved," he told the Sarasota, Fla. Herald-Tribune.

ACP Fellows are sounding off about health care reform. Charles M. Fischman, FACP, spells out how the possibility of a 21% cut in Medicare reimbursement would play out in Florida--with a mass exodus, he predicts. Paul Dolinsky, FACP, says there's plenty of blame to spread around for rising costs.

Labels: flu, H1N1, health care reform, QD

QD: News Every Day--slow start for H1N1 vaccine

ACP Internist's daily digest of news and events continues with the answer to the age-old question: Which came in first, H1N1 influenza or its egg-based vaccine?

Twenty percent of U.S. children had a flu-like illness earlier in October, and most of them likely H1N1 flu. And 7% of the surveyed adults said they'd had a flu-like illness in the past week, according to a household survey of more than 10,000 adults done in the first 11 days of October. Now, an already slow process of using chicken eggs is now burdened by vaccine-makers trying to make diseases for seasonal and H1N1 strains. Also, the virus on which the swine flu vaccine is based reproduces very slowly in eggs, moreso than seasonal flu.

New York City is seeing fewer cases than expected, but Philadelphia's childrens' hospitals are already hunkering down from ER cases that probably could have been treated at home. Both cities had been suggested to have acquired a "herd immunity" from having been hit so hard in the spring.

Leave it to Moody's to break it down into investment advice. Hospitals usually see some positive cash flow during flu season, but H1N1 could muddle the picture.

And, don't miss the H1N1 robotic simulator.

Health care reform
Senators met with White House officials Thursday evening to discuss how to merge the two health care reform bills in the Senate. Politico reported negotiators are contemplating a national government health plan, but allowing states to opt out. But then it's not a national plan ...

Labels: flu, H1N1, health care reform, QD

QD: News Every Day--health care reform and H1N1

ACP Internist's daily digest of news and events continues with health care reform, H1N1 influenza and how primary care shortage issues play out regionally.

Health care reform
Halts to the annual cuts to physician reimbursement under Medicare died in the Senate because legislators objected to $247 billion in unfunded costs over the next decade. Enough legislators from both parties objected to an effort to freeze reimbursement for 10 years while Congress found an alternative to the sustainable growth rate formula. ACP President Joseph W. Stubbs, FACP, said, "Although many [legislators] will claim that their vote against cloture was a vote for fiscal responsibility, there is nothing fiscally responsible about pretending that Medicare will save money, from cuts that Congress has no intention to let go into effect, in order to make it seem like Medicare will spend less than it really will."

Meanwhile, some versions of health care reform legislation in the U.S. House would raise the rate of medical spending, not lower it, reports the Office of the Actuary, an independent arm of the Centers for Medicare and Medicaid Services. Spending would increase by 2.1% over 10 years, or $750 billion, because 34 million more people would have health coverage, according to the report. (Wonks can read it here.)

A lesson can be taken from Massachusetts physicians, who support their health care reform laws by a 5-to-1 margin, albeit with some desired changes, reported the Boston Globe. That's slightly higher than in the rest of the public, according to the most recent general poll by Robert Wood Johnson Foundation and Blue Cross Blue Shield of Massachusetts Foundation. Highlights include:
--Two-thirds of doctors say the law has not diminished the quality of care;
--19 percent say it has improved quality;
--62% say the law has not affected the amount of time they spend with their patients; and
--Nearly 80% say the law had no negative impact on their practice overall or had a positive impact.

The original study was published in the New England Journal of Medicine. Health care reform can expand access but not reduce costs, if lessons from Massachusetts teach us anything, reports The Christian Science Monitor.

H1N1 influenza
Production of a vaccine for swine flu virus is behind schedule, said Anne Schuchat, FACP, director of CDC's National Center for Immunization and Respiratory Diseases. Officials expect "widespread availability" by mid-November.

Meanwhile, public radio presents more on "presenteeism" and how a lack of sick days forces some sick workers to show up.

Primary care shortage
ACP's governor of its Connecticut Chapter addresses why so much money is spent on some health care items, such as prescription drugs, medical scans and durable medical equipment, and not on more important areas such as public health education and training medical students. The consequences are dire, as this profile of the Sacramento, Calif. area shows. California has 59 primary-care physicians per 100,000 citizens, whereas 60-80 considered sufficient.

Labels: flu, H1N1, health care reform, primary care shortage, QD

QD: News Every Day--SGR cuts stalled

ACP Internist's daily digest of news and events continues with more on SGR cuts, and one physician who reformed health care in Oregon from the inside, as a legislator and later as governor.

SGR cuts
Legislation to permanently fix the annual threat of sustainable growth rate (SGR) cuts to Medicare physician payment formula has stalled. Some legislators balked on voting for it because the $247 billion price tag over 10 years wasn't offset elsewhere. Permanently ending annual SGR cuts were part of a quid pro quo deal between doctor's groups and Senate Majority Leader Harry Reid; eliminate the SGR in exchange for supporting overall health reform. The money would hold reimbursement where it is until Congress can create a better way to reimburse for Medicare.

Since political debate involves a lot of name-calling, one legislator compared the American Medical Association's position to prostitution for its support. The AMA promptly got all dolled up and released 22 "patient access hot spots" nationwide that the organization claims highlights the impact of Medicare cuts. The AMA analyzed state-level data on five access measures and declared hot spots are based on their ranking in the top 15 of at least two of five measures of access:
-- practicing physicians per 1,000 Medicare beneficiaries,
-- Medicare beneficiaries below 150% of the federal poverty level,
-- estimated underserved population living in primary care health professional shortage areas,
-- hospital emergency room visits per 1,000 population, and
-- percentage who hadn't seen a doctor in the past 12 months because of cost.

In case you missed it ...
A physician enacted health care reform in Oregon, first as president of the state's Senate and then as its Governor. The Oregon Health Plan prioritized medical services by value and the number of services covered was determined by how much money the legislature appropriated. It was radical and it worked. Kaiser Health News profiles the physician.

Meanwhile, ACP governors from Nebraska and North Dakota and a member from Green Bay, Wisc. chimed in their support for health care reform.

Labels: health care reform, medicare, QD, reimbursement

QD: News Every Day--Senate considers SGR overhaul

ACP Internist's daily digest of news and events continues with the tantalizing prospect of permanently ending the annual SGR cuts, changing public support over health care reform, and Maine's effort to recruit medical students to its rural areas.

SGR cuts
The Senate considers today closing debate and proceeding to vote on a way to permanently end annual SGR cuts. This year, a 21% reduction is on the line, which would prompt primary care doctors to stop seeing Medicare patients. Democrats and Republicans had put off the procedural step, called a cloture vote, to allow time for consensus on the issue instead. ACP reports what doctors can do ahead of this key vote. The separation of SGR cuts from health care reform was done in exchange for physician support for both items.

Health care reform
The Robert Wood Johnson Foundation found that about one-third of Americans worry about losing health care coverage, a slight increase from last month. The number of Americans who worry about losing coverage in the next year has increased by 11% points since the spring. Young adults are the most often concerned (40%), followed by middle-aged (38%) and then seniors (29%) even though they have Medicare.

The Washington Post reports 57% of all Americans now favor some form of a public insurance option while 40% oppose it. More specifically, 45% of Americans favor current outlines in Congress, and 48% are opposed.

H1N1 influenza
H1N1 influenza--"swine flu"--has finally been confirmed in pigs. The agriculture department confirmed that a pig exhibited at the Minnesota State Fair was infected, and that the infection was unrelated to teenagers there who later became sick. But, three other piglets may have become ill after being handled by humans.

In case you missed it ...
Tufts University School of Medicine in Boston and the State of Maine will offer all Maine-based students half-tuition scholarships for those who agree to clinical practice in rural Maine. The students will spend most of the first two years in Boston studying at Tufts’ main campus, then get immediate hands-on experience traveling around rural locations in the state. Maine used Recovery Act stimulus package funds and private sources for the scholarships and hopes in return to retain 75% of students as doctors after graduation.

Also, Illinois' largest insurer is launching a patient-centered medical home pilot. The Chicago Tribune spells out how it might work.

Labels: H1N1, health care reform, medical education, QD, reimbursement

QD: News Every Day--the H1N1 fist bump

ACP Internist's daily digest of news and events continues with ways to avoid spreading the flu (and how it's making us rude), Michigan's proposed doctor tax, and a review of evidence-based medicine.

H1N1 influenza
A feature story profiles how ways to avoid spreading disease are making society less civil (fist bumps instead of handshakes) Thomas Fekete, FACP, says that it's only reducing risk by 1%-2%.

Primary care shortage
Michigan is considering taxing physicians. They propose a 3% physician tax to offset Medicaid cuts to hospitals. The measure could generate $300 million, which would recoup another $525 million in matching federal money. Michigan's hospitals, nursing homes and health plans already pay a physician tax, as do 44 other states. The Michigan State Medical Society Michigan Osteopathic Association oppose it, saying it will exacerbate the primary care shortage and shortchange specialists, but the Michigan College of Emergency Physicians supports it, saying the tax would fund increased reimbursement for Medicaid, which in turn would encourage more primary care doctors to accept those patients.

On the plus side of the balance sheet, Pikeville College will expand its School of Osteopathic Medicine to reduce the primary care shortage in eastern Kentucky. The $4.5 million expansion may eventually increase each year's class from 75 to 125 students. Of course, once they're students, they're overwhelmed by the pace and the scope of school loans, as profiles in northwest Indiana relate.

Evidence-based medicine
One doctor relates the dangers of trying to apply rigorous reviews to individual patients, in this case, his own mother. Another caveat to evidence-based medicine is who's providing the evidence base. Online health sites that allow patients to directly compare (sometimes unapproved) treatments and outcomes are cropping up more rapidly--nearly 500 by now. These sites combine social media with aspects of wiki-style medical references and evidence-based medicine. Patients are turning to them for H1N1, for example. ACP Internist profiled one such site and the controversy it generated a year ago.

Labels: evidence-based medicine, flu, H1N1, primary care shortage, QD

QD: News Every Day--One stolen laptop threatens all doctors' personal data

ACP Internist's daily digest of news and events continues with a stolen laptop's threat to physician's personal info, plus the Senate voting and voting and voting on physician payments, and the reasons why the public is so divided on the way they view public health issues.

Almost all U.S. physicians, 800,000 total, have been warned that a stolen laptop had their names, addresses social security numbers and provider identification numbers on it. An employee of the trade group representing Blue Cross insurance plans moved information to a personal laptop that was then stolen, which leave as many as 20% of all doctors vulnerable to identity theft.

H1N1 influenza
The World Health Organization urged prompt antiviral treatments in people with suspected H1N1 flu because it can lead to pneumonia so quickly in young, otherwise healthy people.

Physician payments
A bill that would increase Medicare payments to physicians will require three votes by the Senate--needing 60 votes each time--before the Senate can take a fourth vote. Greatest legislative body in the world, indeed. Oh, and the Congressional Budget Office estimated the $240 billion bill will actually cost $247 billion over 10 years.

Primary care shortage
A blog post explaining the reasons why there is a primary care shortage doesn't offer any new insight so much as it puts all the reasons in one easy-to-read place. These aren't esoteric issues; they play out in real life all across the country, as this profile explains what's happening in Omaha.

In case you missed it ...
Much of the disconnect on health care reform can be explained by political beliefs, researchers reported in the American Journal of Public Health. They tested a news article describing how a lack of sidewalks and presence of fast food were linked to type 2 diabetes. Republicans were less likely to believe junk food led to a diabetes epidemic than Democrats. Researchers told ABC News that the same message has to be framed differently to the two audiences to garner support.

Labels: H1N1, medicare, physician shortage, QD

QD: News Every Day--legislative tricks, treat the underserved and banning sick kids ... from hospitals

ACP Internist's daily digest of internal medicine in the news continues with a look at legislative tricks for health legislation, a medical school that sends students into poor neighborhoods as part of their training, and hospitals that are enacting bans on minor visitors to avoid spreading H1N1.

Health care reform
Senates are seeking a bill that increases Medicare fees by $247 billion in the next decade. Because it will raise the deficit, Senators are trying a two-bill approach, a bit of legislative sleight-of-hand, to let them claim that health care reform won't cost more. At stake is a 21% reduction in Medicare reimbursement that was is scheduled to take effect in January.

In another bit of having one's cake while eating it, too, seniors will pay more for Medicare Advantage when costs increase from an average of $32 to $39 per month next year. Insurers are cutting plans that have no premiums--a federal requirement. Also being scrutinized are the free perks meant to entice traditional Medicare patients into private Medicare Advantage policies. But free to patients means paid for by the government--or sometimes hidden as higher co-pays and additional fees.

Investor's Business Daily points out a looming fight between primary care and specialty medicine. Legislation in the Senate gives primary care doctors a 10% bonus if they work in a Health Professional Shortage Area and 60% of their services are primary care. Half of the funding for the bonus comes from across-the-board cuts for specialists, who are refusing support.

Primary care shortage
Federally qualified clinics could treat more than 20 million patients this year, 2 million more than last year, the AP reports. The increase comes at a time that states are cutting their health care budgets.

To serve this need, Florida International University curriculum will send medical students to poor neighborhoods as part of their training. TIME profiles the program (and quotes ACP president Joseph W. Stubbs, FACP in the process.)

Finally, an emergency room doctor wrote an open letter to President Obama, making the points that:
--people without health care head to ER for treatment,
--medical training is expensive and causes primary care shortages, and
--legislators would discuss the space program without involving astrophysicists, so it's time to get doctors involved in health care reform.

These are all familiar points, but the letter is worth a read.

In case you missed it ...
To avoid spreading H1N1 influenza, hospitals have begun banning visitors less than 18 years old. These are children's' hospitals, too. M.D. Anderson followed suit, as well.

Labels: flu, health care reform, medical education, medicare, primary care shortage, QD

QD: News Every Day--The disconnect of health reform

ACP Internist's daily digest of internal medicine in the news continues with the disconnect on health care reform, a larger analysis of who was hospitalized for H1N1, and more on the primary care shortage.

Health care reform
Americans want health care reform to change, but they don't want to pay for it.

Meanwhile, the Economic Policy Institute, a think tank focused low- and middle-income Americans, points out that Medicaid and the SCHIP held in check the number of children who would have gone without health between 2000 to 2008. Children without insurance dropped 1.7% between 2000 and 2008, while adults less than 65 without insurance rose 3.1%. By contrast, children with public coverage grew 8.8%, compared to a 3.5% increase for the adult population under 65.

H1N1 influenza
Health officials now say that 46% of 1,400 adults hospitalized with H1N1 influenza did not have a chronic underlying condition, according to the largest analysis to date. The study looked at adults and children hospitalized from April through August in 10 states at medical centers participating in a special disease surveillance network. Anne Schuchat, FACP, who heads the CDC's National Center for Immunization and Respiratory Diseases, said the larger analysis looked at underlying conditions not previously examined. Among adults, 26% had asthma, 10% had diabetes, 8% had some other chronic lung disease, 8% had weakened immune systems and 6% were pregnant.

Primary care shortage
A financial advisor chimes in with his analysis of why primary care doesn't pay, including input from his own internist. The doctor says, "The average income of a primary care doctor in Massachusetts is about $86,000. Why do I do it? Because I love it."

The medical home
Profiles of practices trying the patient-centered medical home include Greenhouse Internists in Mt. Airy, Pa. and the Adirondack Regional Medical Home Pilot, which also an effort to stop the loss of primary care practitioners in the region. And for a lighter note, don't miss ACP Internist's own Stacey Butterfield's report from the MGMA meeting in Denver.

In case you missed it ...
In Minnesota, the Vitality Project prompted one town to build sidewalks and bike trails; restaurants, groceries and schools to push healthier foods; and employers to give workers time to exercise. The experiment added an average 3.1 years to the longevity of about 2,300 residents who calculated their lifespans by answering 36 lifestyle questions.

Labels: diet, exercise, flu, H1N1, health care reform, health insurance, health policy, patient-centered medical home, primary care shortage, QD

QD: News Every Day--Senate committee passes health care reform

ACP Internist's daily digest of internal medicine in the news continues with a key vote on health care reform, severe flu cases and an ACP Fellow honored for treating the poor.

Health care reform
[Updated from its original post] At nearly 3 p.m. today the Senate Finance Committee approved its version of the health care reform bill 14-9. Observers were atwitter (and a-Twittering) every time Republican Sen. Olympia Snowe so much as shifted in her seat. Eventually, she shifted to the left and said she would vote for the bill in committee without taking a position down the line.

Following today's vote, the bill will merge with the Senate Health Committee's version over the next few weeks and then go to the full Senate. On the House side, Rep. Nancy Pelosi will send several versions of a health care reform bill to the Congressional Budget Office, including one with a government-run public insurance option.

Even if a bill is signed into law this year, it will take three years before any tax credits begin.

H1N1 influenza
About 1 in 1,000 will develop severe illness from H1N1 influenza, and when they need hospitalization, they quickly consume limited resources such as mechanical ventilation, according to JAMA. Researchers profiled the outbreaks in Canada and Mexico, and an editorial suggested regionalizing care for patients with advanced respiratory failure. Alternatives also include telemedicine and temporary staffing changes to divert experts to the point of care.

In case you missed it ...
Pedro Jose Greer, FACP, of Miami, Fla. received the 2009 Presidential Medal of Freedom for his work treating the poor regardless of their ability to pay. His profile is here.

You know times are tough when even the Mayo Clinic, the model for health care, get criticism for limiting Medicare patients to Minnesotans and the border states of Iowa, Wisconsin and the Dakotas. But if you're wealthy, you can turn to your financial planner for Medicare advice.

Labels: H1N1, health care reform, QD

QD: News Every Day on health care reform, primary care shortage and health care use

ACP Internist's daily digest of internal medicine in the news continues with the disconnect on who's supporting health care reform, the primary care shortage and who's to blame for how American consumer health care.

Health Care Reform
According to an Urban Institute study of 20 congressional districts where more than 30% of residents have no health coverage, members of congress whose constituents might gain the most from reform sometimes oppose it, while others representing voters who will likely pay more for little gain support it.

Primary care shortage
Kaiser Health News reports--surprise!--that little is being done to ramp up the number of primary care doctors to meet the needs of any beneficiaries of health care reform.

A paper in Health Affairs suggests using prepaid group practices, "highly structured, multispecialty medical groups that are reimbursed by capitation to serve the enrollees of a health maintenance organization," to achieve a physician-to-population ratio 22% to 37% below the national rate.

It's gotten so bad that one family practitioner earns more from her eBay services. In all fairness to the practice of medicine, she's a top seller.

In case you missed it ...
Last week we reported that doctors drive up health care costs, not patients. This week we note that doctors may order needless tests because of their patients, who read about diseases on the Internet and think they have them. Or, direct-to-consumer ads prompt prescription requests. NPR reports.

Labels: health care reform, primary care shortage, QD

QD: News Every Day on insurance coverage, primary care shortage and H1N1

ACP Internist's daily digest of internal medicine in the news continues with who's covering the uninsured, students weighing in on why they eschew primary care careers, and H1N1's widespread but less lethal path.

Covering the uninsured
While the number of uninsured people rose slightly from 2007 to 2008, more people were covered by government programs as employer-sponsored coverage continued to decline, according to the U.S. Census. The ACP Advocate reports census figures showing that 15% of the population was uninsured in 2008, increasing from 45.7 million to 46.3 million. However, coverage by private plans fell from 67.5% to 66.7% and coverage by employers fell from 59.3% to 58.5%. Government coverage rose from 27.8% to 29%.

Primary care shortage
Medical students weigh in on health reform, and have their doubts. Also, they won't go into primary care. "When it's a difference of $200,000 in your paycheck, it's tough," one student said.

Flu update
The H1N1 pandemic has been more widespread than lethal, notes the Harvard Health Letter. The virus seems to cause fewer cases of serious disease than expected. Harvard experts discussed the latest at a forum, with video posted online. In short, estimates for the death rate for H1N1 range between one death for every 2,000 symptomatic cases and one death for every 14,000 (0.007%). In comparison, the death rate for seasonal flu is roughly one death for every 1,000 to 2,000 cases. Seasonal flu infects roughly 5% to 20% of the population annually, whereas pandemics infect 25% to 40%. This H1N1 epidemic may not rise to pandemic levels.

In case you missed it ...
Doctors drive medical consumption, not patients. Illness and patient preference play a much smaller role. NPR reports on one epidemiologist's lifelong work. Meanwhile, a Newsweek columnist weighs evidence-based medical treatments against clinical judgment. It's the age-old question: How does a study impact treatment of the patient sitting before a doctor, seeking a cure?

Labels: epidemiology, evidence-based medicine, flu, H1N1, health insurance, medical education, primary care shortage, QD

QD: News Every Day--health care reform / Surgeon General / unlicensed providers

ACP Internist's daily digest of internal medicine in the news continues with sides blurring on health care reform, a new Surgeon General favorable to primary care and the suggestion of continuous credential monitoring for providers.

Health Care Reform
According to the Congressional Budget Office, the Senate Finance Committee's proposal will:
--slow spending growth on medical care
--lower the deficit
--cost less than President Obama's threshold
--cover 29 million uninsured Americans
--cover 94% of all Americans

The Finance Committee's bill requires a vote, possibly on Tuesday, and then will be merged with a bill in the Senate's Health, Education, Labor and Pensions Committee.

Now, Congress needs to figure out who will pay for it all, the wealthy or the insurance companies.

Meanwhile, some Republicans who carry the title of "former" are supporting some kind of reform: former Senate Majority Leaders Bob Dole and Bill Frist, and former Medicare administrator Mark McClellan. Former Health and Human Services Secretary Tommy Thompson cited the Senate Finance Committee's plan specifically.

And while Republican governors Arnold Schwarzenegger and Bobby Jindal support reforming health care in some way, two Democratic governors oppose expanding Medicare because of its impact on the states.

In case you missed it ...
Regina Benjamin, MD, took one step closer to becoming Surgeon General. The Senate Health, Education, Labor and Pensions Committee approved the nomination; she now goes to the full Senate. But there's no timetable to vote on Dr. Benjamin, a primary care physician.

Nearly one in 5 health care practitioners operate under malpractice allegations, an expired license or false credentials, and nearly 2% practice without a license. The study, done by a company that provides credentialing verification, prompted them to suggest continuous Web-based monitoring instead of reviews every two to three years.

Where one lives impacts the health care received, since insurance coverage, access to preventive medicine and disease treatment vary widely among states, according to a study released by the Commonwealth Foundation. Vermont focused on health care and its robust residents faired the best, followed by Hawaii, Iowa, Minnesota and Maine. As usual, the South trundles behind the rest of the nation's health care performance. Mississippi has the worst health care, with Oklahoma, Louisiana and Arkansas rounding out the results.

Labels: disparities, health care cost, health care reform, QD

QD: News Every Day--obesity, H1N1 and faking illness vs. "presenteeism"

ACP Internist's daily digest of internal medicine in the news continues with obesity programs, H1N1 updates and employees who fake calling in sick vs. those who won't when they really are.

Obesity
Schools, workplaces, food retailers and food and beverage makers are chipping in for the Healthy Weight Commitment Foundation, an effort to reduce obesity by balancing calorie consumption through physical activity. As just a few examples, food manufacturers will change product offerings, packaging, and labeling. Companies may provide exercise activities or facilities, offer weight management programs, and provide healthier foods in workplace cafeterias and vending machines. The Robert Wood Johnson Foundation, The National Business Group on Health and the University of California, Berkeley Center for Weight and Health will evaluate progress.

An internist is developing recommendations for physicians on how to guide and treat overweight patients on behalf of the STOP Obesity Alliance, a coalition of professional and labor groups, businesses, insurers and health care providers. The internist outlines his success in a case study.

H1N1 Flu
Health and Human Services Secretary Kathleen Sebelius further encouraged H1N1 vaccination, calling it "safe and secure" and adding that it's made the same way as seasonal flu vaccines.

Although H1N1 vaccination in the U.S. is slowly starting, states have ordered more than 2 million doses, mostly of nasal spray, for the first patients, according to Thomas Frieden, MD, director of the CDC. In Chicago, John Segreti, ACP Member, an infectious diseases expert at Rush University Medical Center, told Reuters his facility will distribute its first 2,000 doses to children and will wait for inactivated vaccine for health workers.

Emory University doctors licensed their interactive Web site to allow patients with potential H1N1 cases to self-screen using the same triage calculations their doctors and the CDC use. Questions about fever, symptoms and underlying health help patients determine whether they've got H1N1 flu, and what to do next--rest, call their doctor or seek immediate treatment. This site and related hot lines have been developed to keep people from flooding emergency departments. The materials, known as Strategy for Off-Site Rapid Triage (SORT) and Real-time Epidemiological Assessment for Community Health (REACH), were created and developed at Emory University. Ruth Parker, FACP, was one of the developers.

In case you missed it ...
The proportion of employees calling in sick when they're not hasn't changed among U.S. workers--at about one-third and holding--but fewer are getting fired for it, according to CareerBuilder.com as reported by Reuters. Of employers surveyed, 15% said they fired an employee for missing work without a legitimate excuse this year, compared to 18% last year.

The survey showed that most employers typically don't typically question absences (29% in 2009, 31% in 2008, 35% in 2007) and two-thirds of them let workers use sick days as "mental health days." The one-third of employers who do check on absenteeism require a doctor's note, call the person at home or have another worker call or drive by the employee's home. Employers cited stress and burnout from the recession as a reason they think employees fake illness.

The bigger fear is "presenteeism," those who show up to work no matter how sick they are. (They're also called "mucus troopers.")

Labels: H1N1, Nutrition, obesity, QD, Workplace issues

QD: News Every Day

Health care reform
Nothing good gets done until a committee has considered it. Now, the Senate Finance Committee put off voting on health care reform until the Congressional Budget Office chimes in with estimate of how much it will cost.

Flu vaccination
Health departments in three states began administering the first of the 7 million currently available H1N1 flu vaccine doses this week. Don't sweat it if your state wasn't one of them; 40 million doses will be available by mid-October and 10 million to 20 million will become available each week after that.

Globally, the World Health Organization has begun mass vaccination campaigns in China and Australia and will be starting soon in the U.S. and Europe. Worldwide, governments have ordered 440 million doses of GlaxoSmithKline's H1N1 vaccine Pandemrix.

In case you missed it ...
The U.S. fares worse than other industrialized countries in rates of preventable deaths--premature deaths caused by diabetes, epilepsy, stroke, influenza, ulcers and pneumonia--and has been falling further behind over the past decade, according to a Commonwealth Fund study published in the journal Health Affairs.

Labels: Diabetes, flu, H1N1, health care reform, QD, stroke

QD: News Every Day

Health care reform
Five bills floating around Congress need to be combined. The report suggests a broad outline of health care reform is emerging. But two key Democrats have pledged to withhold support. Any merger will be tough, leaders say.

Republican senators are using procedural votes to block nominations at the Department of Health and Human Services, including that of Surgeon General nominee Regina Benjamin. Republican senators plan to withhold consent to move the nominations to the full Senate in a fight over a warning letter that HHS sent to an insurance company accused of misleading enrollees over health care reform. Dr. Benjamin was popular among some ACP Internist readers, who were pleased to have a primary care doctor as the nation's most visible physician.

Does San Francisco hold the key to health care reform? Its model is being hailed despite employer mandates and available coverage for any uninsured adult who lives in the city and earns as much as 500% of the federal poverty level.

But any kind of mandate isn't the answer, as 2% of people refuse health insurance, says Kaiser Health News.

In case you missed it ...
Doctors for America sent physicians from each state to Washington, D.C., to advocate for meaningful health reform. Physicians met with President Obama in the Rose Garden. Doctors for America’s Executive Director, Mandy Krauthamer, ACP Member, and other ACP members joined the cause as their states' representatives.

“The urgent need for health reform cannot be overstated," Dr. Krauthamer said in an e-mailed press release. "These physicians from around the country have taken time away from their families and their practices to come to Washington to advocate for passage of comprehensive health reform this year. As physicians, we know that this is the right thing for our patients, our profession and our nation.”

Profiles of the Doctors for America members that went to the White House are online. Meanwhile, three former American Medical Association presidents who weren't invited to the White House event aired their ideas for reform elsewhere.

Labels: health care reform, QD

QD: News Every Day

ACP Internist's daily digest of primary care in the news continues with sudden coherence on Obamacare, prescription med fatalities and the trend of falling patient volume and procedures during the recession.

Health care reform
Overnight, Democrats and moderates in the Senate Finance Committee agreed to $400 billion in federal subsidies to defray premium costs for lower-income families and help small businesses offer coverage to their workers. Amendments will seek to let the states form their own public options and make health care affordable. But the compromise doesn't offer a permanent fix for the Sustainable Growth Rate. It could hurt physicians who are the biggest users and discourage them from taking on patients. And it still needs to merge with other bills.

If you're unclear which health care reform bill is which, the San Francisco Chronicle explains them.

In case you missed it:
Drug overdoses, mostly from prescription meds, overtook traffic accidents as the leading cause of death in some states.

The Robert Wood Johnson Foundation warns that not passing health care reform could hurt the states most of all.

Revenue in medical practices declined in 2008, possibly tied to smaller patient volumes and increasing bad debt due to patient financial hardship.

According to the "MGMA Cost Survey: 2009 Reports Based on 2008 Data," multispecialty group practices saw a 1.9% decrease in total medical revenue in 2008. (MGMA captures data on both multispecialty groups and single-specialty practices, but uses multispecialty data as a proxy for overall trends.)

Procedure volume fell 9.9% and patient volume shrunk 11.3% from 2006 to 2008. And bad debt in multispecialty group practices from fee-for-service charges increased 13% from 2006 to 2008, suggesting that patients may be having a harder time paying their medical bills.

In 2008, multispecialty practices cut overhead expenses 1.4%, largely by cutting support staff costs by 1.5%--the first decline in several years. Support staff make up 32% of medical practice expenses. While medical groups reduced support staff costs, their total worker count remained constant, indicating that employees may have gone without raises and bonuses or perhaps even suffered pay cuts.

Revenue by specialty:

Labels: drugs, health care reform, practice management, QD, recession

QD: News Every Day

ACP Internist's daily digest of primary care in the news continues with legislative jockeying for health care reform, public rejection of flu vaccination and primary care's dominance of mental health prescribing.

Health care reform
Legislation proceeds apace, with congressional members jockeying and pushing for the House and Senate bills to reach their respective chambers by mid-month. Abortion restrictions were defeated, as were other provisions. But there are many hurdles to clear as legislators threaten to cancel the Columbus Day break to get the legislation finished by either Thanksgiving or the end of the year.

Meanwhile, former Senate Majority Leader Tom Daschle said lawmakers were “flummoxed” when attempting to craft specific reform legislation, so Gary R. Gibson, FACP, has created an algorithm to help them understand it.

Flu prevention
Consumer Reports says only a third of Americans plan to get the H1N1 vaccine. More than half of adults with risk factors don't know what complications the flu could cause. They're worried about risks from the vaccine itself, or they're not confident of its efficacy. Or, they just don't think they'll get the flu.

In an NEJM perspective, authors say there's a pressing need for research into whether N95 masks work better or worse than surgical masks to prevent spreading the flu. So JAMA obliged with a study finding that surgical masks work just as well. An accompanying editorial notes that other preventive measures, such as vaccinating health care workers and hand washing, are critical but overlooked.

In case you missed it:
Mental health issues affect 1 in 4 Americans, 1 in 17 severely. Mostly, they go to their primary care clinicians for help, says the Agency for Healthcare Research and Quality.

Fifty-nine percent of U.S. mental health drug prescriptions are written by family doctors, reports Researchers from Thomson Reuters and the U.S. Substance Abuse and Mental Health Services Administration. They examined 472 million prescriptions written for psychotropic drugs from August 2006 and July 2007 and found general practitioners prescribed 62 percent of antidepressants and 52 percent of stimulants, mainly drugs for treating attention deficit hyperactivity disorder.

Labels: flu, H1N1, health care reform, mental health, mental illness, QD

QD: News Every Day

ACP Internist begins a daily digest of primary care in the news, debuting with an update on health care reform's messy reconciliation in Congress, good news about Medicare access (as health care currently stands) and what a national EHR network would look like.

Most recently for health care reform:
Two Democratic proposals to create a government insurance plan to compete with private insurers failed, while members of Congress turn their attention toward paying for abortion and insurance coverage for illegal immigrants. Now, Sen. Max Baucus is looking to revise a key financing provision after an analysis showed its tax burden would fall on seniors. In the wake of voting, amendments, provisions and alternatives are being slung left and right (politically, as well as figuratively.)

Since it's not a news cycle without something on H1N1, hundreds of New York state's health care workers protested a mandate that medical professionals get seasonal and swine-flu vaccines. But state health commissioner Richard F. Daines, FACP, told Gannett News Service, "This isn't the time to pump air into a completely deflated argument about vaccine safety."

Other issues internists should also be aware of include:
The Government Accountability Office found that less than 3% of Medicare beneficiaries had major problems accessing physician services, even while more people used the benefit and the number of services per beneficiary increased. More physicians are accepting Medicare, too. Unfortunately for Medicaid, it's far too easy to fraudulently access addictive drugs--65,000 instances costing of about $65 million in 2006 and 2007.

Finally, doctors' offices and hospitals are slowly, slowly moving toward electronic health records. Another view on the issue is instead of one national database, there'd be a "network of networks."

Labels: electronic health records, electronic medical records, emr, H1N1, health care reform, medicare, QD

ACP Internist hosted Grand Rounds on June 16, wrapping up the best of the medical blogosphere. Click here for the complete wrap-up.

Contact ACP Internist

Send comments to ACP Internist staff at acpinternist@acponline.org.

Blog log

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

db's Medical Rants
Robert M. Centor, FACP, contributes short essays contemplating medicine and the health care system.

Everything Health
EverythingHealth is designed to address the rapid changes in science, medicine, health and healing in the 21st Century.

Getting Better with Dr. Val
Getting Better is the continuation of Dr. Val Jones' previous blog at Revolution Health. It is devoted to helping people understand health issues from a balanced, scientifically sound perspective.

HealthHombre
A roundup of health policy news drawn from a database of hundreds of Web sites.

Interact MD
Michael Benjamin, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

Kevin, MD
The alter ego of Kevin Pho, ACP Member, is the closest thing to royalty in the medical blog world.

LSUHSC-S Medical Library Evidence Alert
Major guidelines, systematic reviews, meta-analyses and/or major reviews by national and international organizations.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by a doctor.

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Friday, November 20, 2009

QD: News Every Day--Santa's take on H1N1 influenza, part II

Thursday, November 19, 2009

QD: News Every Day--Santa's take on H1N1 influenza

Wednesday, November 18, 2009

QD: News Every Day--when evidence and politics collide

Tuesday, November 17, 2009

QD: News Every Day--payment fix inches forward (for this year, anyway)

Monday, November 16, 2009

QD: News Every Day--not the intended effect

Friday, November 13, 2009

QD: News Every Day--flu's growing tally

Thursday, November 12, 2009

QD: News Every Day--no holidays for Congress

Wednesday, November 11, 2009

QD: News Every Day--dry, boring health care reform? Think again.

Tuesday, November 10, 2009

QD: News Every Day--more time, more patients, more quality

Monday, November 9, 2009

QD: News Every Day--health reform ready to reconcile

Friday, November 6, 2009

QD: News Every Day--waiting for the weekend

Thursday, November 5, 2009

QD: News Every Day--health care reform's eerie repeat history

Wednesday, November 4, 2009

QD: News Every Day--health care reform's 'sunshine provision'

Tuesday, November 3, 2009

QD: News Every Day--health care reform splits urban, rural hospitals

Monday, November 2, 2009

QD: News Every Day--the public option as a Straw Man

Friday, October 30, 2009

QD: News Every Day--the Halloween edition

Thursday, October 29, 2009

QD: News Every Day--public option in da House!

Wednesday, October 28, 2009

QD: News Every Day--public option unsettles Senators

Tuesday, October 27, 2009

QD: News Every Day--the need for health reform

Monday, October 26, 2009

QD: News Every Day--H1N1 'emergency' and vaccine shortage

Friday, October 23, 2009

QD: News Every Day--slow start for H1N1 vaccine

Thursday, October 22, 2009

QD: News Every Day--health care reform and H1N1

Wednesday, October 21, 2009

QD: News Every Day--SGR cuts stalled

Tuesday, October 20, 2009

QD: News Every Day--Senate considers SGR overhaul

Monday, October 19, 2009

QD: News Every Day--the H1N1 fist bump

Friday, October 16, 2009

QD: News Every Day--One stolen laptop threatens all doctors' personal data

Thursday, October 15, 2009

QD: News Every Day--legislative tricks, treat the underserved and banning sick kids ... from hospitals

Wednesday, October 14, 2009

QD: News Every Day--The disconnect of health reform

Tuesday, October 13, 2009

QD: News Every Day--Senate committee passes health care reform

Monday, October 12, 2009

QD: News Every Day on health care reform, primary care shortage and health care use

Friday, October 9, 2009

QD: News Every Day on insurance coverage, primary care shortage and H1N1

Thursday, October 8, 2009

QD: News Every Day--health care reform / Surgeon General / unlicensed providers

Wednesday, October 7, 2009

QD: News Every Day--obesity, H1N1 and faking illness vs. "presenteeism"

Tuesday, October 6, 2009

QD: News Every Day

Monday, October 5, 2009

QD: News Every Day

Friday, October 2, 2009

QD: News Every Day

Thursday, October 1, 2009

QD: News Every Day

Wednesday, September 30, 2009

QD: News Every Day