Friday, March 12, 2010
QD: News Every Day--Considering health care reform, and the uncertainties of medicine
Democratic legislators want at least a week to consider elements of health care reform, as they parse out language over abortion, federal subsidies and regulating insurers. (Los Angeles Times, AP)
The Byzantine rules of passing legislation have left House representatives in the position of having to trust their colleagues in the Senate to follow through on their promise to fully reconcile health care reform goals, not just use reconciliation to pass it. Yet, they don't fully do so. (The Hill)
Literature in medicine
Book clubs in the workplace are common, and now, they're extending into the hospital. Literature in medicine programs are growing, and medical staff say a background in the humanities helps them deal with the messiness and uncertainty of practicing medicine in real life. (AP)
Labels: health care reform, Literature in medicine, QD
posted by Ryan DuBosar at
11:39 AM
0 Comments
Thursday, March 11, 2010
QD: News Every Day--Federal action leads to states' reaction
Congressional leaders and the White House will introduce health care legislation's latest incarnation to the entire Congress today. Immigration reform and abortion remain sticking points for some Democrats. (AP, The Hill, New York Magazine)
Meanwhile, Virginia's legislature passed a bill that would exempt that state from federal health care reform. It's the first state to reach this point, and legislators recognize their action as symbolic. But 34 other states are lining up to fight state recognition of federal law, setting up a Constitutional debate, albeit a short-lived one. (New York Times, WTVR of Richmond, Va., University of Missouri-Kansas City School of Law, New England Journal of Medicine)
Labels: health care reform, QD
posted by Ryan DuBosar at
9:51 AM
0 Comments
Wednesday, March 10, 2010
QD: News Every Day--The end is in sight (until later)
The Senate voted today to delay until September 30 Medicare's 21% reimbursement cut. The legislation also extends federal financial assistance for state Medicaid programs for six months and COBRA and unemployment insurance benefits through all of 2010. (Modern Physician)
For the broader issue of health care reform, Democrats are trying to build a majority for the final push, while Republicans hope to capitalize on the divisions as well as create procedural roadblocks to the reconciliation process that might be used to pass it. (Christian Science Monitor, Washington Post, New York Times)
Labels: health care reform, medicare, QD, reimbursement
posted by Ryan DuBosar at
11:24 AM
0 Comments
Tuesday, March 9, 2010
QD: News Every Day--Reform rhetoric heats up
All eyes are on the bully pulpit as President Barack Obama begins stumping for health care reform. His talking points include rising insurance rates, legislators who fear election repercussions, and those who would politicize the process. (New York Times, Los Angeles Times, USA Today)
But the Republicans plan to capitalize on the later two points. If it passes, they'll use it during their own stump speeches during the fall Congressional campaigns. They'll focus on the short-term pain--have people's health care costs fallen by election time--and not the long-term gain. (MSNBC, Politico)
Labels: health care reform, QD
posted by Ryan DuBosar at
11:24 AM
0 Comments
Monday, March 8, 2010
QD: News Every Day--Health care reform's "endgame"
All the talk is of the endgame to health care reform. You'll find the word used repeatedly as the fourth column discusses the timeframe, strategy and roadmap how to finish the legislation. ACP Internist points out that even if passed, future legislators can continue the game year after year. It's the sport of kings.
Medicare pay cut
Primary care doctor William Schreiber, MD, broke down his practice expenses and figures the pending 21% Medicare pay cut would leave him with the equivalent pay of a minimum-wage job. The pay cut has been pushed back until the end of the month. (CNN)
Labels: health care reform, medicare, practice management, QD, reimbursement
posted by Ryan DuBosar at
10:16 AM
0 Comments
Friday, March 5, 2010
QD: News Every Day--Ratcheting up the pressure to pass reform
The push is on to pass health care reform. The president is using his bully pulpit as opponents push back, targeting members of Congress who could for it or against. (Los Angeles Times, Washington Post, NPR, Politico)
Primary care shortage
Government support of medical school education is falling, and medical colleges are shrinking their enrollments and raising medical school tuition to make up for the huge shortfalls. (USA Today)
Labels: health care reform, medical education, primary care shortage, QD
posted by Ryan DuBosar at
11:05 AM
0 Comments
Thursday, March 4, 2010
QD: News Every Day--President resigned to reconciliation
ACP Internist continues its daily wrap-up of current events affecting internal medicine.
Health care reform
Citing the Children's Health Insurance Program and COBRA unemployment health coverage as examples, President Barack Obama called on Congress to pass health care reform using reconciliation. Those two health programs used the legislative tactic to secure passage. Senate Minority Leader Mitch McConnell said health care reform was bigger legislation, and "Big legislation always requires big majorities." (Washington Post, Wall Street Journal)
Haitian earthquake relief
The overwhelming wave of trauma victims has dwindled to a trickle aboard the USNS Comfort, the military hospital ship anchored in the harbor of Port-au-Prince, Haiti. Civilian doctors want the ship to stay to handle what they describe as a second wave of treatment--resetting poorly healed fractures and remaining public health issues. The Navy has not decided what the Comfort's future mission might be, if any. Read reports of the challenges internists faced while aboard the ship. (Baltimore Sun, U.S. Navy, Annals of Internal Medicine)
Lt. Yonnette Thomas, Officer in Charge of the Center for Information Dominance Learning Site in Norfolk, translates between Haitian patients and a delegation of visiting physicians from Colombia aboard the USNS Comfort.
Labels: disaster response, health care reform, QD
posted by Ryan DuBosar at
11:01 AM
0 Comments
Wednesday, March 3, 2010
QD: News Every Day--Medicare cuts delayed by 30 days
Medicare reimbursement cuts have been delayed for 30 days. (Nowhere else in our country's economy would someone's paycheck be bandied about like this.) The same legislation, actually a jobs bills, also extended the time that the federal government will pick up some of the tab for COBRA health insurance. (Health Leaders Media, Los Angeles Times)
As mentioned in yesterday's edition, the president plans to siphon off some Republicans by incorporating a few of their ideas. He might need them to counter Democrats who opposed health care reform legislation, but Republican leadership scoffed at the idea of breakaways. (ACP Internist, Washington Post, Politico)
H1N1 influenza
H1N1 influenza took an unexpected course in its timing and severity. Novel pandemics are different than seasonal flu outbreaks, explains those who tracked its course. And seasonal flu was mild this year, too. (Wall Street Journal, Pittsburgh Tribune-Review)
In case you missed it ...
W.G. Watson, MD, is a 100-year-old practicing obstetrician. One baby he delivered grew up to become his practice's partner, as a matter of fact. (CNN)
Labels: flu, H1N1, health care reform, health insurance, medicare, QD, reimbursement
posted by Ryan DuBosar at
10:00 AM
0 Comments
Tuesday, March 2, 2010
QD: News every day--"Final act" for health care reform?
In a letter today to congressional leaders, President Obama said he is exploring four ideas proposed by Republicans at last Thursday's health summit, including using undercover clinicians to track down Medicare/Medicaid waste, allocating $50 million in federal funds to help states retool methods of dealing with medical malpractice lawsuits, increasing state Medicaid reimbursement to doctors, and expanding access to health savings accounts and high-deductible plans. The White House press secretary said today that the health care reform debate is in its "final act." President Obama is expected to release his revised health care plan tomorrow. (New York Times, Washington Post, LA Times)
Meanwhile, a jobs bill introduced in the Senate would put off Medicare cuts to physician reimbursement until August. (MedPage Today)
Labels: health care reform, medicare, QD, reimbursement
posted by Jennifer Kearney-Strouse at
4:59 PM
0 Comments
Monday, March 1, 2010
QD: News Every Day--Medicare holds claims to prevent pay cuts
Today's the deadline for a 21% cut in Medicare reimbursement. Congress didn't get a temporary fix pushed through in time, so Medicare is going to hold claims for 10 days to allow lawmakers enough time to act. Still, solo doctors and small practices worry that they will immediately feel the pinch. One internal medicine practice wrote its patients partly to warn them, but also to put pressure on lawmakers to act. Another warns that practices serving a large proportion of retirees are in even more trouble. ACP President Joseph Stubbs, FACP, remarked to Medscape that this has happened before, forcing some practices to take out short-term loans to meet payroll. (Health Leaders Media, The Daily Sentinel, TopNews.com)
It's going to be a busy week. Lawmakers can take up the issue of Medicare cuts later this week, but the White House is also going to signal its intentions on health care reform in the next few days. Both sides are taking sides, and talk about bipartisanship is being left behind. Democrats may have the votes to pass it without Republican support, but it's not a sure thing. Democrats counter that with 100 Republican amendments, the bill is bipartisan even if the final voting isn't. (New York Times, The Christian Science Monitor, Wall Street Journal, CNN)
In case you missed it ...
President Barack Obama received his annual check-up, and the results are online if you want to peek at the president's lab results.
Labels: health care reform, medicare, QD, reimbursement
posted by Ryan DuBosar at
10:30 AM
0 Comments
Friday, February 26, 2010
QD: News Every Day--Coming down from the summit
Thursday's health care reform summit reflected in six hours much of the past two years of discussions about health care reform. Starting with rebukes over the previous presidential campaign, the meeting resembled a more civil version of last summer's rowdy town hall meetings, and certainly reflected and reverberated recent months of congressional wrangling. (Los Angeles Times, NPR)
Despite talk of common ground, with no traction gained yesterday among Republicans, Democrats may try again to act on their own. (New York Times, Los Angeles Times)
Optimists says the summit could still have some positive impact: adding urgency, stressing nine common points between the parties, and adding fresh ideas. (Health Leaders Media)
Labels: health care reform, QD
posted by Ryan DuBosar at
9:14 AM
1 Comments
Thursday, February 25, 2010
QD: News Every Day--Can't they wait until it's over to complain?
The health care reform summit between party leaders hadn't yet started when the morning papers rolled out, calling for low expectations and fall-back positions. But one can't blame the pundits and politicians, who have measured the national mood on the subject. (Boston Globe, Wall Street Journal, USAToday)
H1N1 influenza
H1N1 has not peaked globally, according to the World Health Organization. (Reuters)
In case you missed it ...
Yet another take on practice management has emerged, combining its own elements of the patient-centered medical home and electronic medical records. It's been dubbed the E*TRADE of medical care, putting the patient in charge. One might call it another twist on concierge care; there's a $595 retainer fee once the practice exists its start-up phase. But it promises doctors patient panels of 900, no more than 12 patient visits a day and continual care instead of episodic visits. (Health Data Management)
Labels: concierge medicine, H1N1, health care reform, patient-centered medical home, primary care, QD
posted by Ryan DuBosar at
10:08 AM
0 Comments
Wednesday, February 24, 2010
QD: News Every Day--Amid Summit Fight's Eve
ACP Internist takes a literary look at tomorrow's anticipated health care summit between Congress and the White House. Shakespeare's A Midsummer Night's Dream follows the misadventures of two couples entering an enchanted wood; likewise, Democrats and Republicans enter into tomorrow's six-hour talk thinking puckish thoughts about each other. 
The summit is just political theater, so staging is everything. The audiences are important. Lights, camera, inaction! (AP, Politico, New York Times)
Democrats are talking as if they can revive health care reform from its dreamy slumber, possibly using reconciliation as a procedural maneuver. To paraphrase The Bard, "The course of true reform never did run smooth." (Los Angeles Times, NPR)
Primary care shortage
Primary care physicians have cut their average hours per week, citing low pay and worse work-life balance. Average work hours have fallen from 55 to 51 hours per week between 1996 and 2008, according to JAMA, or 36,000 doctors in a decade. But the doctors say cutting back will extend their careers overall. (Washington Post)
H1N1 influenza
Flu experts at the World Health Organization met to decide whether the H1N1 pandemic has peaked for this year. They did recommend that the next seasonal flu vaccine should include H1N1. Danielle Ofri, FACP, explained that the pandemic's toll had as much of an emotional impact on her patients as it did on their physical health. (AP, Reuters, CNN)
In case you missed it ...
The Food and Drug Administration and National Institutes of Health will collaborate on a bench-to-bedside process to speed how quickly basic research becomes medical treatments. A Joint Leadership Council between the two agencies will ensure regulatory considerations are part of biomedical research, and that the latest science is integrated into regulatory reviews. FDA Commissioner Margaret A. Hamburg, FACP, announced, "We are working in collaboration with the best minds and research institutions available, so that we can better develop and utilize new tools, standards and approaches needed to properly assess the safety, effectiveness and quality of products currently in development or already on the market."
Labels: FDA, H1N1, health care reform, primary care shortage, QD
posted by Ryan DuBosar at
11:14 AM
0 Comments
Tuesday, February 23, 2010
QD: News Every Day--counting down to Thursday's summit
ACP Internist continues its look at Thursday's pending health care summit. The White House released its vision of health care reform yesterday to build party unity. But it drew immediate attack by the opposition. (ACP Internist, USAToday, The Christian Science Monitor)
With states feeling the pinch of Medicare and Medicaid spending--and rebelling in some cases--the federal government is using stimulus act spending to provide $4.3 billion to states to for prescription drug costs. Governors from New York and California say more is needed. (Health Leaders Media, Reuters)
In case you missed it ...
Drug companies contributed financial support to more than half the nation's internal medicine residency programs, even though three-quarters of residency directors said such aid is "not desirable." At issue are the pocket guides, meals, office supplies and drug samples given to doctors just as they gain the power of the pen. (New York Times, JAMA)
Labels: conflict-of-interest, drug companies, health care reform, Medicaid, medicare, QD, residency
posted by Ryan DuBosar at
11:58 AM
1 Comments
Monday, February 22, 2010
QD: News Every Day--president releases new health reform proposal
ACP Internist's daily digest of news and events continues with a look at the latest on health care reform.
President Obama released his new proposal for health care reform today, in advance of a bipartisan health summit scheduled for this Thursday. The plan is modeled on the bill passed by the Senate in December but would cost $79 billion more, although less than the $1.05-trillion House bill, the New York Times reported. Republicans called the proposal "government takeover of health care," while the White House billed it as an "opening bid" for Thursday's meeting, the Washington Post said. The White House has posted a summary of the proposal online. (New York Times, Washington Post, WhiteHouse.gov)
Labels: health care reform, QD
posted by Jennifer Kearney-Strouse at
4:48 PM
0 Comments
Friday, February 19, 2010
QD: News Every Day--health reform smacks into health insurance
ACP Internist continues its look at health care reform efforts in the U.S. Reconciliation might be back. Not between Democrats and Republicans, but the procedural move that could attach health care reform to a budget bill that requires a simple majority in the Senate instead of a filibuster-proof supermajority. That's the stick the White House is wielding if the health care summit on Feb. 25 doesn't produce results. President Barack Obama will release details Monday about his plan for comprehensive reform. (AP, New York Times, Los Angeles Times)
It's a perfect storm for health insurance. The economy has driven record numbers of people to Medicaid. 15 million more people could be added, but states are cutting programs and reducing payments to doctors. Medicare Advantage premiums are rising and private insurance rates are climbing, too. President Obama is using the private insurance rates as a talking point to push his agenda. (Washington Post, New York Times, Los Angeles Times, Reuters)
Labels: health care reform, health insurance, Medicaid, medicare, QD
posted by Ryan DuBosar at
11:41 AM
0 Comments
Thursday, February 18, 2010
QD: News Every Day--Politics and health care in America and England
Stalled legislation in the House and Senate moved ever-so-slightly, as President Barack Obama plans to use the bills as the basis for next week's health care summit, Health and Human Services Secretary Kathleen Sebelius announced. She also pointed to rising insurance premiums as evidence of the need for reform. (CNN, AP/Washington Post)
In England, Conservative and Labour parliamentarians are fighting about hospital readmission rates. Conservatives do not want to reimburse hospitals for the initial visit if the patient is readmitted as an emergency for a related problem. It's not a punishment, but is meant "to remove the incentive for them to discharge patients without proper support."
In England, about 500,000 patients are readmitted within a month of discharge, emergency readmissions increased by 52% between 1998 and 2007, and hospital beds have been cut by 12% in the last five years. (The Telegraph)
Electronic health records
SK&A, a health care marketing firm, announced electronic medical record adoption increased by 3.2%, to 36.1%, over a similar study last year. The report broke down the data by size, specialty, volume and other demographics. It also assessed software functions in relation to “meaningful use” criteria:
--Physicians primarily use electronic medical records for notes (28.3%) instead of labs results or e-prescribing;
--EHR adoption increases with the number of physicians, exam rooms and daily patient volume;
--EHR adoption is more prevalent in hospital-owned (44.1%) or health system-owned (50.2%) sites. Other practice ownership models hovered at about one in three for EHR adoption; and
--Dialysis, critical care medicine and radiology practices are the highest adopters, and allergy/immunology, general surgery and general practice are the lowest adopters.
Labels: electronic medical records, health care reform, hospital medicine, QD
posted by Ryan DuBosar at
12:01 PM
0 Comments
Wednesday, February 17, 2010
QD: News Every Day--How the primary care shortage plays out
ACP Internist looks at how states are using grants to fix their primary care shortages.
Michigan launched grants for primary care doctors to repay medical school loans and is looking to tap into federal incentives to fill its needs in rural and urban shortage areas. Alaska also needs primary care doctors, so the state senate is pushing through recruiting incentives of its own. (They should show re-runs of Northern Exposure.) Rural Indiana doesn't have a quirky '90s hit television program to its credit, but it has nurse practitioners who are finding their niche on physicians-led teams--relieving the backlog and providing patient education. (Detroit Free Press, KTUU-TV, Journal & Courier)
There's especially good news about federal spending for health care. The $1.85 billion invested to date in health centers from federal stimulus spending translated into $3.2 billion in new economic activity in these communities. A report from The George Washington University School of Public Health and Health services adds that more than 1,100 health centers have received stimulus funds that will let them serve 21 million people next year, including 3 million more new patients. The centers tend to be located in areas with higher rates of unemployment and recent job losses.
California faces a big hurdle in primary care. There's only 700 geriatricians, a problem found everywhere else but particularly acute in Oakland. Stakeholders in the system discuss whether California could switch to a global payment system and accountable care organizations to try to make health care work. Something has to be done. The state's cash-strapped rural hospitals report cutting hours and services. (San Mateo County Times, California Healthline, California Farm Bureau Federation)
Labels: geriatrics, primary care shortage, QD
posted by Ryan DuBosar at
11:45 AM
0 Comments
Friday, February 12, 2010
QD: News Every Day--D.C. digs out and lines up
ACP Internist continues its look at health care reform as opposing sides line up for an event still two weeks away. Both Democrats and Republicans are skeptical. (AP, Politico)
The states want reform now, so they are doing it for themselves. Colorado introduced 10 bills in reaction to the state's falling grades for children's health care. Measures range from aggressive Medicaid fraud auditing to standardized insurance billing codes and uniform insurance forms. (Denver Daily News)
H1N1 Influenza
The World Health Organization will decide later this month whether the H1N1 influenza pandemic has peaked. It remains the dominant flu strain and could become part of next year's vaccinations. (Reuters)
Organizations continue to lift restrictions prompted by H1N1. The latest includes pro basketballers the Cleveland Cavaliers, who have restored water fountains to their arena. (Or maybe they're just meeting their building codes.) But British Columbians aren't being so, well, cavalier about their sporting event (that is, the Olympics). They're offering H1N1 shots to all athletes and spectators. (FanHouse, PBS)
Labels: H1N1, health care reform, QD
posted by Ryan DuBosar at
9:54 AM
0 Comments
Thursday, February 11, 2010
QD: News Every Day--Health policies slow to impact best clinical practices
ACP Internist continues its look at subjects important to internal medicine. Today, we follow the money.
Evidence-based medicine
The U.S. could save one-third of the $15 billion spent on stents annually if all doctors followed COURAGE trial conclusions and used generic drugs first, and stents only if pain persists. William Boden, FACP, headed that trial, and now says that reimbursement drives clinical practice. Dartmouth's Elliott Fisher, MD, says this "perverse incentive" doesn't improve health care. (Wall Street Journal, CNN)
Physician reimbursement reform
Following the Food and Drug Administration's record-breaking budget allocation, seven former agency commissioners and interest groups are still saying it's not enough to make up for years of underfunding. Even regulated industries want more funding to boost the public perception of product safety. (ACP Internist, Los Angeles Times)
Labels: evidence-based medicine, FDA, health care cost, health care delivery, health policy, QD
posted by Ryan DuBosar at
9:16 AM
0 Comments
Wednesday, February 10, 2010
QD: News Every Day--reform for patients and relief for providers
ACP Internist continues to daily news round-up with a look at health care reform.
Health care reform
President Barack Obama signaled his willingness to compromise in order to achieve at least some aspects of health care reform legislation. But he also took his shots as well, cautioning Republicans against "obstinacy." (AP, Politico)
Even if federal legislators find common ground, the states are still rebelling. The latest salvo, just as one example of its kind, finds Idaho's lawmakers debating a law that would pre-empt business and individual insurance mandates and sue the federal government that tries to enact them. (KIFI TV 8)
Physician reimbursement reform
Congress attached language to stop a 21% cut in Medicare reimbursement to its jobs legislation. But Congress is trying to patch the same old tire, (free registration required) says ACP President Joseph W. Stubbs, FACP. Congress is attempting to earmarks $82 billion to overhaul Medicare's sustainable growth-rate. But its $200 billion debt will rise until there is a permanent fix, he said. (NPR, Modern Physician)
Labels: health care reform, QD, reimbursement
posted by Ryan DuBosar at
11:18 AM
0 Comments
Tuesday, February 9, 2010
QD: News Every Day--Approaching a summit from opposite sides of the mountain
Health care reform
The White House summit between opposing sides of health care reform is planned for Feb. 25, with broadcast coverage on C-SPAN. The summit has drawn criticism from those opposing last year's effort, but that didn't stop opposition leadership from sending ahead some pointed questions and asking for a response. [Hint: They want the answer to be, "Start over."] (USA Today, Washington Post)
Haitian relief efforts
Telemedicine has arrived to Haiti. While waiting for hi-tech hookups, ham radio operators have aided in communications. (New York Times)
Patient-centered medical home
Five counties in north Texas have adopted a widespread medical home concept. It's led by an insurance company in conjunction with two large physician practices. (Dallas Morning News)
Labels: disaster response, health care reform, patient-centered medical home, QD, telemedicine
posted by Ryan DuBosar at
12:50 PM
0 Comments
Monday, February 8, 2010
QD: News Every Day--Obama calls for a health reform summit
Health care reform
In a bid of showmanship, President Barack Obama invited Republicans to the White House for a televised half-day summit to lay out ideas for health care reform. During the president's State of the Union address, he asked if anyone had better ideas to bring to the table, and a chippy House Minority Leader, John Boehner, raised his hand. Here's his chance to speak. (Wall Street Journal, TIME)
H1N1 influenza
The H1N1 epidemic has "one foot in the grave," William Schaffner, MACP, told TIME magazine. Anne Schuchat, FACP, updated reporters about the issue last week. (transcript and audio)
With that good news, the Roman Catholic Archdiocese of Boston plans to restart offering the Communion cup and sharing the Sign of Peace, which were stopped because of its spread. Meanwhile, professional hockey's New York Islanders will host free flu shots to all fans at tomorrow's game. (Leave your own punch line in the comments field.) (WHDH-TV, NHL.com)
In case you missed it ...
A Dallas-Fort Worth area hospital used the speed-dating model to match patients to primary care physicians. In case you're not familiar with the concept, speed dating involves quickly rotating people for chats of a few minutes at a time. At the end of the event, people decide who they'd like to see again. (American Medical News)
Labels: H1N1, health care reform, QD
posted by Ryan DuBosar at
10:11 AM
0 Comments
Friday, February 5, 2010
QD: News Every Day--The government's rising stake in health care costs
The federal government may be stalled on health care reform legislation, but the executive branch has been expanding its stake in paying for care.
Yesterday, QD reported that federal and state governments will pay for more than half of the health care purchased in the U.S. by 2012, and likely even sooner. Today, Medicare's actuaries announced that growth in national health expenditures (NHE) outpaced growth in the Gross Domestic Product (GDP) last year. The recession, H1N1 programs and federal subsidies for COBRA benefits all contributed to the largest one-year increase in history, from 16.2% of GDP in 2008 to 17.3% of GDP last year.
In 2010, NHE growth will decelerate to 3.9% while GDP is anticipated to rebound to 4% growth. But, and this is a big caveat, much of the projected slowdown in NHE growth is attributed to the 21.3% slashing of Medicare physician payment rates called for under current law’s Sustainable Growth Rate provisions.
We here at QD love a good chart to explain all this, and there's plenty to peruse.
Also released today is a report that, one year after expanding Children’s Health Insurance Programs, 2.6 million more children gained Medicaid or CHIP coverage. As a result of the extra federal spending, all but two states cover children in families earning at least 200% of the federal poverty level, ($48,100 for a family of four in 2009.)
Health care reform
Speaking to a friendly audience, President Barack Obama broadly outlined his goals for moving forward on health care reform. He called for a "methodical, open process" and a public airing of ideas from partisan legislators and non-partisan experts. Vice President Joe Biden backed up those statements, but U.S. House leaders dodged the topic following a meeting with the President. (New York Times, The Hill, Politico)
Labels: H1N1, health care cost, health care reform, Medicaid, QD
posted by Ryan DuBosar at
11:51 AM
0 Comments
Wednesday, February 3, 2010
QD: News Every Day--Internists still seeing yet-untreated Haitians
ACP Internist's wrap-up of current events turns its attention back toward Hati, where 22 days after the earthquake, patients are still being seen for the first time for injuries. Peter Melchert, ACP Member, a hospitalist from Abbott Northwestern Hospital and Children's Hospital in Minneapolis, reports via internist and writer Craig Bowron, FACP. (MinnPost.com)
Health care reform
Amid a near-abandonment of broad sweeping reform, Congress members hope to salvage small victories. They are looking now at repealing the federal antitrust exemption for insurance companies to drive down prices in regions dominated by one company. Even this one small component faces Senate opposition, and the odds are even longer for the procedural maneuver of reconciliation, which is still being mulled in some pockets of Congress. Republicans want to start from scratch, while others have started drafting a compromise bill. And the clock is ticking as elected officials look to turn their attention toward other issues, such as employment, and as states assert their rights by drafting legislation that would bar individual insurance mandates. (Wall Street Journal, Politico, AP, AP/San Francisco Chronicle, AP/Boston Globe)
In case you missed it ...
Internists are discussing the pros and cons of e-mail diagnoses. Some see time savings, others see a time drag, or fear liability issues and the practice of "garbage" medicine (registration required). About 5% of patients used e-mail last year to talk to their doctors, but 51% looked up health information on the Internet. (Medscape, Reuters)
Labels: disaster response, health care reform, health policy, patient communication, QD
posted by Ryan DuBosar at
11:43 AM
0 Comments
Tuesday, February 2, 2010
QD: News Every Day--Vaccine shortages become surpluses
ACP Internist's daily digest continues with an update on H1N1 influenza and other vaccine news.
H1N1 influenza
Many wealthier countries now have a surplus of H1N1 influenza vaccine, while poorer countries continue to struggle. The obvious solution seems to be sending vaccine from countries with too much to those without enough, but the reality is much more complex. (The New York Times)
Vaccines and autism
The Lancet today retracted a study from 1998 linking the measles-mumps-rubella vaccine to autism, after the U.K. General Medical Counsel's Fitness to Practice Panel concluded last week that the research had been conducted unethically. (The Lancet, L.A. Times)
In case you missed it ...
Baptist Princeton Hospital in Birmingham, Ala. uses employee badges to track whether staff wash their hands when entering and leaving a patient's room. Hospital officials, including the CEO, get the details on habitually noncompliant staff, who in turn could get a private text or e-mail to prod them. (NPR)
Labels: H1N1, patient safety, QD, vaccination
posted by Jennifer Kearney-Strouse at
3:40 PM
0 Comments
Monday, February 1, 2010
QD: News Every Day--Congress was close to passing health care reform
ACP Internist's wrap-up of current events looks at how close health care reform came to passage. Meanwhile, two other "reforms" that passed years ago--national mental health parity and one city's requirement that eateries disclose their calorie counts--are soon to become reality.
Health care reform
A final deal for health care reform had been agreed to just before Scott Brown won Massachusetts' senatorial seat. His election and opposition to the legislation brought the near-deal to an end. He suggested starting the whole process over. (The Hill, Politico)
Mental health care
Mental health parity regulations released by the federal government will take effect July 1. Insurers will have to apply the same standards for mental health care that they do for other types of health coverage. Co-pays can't be higher for mental health than other coverage, and there can't be separate deductibles. One mental health advocate told the Winston-Salem Journal, "You would never tell a diabetic you can only see your doctor 20 times a year even though your diabetes is totally out of control. Both are biologically-based illnesses. But health plans enforced these limits on people with bipolar illness even if the illness was out of control." (Reuters, AP/ABC News, Winston-Salem Journal)
Primary care shortage
Quinnipiac University (the ubiquitous political pollsters) is founding a medical school dedicated to primary care and global health and plan their first classes for 2013 or 2014. Next, they need to find a university or hospital as their clinical partner.
In case you missed it ...
Philadelphia is phasing in its requirement that food chains post calorie information on their menus and ordering boards. But will thicker menus lead to thinner people? (Philadelphia Inquirer)
Labels: health care reform, mental health, Nutrition, obesity, parity, primary care shortage, QD, weight loss
posted by Ryan DuBosar at
11:41 AM
0 Comments
Friday, January 29, 2010
QD: News Every Day--Liability risk leads to reduced physician hours, study says
ACP Internist's wrap-up of current events looks at medical liability risk and news on H1N1 influenza.
Health care reform
Medical malpractice caps have been one area of contention in health care reform. Now economists (the dismal science, indeed) say that a jump of 10% in expected medical liability risk makes doctors reduce their workload by 1.7 hours per week. That's like having one in 35 physicians quit entirely, or a loss of 21,800 physicians overall. (NPR)
H1N1 influenza
Although some hospitals have lifted their visitation restrictions enacted to curb the spread of H1N1, officials in Virginia have kept theirs in place at 18 area hospitals because the state is still reporting regional virus activity. Meanwhile, WHO announced today that H1N1 continues to spread in some areas of the world but that "activity in general is decreasing." (Daily Press of Newport News, Va., Reuters)
In case you missed it ...
President Obama's State of the Union address talked about jobs much more than health care reform. He may have overlooked that the issues can overlap. Doctors' offices hired 8,900 staff and hospitals added 1,400 in December 2009, according to preliminary data from the Bureau of Labor Statistics. Outpatient medical centers added 2,500 positions and home health care agencies added 8,000. (American Medical News)
Labels: H1N1, health care reform, malpractice, QD
posted by Jennifer Kearney-Strouse at
1:16 PM
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Thursday, January 28, 2010
QD: News Every Day--Health care reform scarce in presidential address
ACP Internist's wrap-up of current events looks at a lack of attention to health care reform in the State of the Union address. For those keeping track, President Barack Obama didn't mention health care until a half-hour into his nearly 70-minute speech. When he did, it was nine paragraphs out of 112. He vowed to keep pushing for reform, but didn't lay out any specifics. (New York Times, White House transcript, The Hill, Politico)
Primary care shortage
Dentists want to screen their patients for cardiovascular disease and other chronic conditions. More than three-quarters of nearly 2,000 dentists surveyed thought it was important for them to screen for hypertension, cardiovascular disease, diabetes, hepatitis and HIV. Two-thirds would tell the patients the results right away and nearly all would refer for primary care treatment. (And of course, four out of five dentists still recommend a certain brand of gum.)
Labels: health care reform, primary care shortage, QD
posted by Ryan DuBosar at
12:28 PM
0 Comments
Wednesday, January 27, 2010
QD: News Every Day--health care reform pauses for a gut-check
ACP Internist's wrap-up of current events looks at health care reform, and the slow process state legislators encounter when trying to solve health policy issues such as the shortage of primary care physicians.
Health care reform
Congress will pause on health care reform, at least until tonight's State of the Union address, while they search for a clear direction to proceed. Legislators say their constituents are telling them (and pollsters) that they want more focus on jobs and the economy, and less on health care. (AP/San Francisco Chronicle, AP, Wall Street Journal)
Primary care shortage
Regulatory overhaul is one way to solve the primary care shortage, but it moves sloooowly. A New Jersey task force is looking at the particulars in the Garden State--a projected 12% deficit by 2020. For primary care, that's 1,000 too few doctors. A state legislator asked the state's Board of Medical Examiners to add questions to one of its surveys to collect data that could be used to attract federal funds. No word back yet. The president of the association for teaching hospitals asked legislators to prove their interest in retaining physicians. (Courier News)
Michigan is facing a retention problem, as well. Thousands of doctors leave the state after their residencies, and an 8% cut in Medicare reimbursement may drive more away, says the state's medical society. That group is looking to drive physicians into the state's universities, where they may get better reimbursement. (South Bend Tribune)
In case you missed it ...
An internist undergoes recertification and mulls the relevance of standardized exams to her real-life practice, and to her work-life balance. (JAMA, subscription required)
Labels: health care reform, primary care shortage, QD, work-life balance
posted by Ryan DuBosar at
11:42 AM
0 Comments
Tuesday, January 26, 2010
QD: News Every Day--Health reform reconciliation (for Democrats, anyway)
ACP Internist's wrap-up of current events looks at an agreement to try to salvage health care reform legislation.
Health care reform
Democrats will use a legislative maneuver called reconciliation to pass health care reform legislation. The procedure bypasses the Democrat's lost filibuster-proof majority in the Senate. In short, the House will modify the Senate's legislation with enough changes to try to pass it in both Chambers. Reconciliation hadn't been a popular option before today's announcement. (San Diego Union-Tribune, Politico, Boston Globe)
The White House continues to mull over what's achievable. To avoid being perceived as trying to push through health care policy, it had sought cooperation with Republicans on the low-hanging fruit--capping medical malpractice, buying insurance across state lines and tax credits for those buy their own insurance. But Republicans aren't necessarily in agreement on those very issues, which couldn't pass a Republican-controlled Senate in the 90s and 00s. (New York Daily News, NPR)
Patient-centered medical home
Carilion Clinic Family Medicine's Parkway Vinton practice describes how it implemented the patient-centered medical home. Care coordinators, a new role in the practice, track patients with chronic illnesses, ensure screening tests are up to date, answer questions and locate community support. The National Committee for Quality Assurance certified the practice its first Level-3 Patient-Centered Medical Home in the state. (Roanoke Times)
In case you missed it ...
Joseph Kim, MD, who hosts a blog on non-clinical physician careers, mulls over the options for doctors who want to pursue an MBA.
Labels: careers, health care reform, patient-centered medical home, QD
posted by Ryan DuBosar at
11:37 AM
1 Comments
Monday, January 25, 2010
QD: News Every Day--Health politics becomes health policy
ACP Internist's wrap-up of current events turns its attention toward health care reform, and how health care policy translates into health care delivery.
Health care reform
Congressional legislation will move forward with the least controversial elements of health care reform: solving Medicare's pending insolvency and closing a gap in Medicare Part D coverage. But Democrats and Republicans differ on how to accomplish such goals. (Wall Street Journal)
Medicare's reimbursement system has long stuck in the craw of primary care physicians. As a result, they don't always accept such patients, so one in three Medicare enrollees had trouble finding a primary care doctor when entering the Medicare population, according to a June 2008 report by the Medicare Payment Advisory Commission. The impact is shortening an already pressed primary care system. In Arizona, only three of that state's 15 counties have the appropriate ratio of primary care doctors to the general population. (The Arizona Republic)
Physicians aren't waiting for health care reform that may never come. They continue to leave community practice and delve into concierge care, which they say allows them to practice the thorough, hands-on medicine they'd envisioned when they graduated medical school. ACP Fellow David Grulke, MD, of Norfolk, Va., converted his practice to a concierge model in 2002. He charges $660 to $1,080 annually (unlike some practices that charge thousands or more) and describes it as a service for ordinary people who want a relationship with their doctor. In the same article, Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, tells the Virginian-Pilot such arrangements are the symptom of a broken care system. (Virginian-Pilot)
Haitian relief efforts
ACP Member Myriame Casimir, MD, was raised in Haiti. Today, she returns there on a medical mission comprised of her and 20 other providers from Rush University Medical Center in Chicago. (Chicago Tribune)
Also, an aid worker used a first-aid app on his cell phone to survive 60 hours trapped in the rubble of a building. (CNN)
In case you missed it ...
ACP Fellow Turi McNamee, MD, blogs about the "weekend effect" and concludes that, on Satursdays and Sunday, it's better to be shot than have a heart attack. She covers her local hospital's shifts on weekends and wonders what the impact will be on her facility's relaxed atmosphere if more research leads to an increase in weekend staffing. (True/Slant)
Labels: concierge medicine, disaster response, health care reform, medicare, primary care shortage, QD, weekend effect
posted by Ryan DuBosar at
10:10 AM
2 Comments
Friday, January 22, 2010
QD: News Every Day--Common ground in health care reform
ACP Internist's wrap-up of current events turns its attention toward those toiling in the wake of collapse--of health care reform. Congressional aides, the folks who do all the heavy lifting for new legislation, are seeking common ground for a pared back health care reform bill. Labor groups, patient advocates and some physicians, including Nancy Nielsen, MACP, a former AMA president, are calling for health reform. While it won't be easy to find common ground, there is a short list of items in the making. (New York Times, Los Angeles Times, AP/Washington Post)
Haitian relief efforts
In a country in dire need of emergency care, internists who'd regularly traveled to the country over the years return yet again to staff clinics and hospitals. They find themselves doing pre- and post-operative care and administering what medical supplies they can muster, such as in Cite Soleil, described as one of the poorest ghettos in the Western Hemisphere. Hospitals in Les Cayes, a hundred miles away from Port-au-Prince, survived the earthquake and are performing surgery around the clock to keep up. (Verona-Cedar Grove Times, Daily Hampshire Gazette)
ACP recommends supporting Haitian relief efforts through one or more of the organizations listed here.
In case you missed it ...
A physician recounts his own experience with a rare, life-threatening illness, and notes that the patient gets lost in discussions of treatments, health care delivery and health care reform. (Philadelphia Inquirer)
Labels: disaster response, health care delivery, health care reform, QD
posted by Ryan DuBosar at
11:14 AM
0 Comments
Thursday, January 21, 2010
QD: News Every Day--More internists arriving in Haiti
ACP Internist's wrap-up of current events follows MSNBC's chief health correspondent traveling through Haitian hospitals. He reports as they get up to speed on caring for patients in their facilities, they are also trying to coordinate care. Simple tasks, such as finding out who has space, are difficult. Relief efforts by many countries aren't fully coordinated with each other or with many of the nongovernmental efforts underway. Despite reports, logistical challenges are improving. (MSNBC, CNN)
Amid the logistics, independent medical teams are succeeding, such as a group from Christiana Care Hospital in Newark, Del. Reynold Agard, ACP Member, and Erin Meyer, ACP Associate Member, joined a team of 20 who travled to Jacmel, Haiti, a seaside town not far from the quake's epicenter, but that hadn't yet received help. Another team from Bridgeport, Conn., going to Jacmel was joined by Sangeetha Thiviyarajah, ACP Associate Member (pictured here). A team from Cooper University Hospital in Camden, NJ, has started surgical care, and physicians from Dayton, Ohio, set up a morgue, a decontamination area and showers for relief workers. And, the USNS Comfort received its first two patients by helicopter. It's now anchored off the Haitian Coast for an indefinite stay after upgrading to 1,000 hospital beds and more than 1,000 sailors. (Wilmington News-Journal, CTpost.com, Philadelphia Inquirer, Dayton Daily News, U.S. Navy)
The USNS Comfort anchored off the coast of Haiti and began receiving patients on Jan. 20.
Health care reform
Health care reform proponents look to salvage area of health care reform that were agreed upon throughout the legislative process, such as preventing insurers from canceling policies for people who fall ill. But many aspect of health care are related to one another, so a piecemeal approach has its own problems. Drug-makers, insurers and other health-related businesses are positioning themselves in the new landscape. So are medical societies, such as ACP. (free registration required) President Joseph Stubbs, FACP, explains. (Los Angeles Times, Wall Street Journal, MedScape Today)
In case you missed it ...
An internist in California was shocked when she saw the new Medicare schedule had cut reimbursement by 20%. Her overhead costs haven't fallen, so she's contemplating giving up that block of patients, even though she loves caring for them. (Los Altos Town Crier)
Also, LiveScience.com debunks seven common medical myths that even doctors believe.
Labels: disaster response, health care reform, medicare, QD, reimbursement
posted by Ryan DuBosar at
11:21 AM
0 Comments
Wednesday, January 20, 2010
QD: News Every Day--Haiti, U.S. Senate feel strong motions
ACP Internist's wrap-up of current events continues with a look at Haitian relief. Haiti, which felt another earthquake this morning, is home to one of the world's best rural hospitals, a model copied globally. In the face of disaster, it has been overwhelmed. While that facility was built in Haiti's Central Plateau, another hospital was founded where none had been before in Thomassique, across a major river in Haiti. Founder and internist Gilbert Irwin, MD, expects a flood of patients seeking health care after being turned away from the Dominican Republic. Doctors in the capital, Port-au-Prince, reported peaceful conditions, but internist Jonathan Crocker, MD, of Beth Israel Deaconess Medical Center reported busy conditions as medical workers ramp up their efforts. (Boston Globe, Wall Street Journal, Star-Exponent, Harvard Gazette)
Health care reform
Massachusetts voters chose their Republican candidate for the U.S. Senate, fueled by discontent with health care reform efforts so far. The swing breaks the filibuster-proof majority Democrats held while pushing legislation through, and leaves future efforts vulnerable to procedural stonewalling. Amid unpalatable options, what's left is finding a bi-partisan way to move forward. (Boston Globe, Politico, Wall Street Journal, Washington Post)
In case you missed it ...
This may come up professionally, from a patient. This may come up personally. But finally, someone has developed a decision tree whether one should eat food that's been dropped on the floor. More than the five-second rule is involved.(San Francisco Weekly)
Labels: disaster response, health care reform, QD
posted by Ryan DuBosar at
10:54 AM
1 Comments
Tuesday, January 19, 2010
QD: News Every Day--Haiti relief efforts struggle
ACP Internist's wrap-up of current events continues with a look at Haitian relief efforts and the internal medicine community's efforts. Domestically, a special election for Massachusetts's Senate seat could affect health care reform.
Conditions in Haiti could create a medical disaster that would complicate the earthquake's impact. Richard Wenzel, MACP, outlines the conditions in Haiti that might contribute to infectious disease outbreaks such as dengue and malaria. But diarrhea is the bigger concern. Trauma from crush injuries has its own set of sequelae that will require special management including kidney failure, worsening diabetes or asthma, post-traumatic stress disorders or permanent mental and physical impairments. Chronic conditions such as diabetes supplies still require management in the face of short supplies. (Reuters, Wall Street Journal, Newsweek, Diabetes 24/7)
Logistical challenges continue, as Doctors Without Borders planes have been diverted from Haitian airfields to the Dominican Republic. Although bottlenecks delayed many internists' privately planned medical missions or slowed ones made in the wake of the disaster, the waits will make the eventual trips more organized. Some teams are making it through, however, often bringing their own medical supplies from offices, and hospitals are not only sending teams but accepting patients. (The Daily Journal of Illinois, Crain's Detroit Business, NBC New York, CBS 3 of Philadelphia)
The Navy's top doctor predicts the USNS Comfort will be employed in the region for at least six months. For the time being, the Navy's home page is dedicated entirely to coverage of its efforts, including numerous pictures showing the vast scope of the effort. 
Naval Air Crewman 2nd Class Jason Harold of Goldsboro, N.C., transfers a young Haitian earthquake victim from an SH-60B Seahawk helicopter during a medical evacuation in Port-au-Prince, Haiti. U.S. Navy photo by Mass Communication Specialist 2nd Class Candice Villarreal/Released by Lt. j.g. Erik Schneider)
Health care reform
Massachusetts, which has universal health care, now holds the key to the rest of the country getting it, too. Today's special election to elect a new Senator could swing the balance of power. Democrats tried to negotiate ahead of the election but couldn't reach a compromise. The Boston Globe is offering updates all day. If the Democrats do lose their Senate seat, there's still three ways to push the bill through in the face of likely opposition. (Wall Street Journal, Washington Post, Boston Globe, Christian Science Monitor)
H1N1 influenza
The Centers for Disease Control and Prevention estimates as many as 80 million Americans have been infected with H1N1 influenza, with 16,000 dead and 360,000 hospitalized. About one in five Americans overall have been vaccinated, but 90% of the most vulnerable people, those less than 65 with conditions that put them at risk for flu complications, aren't. Globally, the pandemic is still active. (Reuters, Los Angeles Times)
In the mean time, hospitals are lifting their visitor restrictions. (Des Moines Register)
Labels: disaster response, H1N1, health care reform, QD
posted by Ryan DuBosar at
10:30 AM
0 Comments
Friday, January 15, 2010
QD: News Every Day--logistics stymie getting medical care into Haiti
ACP Internist's wrap-up of current events continues to follow the internal medicine community's response to the Haitian earthquake.
Overall, while needed supplies begin to reach Haiti, officials try to clear docks, roads and airports to get material into relief areas. In addition to a sizeable U.S. military presence, the U.S. Navy's hospital ship, USNS Comfort, is loading supplies and personnel and will leave this weekend. (CNN, Christian Science Monitor)
Shown is a map of the intensity of the shaking caused by the Haitian earthquake, adapted from the U.S. Geological Survey
Like other buildings, hospitals collapsed. Doctors Without Borders is struggling to manage medical care in the wake of losing its three facilities there. The group's deputy operations manager describes his group's disaster response operations. This morning, Stefano Zannini of the group updated reporters about the status of several hospitals that survived the quake and began surgeries. (New York Times, Doctors Without Borders, Wall Street Journal)
ACP members had planned medical missions for the spring, only to cancel them to make room for emergency teams. Marlo Hodnett, ACP Member from Madison, Ala., had planned a medical mission to Haiti, scheduled to depart Wednesday. The earthquake Tuesday pre-empted the group's plans. Retired internist Richard Perry, MACP, of Maryland, will put off his February medical education efforts at Hospital Sacre Coeur, 150 miles away, which survived with just a few cracks in the wall but will be repurposed as a medical and naval triage center. When contacted by phone, Dr. Perry told ACP Internist that trauma teams are more important right now--orthopedists, surgeons and their staff. Don Clark, ACP Member, of Charlottetown, Prince Edward Island, Canada, also will delay a planned medical mission, the fourth such he would have taken. Without infrastructure, there wouldn't be much he could do. Steven Williams, ACP Member, of Allegheny General Hospital in Pittsburgh, has visited Haiti for 20 years. He expects the country's already poor medical system to fare even worse under the strain. (Huntsville Times, CBC News, MedPage Today)
A physician with personal and familial connections in Haiti also spoke out about their response professionally, and the personal impact the earthquake's aftermath has had. (Boston University Today)
Editor's Note: QD: News Every Day will not be published on Jan. 18 due to the Martin Luther King Jr. holiday.
Labels: disaster response, QD
posted by Ryan DuBosar at
10:05 AM
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Thursday, January 14, 2010
QD: News Every Day--Haiti's impact
ACP Internist's wrap-up of current events looks at the response to events in Haiti. The full scope of the disaster isn't known two days later. Physicians fear that the already fragile efforts in the country to control tropical diseases will be wiped out entirely. The facilities for Doctors Without Borders have been leveled, so they're inflating field units to help disaster relief efforts. Learn more about this method of disaster response from ACP Hospitalist. (CNN, Discovery Channel, ACP Hospitalist)
Health care reform
Marathon negotiations between the White House and members of Congress settled a few issues and raised a few others. Talks continue today. (Washington Post, Wall Street Journal, New York Times, AP)
Evidence-based medicine
Anne Nedrow, FACP, and Anastasia Rowland-Seymour, ACP Member, will travel to India to study the evidence base for introducing ayurveda, yoga and meditation into U.S. medical education and patient care. In India, such practices are mainstream medical care, not alternative medicine, and are the country has for ayurveda 150 colleges, 50 post-graduate programs and 3,000 hospitals.
Labels: alternative medicine, disaster response, health care reform, infectious disease, QD
posted by Ryan DuBosar at
10:09 AM
0 Comments
Wednesday, January 13, 2010
QD: News Every Day--Medicare pay rises, cost to practice rises more
ACP Internist's wrap-up of current events looks at how primary care providers are faring in today's economic climate. (Cue the stormy background sounds.)
Primary care shortage
Primary care doctors could see a 1.1% Medicare pay increase this year, instead of a 21% cut. The bad news is the cost of practicing medicine will rise 2.5%. (American Medical News)
Thomas Bledsoe, FACP, talks to NPR in an audio report about frustrations in his practice that led him to kick a trash can across the room. Rhode Island is hoping to ease the tension by requiring insurers to invest more than a $100 million more into primary care, to fund the patient-centered medical home and electronic health records, among other goals. But frustrated physicians aren't waiting for government involvement or health care reform. Like Stephen Glasser, ACP Member, they are fleeing to concierge care. (WRNI/NPR, Washington Post)
Health care reform
Sen. Olympia Snowe, the one Republican to show any approval at all for health care reform legislation, defended her vote weeks ago to move the legislation forward (although she'd cautioned her vote was only to do that, not to approve the legislation as written.) Her constituents, including small business leaders, let her know how they felt about the impact of the bills underway in Congress. They may be comforted to know that employer insurance mandates may be dropped from the negotiations underway between the White House and both chambers of Congress. (Bangor Daily News, Boston Globe)
Mammography
In the face of strong controversy about mammography screening guidelines, Lawrence E. Feinberg, FACP, President of ACP's Colorado chapter, discusses the benefits of following U.S. Preventive Service Task Force recommendations. (Denver Post)
Labels: concierge medicine, health care reform, mammography, primary care shortage, QD
posted by Ryan DuBosar at
11:16 AM
0 Comments
Monday, January 11, 2010
QD: News Every Day--math geeks project on health spending, H1N1's spread
ACP Internist's wrap-up of current events looks at how the mathematicians and engineers are changing health care. Actuaries project health spending, an equation projects how the flu would spread throughout an airplane, and the industrial engineers apply tricks from car making to the hospital.
Health care reform
The Senate's health care legislation would raise spending by about 1%, yet extend coverage to currently uninsured people and possibly save money long-term, according to a report released by the Centers for Medicare and Medicaid Services over the weekend. Proponents saw it as good news; opponents, as bad. But, CMS actuarial simulations indicated that as much as 20% of Part A providers who rely on Medicare could become unprofitable in the next decade. (Politico, AP/Washington Post, The Hill, Modern Healthcare)
H1N1 influenza
The waning H1N1 pandemic may let loose a wave of new but as-yet-unknown inter-pandemic or seasonal flus. Val Jones, MD, interviews ACP President Joseph Stubbs, FACP, about the need to continue vaccination efforts, citing 80% of the population as a desirable goal. (MSNBC, ACP Internist blog)
A mathematical model predicts how one plane passenger carrying H1N1 would infect others. The Wells-Riley equation considers among other areas the number of people exposed and the length of exposure. One sick person in economy class could spread H1N1 to two to five others on a five-hour flight, five to 10 on an 11-hour flight and seven to 17 during a 17-hour flight. Researchers at the University of California, Los Angeles pointed out that someone in first class wouldn't have such an impact because of the less-crowded seating.
Primary care shortage
Advanced practice nurses are pushing to run patient-centered medical homes in Ohio. As a bill to create a PCMH pilot project moves through Ohio's state legislature, a nursing association wants to get in on the ground floor to prove they can add value to the concept. Ohio's physician association says the move could threaten to bog down the pilot project. (Youngstown Vindicator)
In case you missed it
Automobile makers have a lesson to teach health care. In Detroit, engineers from General Motor helped University of Michigan Health System implement Lean, a series of exercises that pare away wasted steps, preach cleanliness and try to reduce errors. The automaker's own Lean efforts reduced auto recalls by 85%. Jack Billi, FACP, explains how it worked in his facility. (Crain's Detroit Business)
Labels: H1N1, health care delivery, health care reform, patient-centered medical home, primary care shortage, QD
posted by Ryan DuBosar at
12:28 PM
1 Comments
Friday, January 8, 2010
QD: News Every Day--mulling options for health care reform
ACP Internist's wrap-up of current events looks at how state and federal figures continue to jockey for position in health care reform negotiations.
Health care reform
Democrats in the U.S. House held a conference call to discuss health care reform options before formally returning to session next week. Speaker Nancy Pelosi tried to rally the Representatives, saying they would push her Chamber's agenda where its legislation differed from the Senate's. (Washington Post, The Hill)
The House and Senate may end up compromising on new taxes that would help pay for health care. The House favors a tax on millionaires while the Senate favored a tax on high-value insurance plans. It's easy to understand just who's a millionaire, but if you're curious just what the "Cadillac" plans are, here's an explanation. Meanwhile, the health insurance industry seeks its own tax cut. (The Hill, Kaiser Health News/NPR, Reuters)
The White House enlisted Democratic Governors to promote health care reform. They'd been mostly silent so far, in contrast to their Republican counterparts. At issue is how much money the states will have to contribute to an expanded Medicaid program--that is, every state except Nebraska, which was promised federal support for any expansion in that state in exchange for a crucial Senate vote from its Senator, Ben Nelson, last year. Facing flak for that, Sen. Nelson now wants the federal government to cover all the states' financial burden for expanding Medicaid. (Politico, AP)
ACP outlines how it will continue to work with both chambers as they hammer out details of health care reform. One priority is the primary care shortage, and both the House and Senate bills support expansion and testing of the patient-centered medical home and expand funding for the National Health Service Corps. (ACP Advocate)
H1N1 influenza
Canada is loaning Mexico 5 million doses of H1N1 vaccine. France was looking to sell its leftovers to the Middle East and to Egypt, which wants to inoculate half its schoolchildren. Germany was looking for buyers for its leftovers in Eastern Europe. (Agence France-Presse, IRIN)
Primary care shortage
Tucked away in news coverage just before the holiday break, a story highlighted nurse-managed health centers as a way of relieving the primary care shortage. More than 250 such facilities exist and a nursing consortium is pushing for more legislative and funding support. Currently, 26 states allows nurses to run the centers, 20 require some relationship to a doctor and six require physicians to be at the clinic at least part of the time. (Healthcare Finance News)
Labels: H1N1, health care cost, health care reform, primary care shortage, QD
posted by Ryan DuBosar at
11:34 AM
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Thursday, January 7, 2010
QD: News Every Day--negotiations continue from every direction
ACP Internist's wrap-up of current events looks at the multi-part negotiations occurring between the White House, the U.S. House, the Senate, and every imaginable constituency.
Health care reform
Negotiations continue between the White House and U.S. House and between the congressional leaders themselves. Up for discussion are the excise tax on the 'Cadillac' health care plans, how best to merge the House and Senate legislation, and how married couples who'd buy insurance through the new legislation instead of through employers would pay more than unmarried people. (Wall Street Journal, New York Times, AP/Chicago Tribune, Politico)
H1N1 influenza
It may take until next year before the global threat of H1N1 passes, said World Health Organization chief Margaret Chan. Outbreaks are intensifying in India and Egypt, for example, according to WHO. (Reuters)
Labels: H1N1, health care cost, health care reform, QD
posted by Ryan DuBosar at
11:55 AM
1 Comments
Wednesday, January 6, 2010
QD: News Every Day--how hospitals will fare with health reform
ACP Internist's wrap-up of current events continues. Smaller or urban hospitals may not fare as well as their Midwestern counterparts under health care reform. And, an airline pulls pillows and blankets over flu concerns. (Will they eventually charge a fee for those, too?)
Health care reform
As bicameral negotiations begin, House members say they will adapt the Senate's version of legislation to make health care more affordable. They might barter the public option for more affordable premiums, for example. (New York Times, AP)
Large hospitals could be big winners, as both chambers' bills have language to reward hospitals for efficiency. That could spell a loss for hospitals in big cities, which care for larger percentages of the poor, and in the South. Ahead of the curve are a group of hospitals in the upper Midwest, led by the Mayo Clinic, that lobbied for the change. A report by the Medicare Payment Advisory Commission further addresses regional spending variations. (Washington Post)
The tally of state attorneys general opposing health care reform rose to 13. At issue is a provision in the legislation that the federal government would pay for newly eligible Medicaid enrollees in Nebraska. This places the other 49 states at a disadvantage. (HealthImaging.com)
H1N1 influenza
Southwest Airlines pulled pillows and blankets from its flights because of H1N1 and other infectious diseases. The worry was that plane crews would handle the items after members of the public did. They wouldn't have to worry about cleaning up after Margaret Chan, head of the World Health Organization, who finally got her vaccine after a busy travel schedule delayed her getting it. The disease has killed 11,500 people globally. (South Florida Business Journal, CBS News/AP, Reuters)
Primary care shortage
Eighty percent of Missouri's counties have a shortage of primary care physicians, so Missouri University's School of Medicine created a Rural Track Pipeline Program in 1995 to teach medical students about the importance of practicing in rural areas. (Columbia Missourian)
Labels: H1N1, health care reform, primary care shortage, QD
posted by Ryan DuBosar at
11:32 AM
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Tuesday, January 5, 2010
QD: News Every Day--ping-pong for reform
ACP Internist's wrap-up of current events continues with ping-pong for health care reform, how the recession curbed health care spending and how legislation preventing patient-dumping can hurt the physicians required to provide treatment.
Health care reform
Negotiations for health care reform will avoid the formal conference procedure and instead negotiate directly. The "ping-pong" talks, which don't have to be public, will send the bill back-and-forth between the House and Senate until both chambers agree. C-SPAN wants to televise the negotiations. The goal is to pass the legislation by a State of the Union speech scheduled for February. (Los Angeles Times, C-SPAN, Baltimore Sun)
The recession did what Congress has struggled to do--slow spending for health care. Spending on physicians and services rose by 4.4% in 2008 over the previous year, the slowest increase in 50 years of tracking by the Centers for Medicare and Medicaid Services. Still, spending totaled $2.3 trillion, or more than 16% of the entire economy. The credit freeze in the most recent recession may have dissuaded people from paying large deductibles. (AP, USA Today)
Toward more efficient spending, House and Senate legislation both test the waters on accountable care organizations. Such arrangements prompt primary care doctors, specialists and hospitals to work together and reimburse them based on that care. Health reform legislation would limit the experiment to Medicare. (NPR)
Primary care shortage
More doctors than ever have sought to practice in Wyoming, often through telemedicine. That's not enough. Of the 301 doctors who received state licenses, 18% work full time in the state. And of Wyoming's more than 2,800 licensed doctors, less than 40% practice full time. The paper's editorial board is now calling for loan repayment programs to help rural health recruiting efforts. (Star-Tribune)
In case you missed it ...
In Prescott, Ariz., local physicians consider the Emergency Medical Treatment & Active Labor Act as the "biggest, most voluminous constraint" on doctors in the community. The 1986 law prevents patient dumping, but it while one doctor says it's ethically and morally correct, it also punishes doctors and hospitals who see patients in emergency rooms. In Prescott, that may be as many as 20% of all patients. The issue plays out in the nation's capital, too, where a vacation turned into a much longer stay for a legally visiting tourist who developed complications during her pregnancy and stayed through delivery. (The Daily Courier, Washington Post)
Labels: health care cost, health care reform, primary care shortage, QD
posted by Ryan DuBosar at
11:05 AM
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Monday, January 4, 2010
QD: News Every Day--a new year of familiar debates
ACP Internist's wrap-up of current events continues with health care reform's reconciliation, progress for electronic health records, and one ACP member's memories of his most unusual house calls.
Health care reform
Congressional aides begin to haggle over reconciling their chambers' versions of health reform. The legislators themselves reconvene later this month. (Boston Globe, Wall Street Journal)
Conservatives speculate that an individual mandate to buy health insurance is unconstitutional. Eleven Republican states' attorneys general promise to investigate, as well. (Washington Post, Politico)
While Nevada Senator Harry Reid may have gotten health care through his legislative chamber, back home, Nevada's governor, Jim Gibbons, said it will tack on $613 million in additional expenses to the state budget. Gov. Gibbons is joined by governors from California and New York, who worry that money will be taken from more populous areas, and by Georgia's governor, who may face a half-billion-dollar increase if it eventually passes. (KTNV/ABC News, Politico, Atlanta Journal-Constitution)
Electronic medical records
The Department of Health and Human Services released criteria for doctors to become eligible for federal help for switching to electronic medical records. (Reuters) Those truly interested can slog through the 556-page proposal.
In case you missed it ...
Preston Taylor, FACP, a gastroenterologist in Tucson, Ariz., published a memoir of his most memorable house calls--including house calls to brothels, mobsters, and even a family that came to his house seeking treatment. Back in his day, a house call cost $7, but the family that came to him instead repaid him with a big bag of shrimp. (Arizona Daily Star)
Labels: electronic medical records, health care cost, health care reform, QD
posted by Ryan DuBosar at
11:43 AM
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