ACP Internist

Wednesday, November 18, 2009

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--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--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--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--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--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--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 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

Pay attention! Primary care faces a shortage

NBC devoted prime time news coverage to the shortage of primary care physicians, and interviewed residents on why they're not pursuing primary care. (Apologies for the short commercial NBC posts before its online outtakes.)

Near-daily coverage of the provider shortage crosses our desks at ACP Internist, shown here, here and here to post just a few from recent days. And to post a few more, here, here and here.

It may be cold comfort, but the issue doesn't lack for attention, just a solution.

Labels: health care reform, physician shortage, primary care shortage

Primary care shortage: IMGs filled in gaps, but that's changing CDC says

As the primary care physician shortage worsens, international medical graduates (IMGs) have been critical to filling in gaps in care, especially in underserved areas, according to a CDC report released today.

In 2005-06, one quarter of all visits to office-based physicians were to IMGs, the report says. IMGs also saw a higher percentage of patients using Medicaid or SCHIP as payment compared with their U.S. counterparts and were more likely to practice in shortage areas outside of big cities. However, the report warns that it's getting harder to recruit IMGs to shortage areas because more are coming to the U.S. on less-restrictive visas. The U.S. may face "challenges" if visa policies affecting physician supply remain unchanged, the authors conclude.

With so many new medical graduates rejecting primary care for higher paying specialties and communities struggling to attract primary care docs, should we go back to forcing IMGs to practice in underserved areas as a condition of their visas? Or will the situation force the government to move faster on reforming the dysfunctional Medicare reimbursement system?

Labels: IMGs, primary care shortage

Primary care tops locum tenens requests

The front page of today's Wall Street Journal has a story on the rising demand for temp surgeons in the face of a nationwide shortage. But while demand for surgeons is growing more quickly than for other specialities, most locum tenens requests are, by far, for primary care docs, notes the WSJ's health blog. According to a survey by national locum tenens company Staff Care, primary care accounted for 41.5% of total staff-days requested by clients in 2007, followed by anesthesiologists/CRNAs (20%), behavioral health specialists (17.6%), radiologists (11.6%) and surgeons (7.7%).

Many private practice internists are being forced to make changes in the face of declining reimbursements and the current recession. Are docs who may not have considered locum tenens in the past now giving it more serious thought?

Labels: locum tenens, primary care shortage

Is it always about the primary care shortage?

There's an interesting article in the LA Times about a young doctor who had to give up her independent primary care office to go to work in a big, corporate practice. But it's hard to tell what conclusions to draw from her story. The article itself ties her problems to the infamous primary care shortage. The Wall St. Journal blog argues that the problem is that small practices don't work as a business model. And from my reading of the story, it seems to me that her problem was the opposite of what we think of the primary care crisis: she had a shortage of patients, maybe due to the economic crisis. Here at ACP, we were just talking this morning about the potential impact of the recession on physicians. Fewer primary care visits but more hospitalizations (because patients are skimping on chronic care)? More patients who come in for care but can't pay their bills? Is anyone seeing this out there yet?

Labels: primary care shortage

Unhappy docs

A new survey by the Physicians' Foundation finds that half of practicing primary care physicians plan to either leave practice or reduce the number of patients they see over the next three years. Is this wishful thinking on their part about creating better work/life balance, or an indication that primary care is about to disappear? By the time health care reform is enacted, will there be anyone left to take advantage of it?

The other interesting stat from the survey is that 78% of the physicians believe there is a primary care shortage. Our question: what's up with that other 22%?

Labels: primary care shortage

Guest blogger: My pet peeve of the day

Guest blogger Toni J. Brayer, FACP, of ACP Internist's Editorial Advisory Board, offers her comments on how the primary care shortage will doom attempts to reform health care. She writes:

Anyone who reads EverythingHealth or many other health blogs (KevinMD, Maggie Maher, Dr. Rob, Dr. Val, and Happy Hospitalist to name a few) knows that primary care physicians are a dying breed. Everyone talks about the money (painfully low reimbursement) as the cause, but equally annoying is the LACK OF RESPECT for the specialty.

Repeatedly I run across doctors who have no training in family medicine or internal medicine who say "Oh, I'll just be a primary care doctor." One doctor is an 86-year-old surgeon who was denied operating privileges so he's going to "be a primary care doctor." He did surgery training in 1948.

Another doctor hasn't ever seen a live patient. He originally trained in pathology and has done only laboratory work. He is moving to Hawaii to be a "primary care doctor."

Another has been a hospital administrator for years but wants to "see patients again" so he is going to do "primary care a half-day a week."

Give me a break! This is not a specialty you can drop in and out of as a hobby.

There is a severe lack of understanding about primary care medicine and the medical specialties of family medicine and general internal medicine. Each of these specialties requires years of residency after internship and continued medical education and exams for board certification status.

A tremendous body of knowledge is needed to be a primary care physician. One must have diagnostic acumen, know all treatment modalities, have skills in psychology, inherent common sense, knowledge of medical economics, a vast knowledge of pharmacology and hundreds of drug interactions. Primary care physicians must keep up with all of the medical literature and current evidence to be at the top of their game.

I've practiced non-stop for over 20 years and I am still challenged by patient care. Even though I could probably deliver a baby or remove an appendix or even amputate a limb if I were stranded on a desert island, I would never be so bold as to think I could drop in and out of those specialties and render good patient care.

Unfortunately the shortage of REAL primary care doctors means the field is wide open to anyone who wants to hang out a shingle and give it a try.

Labels: primary care shortage

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.

RSS feed

American College of Physicians: Internal Medicine — Doctors for Adults ®

Related ACP Resources:

ACP EHR Partner Program

ACP Internist

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.

Thursday, November 5, 2009

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

Thursday, October 29, 2009

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

Tuesday, October 27, 2009

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

Thursday, October 22, 2009

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

Monday, October 19, 2009

QD: News Every Day--the H1N1 fist bump

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

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

Wednesday, July 15, 2009

Pay attention! Primary care faces a shortage

Wednesday, February 11, 2009

Primary care shortage: IMGs filled in gaps, but that's changing CDC says

Tuesday, January 13, 2009

Primary care tops locum tenens requests

Monday, December 15, 2008

Is it always about the primary care shortage?

Tuesday, November 18, 2008

Unhappy docs

Wednesday, November 12, 2008

Guest blogger: My pet peeve of the day

Contact ACP Internist

Previous Posts

Archives

Blog log