Author Archives: correaf

Health Officials to Docs: Help Save ACA

Health officials are encouraging doctors who support the health law to help save it. By telling patients about how the Affordable Care Act will benefit them and the entire system, physicians can help garner support for the ACA, said Kathleen Sebelius, secretary of Health and Human Services.

“The notion that [you] are going to share factual information and have people share that information with friends and neighbors and patients on websites, in blogs, and church groups, and at [parent/teacher organization meetings], that’s really what makes a huge impact,” Ms. Sebelius said while addressing primary care and specialist physicians at the annual conference of Doctors for America. She added that doctors should not only spread the news, but become a part of the process as well.

“Your comments, certainly, about what is happening in rulemaking is helpful … but more than that is participating in some of the new models of care,” Ms. Sebelius said.

Many physicians are skeptical about the ACA according to some surveys. However, Doctors for America is among those who support of the law. It remains to be seen whether there’s enough agreement among doctors to make a difference.  What do you think? Tell us in the comments section.

—Frances Correa (@FMCReporting on Twitter)

1 Comment

Filed under health reform, IMNG, Practice Trends, Uncategorized

Fewer Residents Are Self-Prescribing

Fewer medical residents are self-medicating these days. That’s according to a study published Feb. 27 in the Archives of Internal Medicine, where researchers found just over 7% of medical residents prescribed themselves medications including stimulants, mood stabilizers, and antipsychotics. That’s in stark contrast to the 52% who said they self-medicated back in 1998.

This time around, researchers surveyed 1,555 interns , most (1,267) of whom completed at least one follow-up survey during the internship year. Among those who followed up,  11% reporting taking prescription medication, 50% of which came from a personal physician, 24% from a colleague, 18% from a sample cabinet, and 7.6% from their own script pad.

Courtesy the National Cancer Institute

Comparatively, the 1998 findings show that 78% reported taking a prescription medication, with more than half being self-presribed. More than 40% of self-prescribed medication came from a sample cabinet; 11% from a drug rep.

So why the decrease? Authors of the Archives study said one reason is the growing awareness of the influence of the pharmaceutical industry on intern behavior and medical practices.

“This study suggests that there has been a dramatic shift among physicians in training away from self-prescription and use of medications from sample cabinets and pharmaceutical representatives,” they wrote.

Going forward, researchers should look at whether the shift also exists in practice, where personal use of samples is common and interactions with drug representatives is more frequent, the authors recommended.

—Frances Correa (@FMCReporting on Twitter)

Leave a comment

Filed under IMNG, Practice Trends

Poll: Most Want the Mandate Nixed. Do You?

As the Supreme Court prepares to take on challenges to the Affordable Care Act, new data suggests that Americans remain divided on the constitutionality of the law’s requirement that all Americans purchase health insurance. Little more than half of Americans (54%) think the individual mandate should be ruled unconstitutional and that the Supreme Court will likely agree (55%), according to a recent poll by the Kaiser Family Foundation. The poll was based on telephone interviews with 1,206 adults in the United States from. Jan 12-17.

Courtesy Kaiser Family Foundation

The poll also found that more than half (59%) of Americans think the Supreme Court Justices will base their ruling on their own opinions.  That sentiment is being echoed by the conservative interest group Freedom Watch, which recently filed its second petition to request Justice Elena Kagan to recuse herself. Supporters of the petition take issue with Justice Kagan’s former position as Solicitor General and close adviser to President Obama while the law was being written.

If the mandate were ruled unconstitutional, it’s not clear if the rest of the law would remain solvent. According to the poll, 55% of American thought remaining provisions of the law would survive but 30% said it would mean the end of the law entirely.

Courtesy Kaiser Family Foundation

Further, the Kaiser poll shows that Americans are split on their own opinions of the ACA. According to the poll, 44% are against the law, 37% support the law, and 19% are unsure.

However, a majority (67%) oppose the mandate because it forced American to do something they don’t want to do (30%) or because health insurance is unaffordable (25%). An additional 22% just don’t like the idea of paying a fine for not having insurance.

Those who do support the mandate (30%) said it guarantees that everyone needs health coverage (32%) and that the mandate can guarantee that (17%). Some also said the mandate could control costs (15%).

Do you agree with these findings? Tell us more.

– Frances Correa (FMCReporting)

Leave a comment

Filed under Health Policy, health reform, IMNG, Polls, Practice Trends

House: System Reforms Second to SGR Repeal

Delivery system reforms come second to repealing the Sustainable Growth Rate formula. That’s according to congressional testimony by private sector payers at a recent hearing of the House Ways and Means Committee.  While each of the panelists presented compelling ideas for delivery system reform, all agreed that the first step to progress is a new payment model.

“The extent to which Medicare can more more swiftly to payment reforms, I think we’d see progress there,” said panelist Dr. Jack Lewin, the chief executive officer of the American College of Cardiology.

Rep. Mike Thompson (D-Calif.) said SGR repeal, not delivery reform, is the number one concern of both doctors and Medicare beneficiaries.

Alicia Ault/Elsevier Global Medical News

“[Doctors] want to make sure that they’re going to get paid for the medical services they provide and Medicare patients want to make sure they’re going to have a doctor to go to; and it stops right about there,” he said. His concerns were echoed by Ranking Member Pete Stark (D-Calif.).

“We keep avoiding the topic of Sustainable Growth Rate formula, in favor of the easier conversations about delivery system reforms, around which we have much stronger agreement,” Rep. Stark said.

Dr. John Bender, president and CEO of Miramont Family Medicine of Fort Collins, Colo., testified that if SGR is not repealed, doctors could have a harder time keeping their practices afloat. He added that he was forced to take out $70,000 loan to cover payroll 4 years ago when SGR was not repealed and Medicare payments were delayed. Today, with stricter policies on loans, that might not be an option, Dr. Bender said, and his practice could go bankrupt.

Len Nichols, director for health policy research and ethics at George Mason University, testified that the Affordable Care Act has brought an end to “business as usual.” He said that Medicare and private payers must work together to find savings, or else face steep cuts.

“We could cut our way to fiscal balance, and in so doing, reduce access to care for millions of Americans. I fear this pathway would likely fail,” Nichols said. “Alternatively, we could align incentives so thoroughly that we actually link the self-interest of clinicians with our common interest in cost reduction and quality improvement, which covering all Americans.”

Rep. Thompson called on his fellow lawmakers to put partisan differences aside to solve the problem that Congress created.

“We have dropped the ball on this one … We need to come together as members of Congress, party stripe not withstanding, and figure out how we come up with the dollars to fix this,” he said.

—Frances Correa (@FMCReporting on Twitter)

Leave a comment

Filed under Family Medicine, Health Policy, health reform, IMNG, Practice Trends, Primary care

Beauty Poisoning

Foreign-made skin-lightening creams, found to contain toxic levels of mercury, are poisoning users as well as the people they live with, according to a report from the Centers for Disease Control and Prevention.

The CDC identified a Mexican-made cream as the likely source of mercury exposure in 22 people in 5 households in California and Virginia. While previous cases have shows similar levels of mercury exposure from skin-lightening creams, this is the first instance where exposure has been measured in non-users, CDC said. The non-labeled creams contained  2%-5.7% mercury.

Skin lightening agents that are readily available for sale in Ghana/ ©2011 Elsevier Inc. All rights reserved.

Among the sample, 15 people ages 8 months to 67 years had elevated urinary mercury concentrations (9 users and 6 non-users). Non-users were exposed to the mercury through contact with cream users or with contaminated household items, the CDC said.  Younger children, compared to older children, had much higher concentrations.

While 15 people had elevated mercury levels, only 6 (all users) exhibited symptoms of mercury exposure. Users of the skin-lightening creams said they had used it as an acne treatment, for skin-lightening, and to fade freckles.

Although mercury-containing creams are banned by the Food and Drug Administration, high levels of mercury have been found in foreign-made skin-lightening creams across the country, including Chicago, New York, Minnesota, and Baltimore.

In 2010, an FDA spokesperson told the Chicago Tribune that with fewer than 500 inspectors dedicated to reviewing imports, banned items often get through anyway. The FDA could not comment before press time.

The CDC advises clinicians who recognize mercury toxicity to consider mercury-containing creams as a possible cause, even for children. Consult a medical toxicologist before beginning treatment, CDC advises.

—Frances Correa (@FMCReporting on Twitter)

2 Comments

Filed under Dermatology, Family Medicine, IMNG, Primary care

Experts Call on Docs to Lead Cost Control

Doctors must play an integral role in reducing health care costs, health policy experts say. At the annual conference of consumer group Families USA, Dr. Atul Gawande and Dr. Ezekiel J. Emanuel said that doctors participating in reducing costs will have a greater affect than the health care law itself.

Dr. Atul Gawande / Frances Correa/ Elsevier Global Medical News

“Washington will not be able to save the costs. They’ll provide the framework, but in your communities, that’s where you’ll do it,” said Dr. Gawande, a health policy researcher and endocrine surgeon at Brigham and Women’s Hospital in Boston. Dr. Gawande said that the Affordable Care Act will provide the data for doctors to identify where to trim costs. Both Dr. Gawande and Dr. Emanuel said doctors can take a leading role in cost control by focusing on the sickest 5% of patients. According to a 2009 report from the Agency for Healthcare Research and Quality, the sickest 5% of patients account for 50% of national health care expenditures.

Dr. Gawande cited the work of Dr. Jeffrey Brenner. By analyzing medical billing data from practices in Camden, N.J., Dr. Brenner, a primary care physician, was able to map out the most impoverished areas with the highest health care costs. With a focused approach that included home visits and the help of social workers, Dr. Brenner decreased one patient’s inpatient hospital time from 7 months in one year to 3 weeks. While under his care, the patient lost 200 pounds, and quit smoking, drinking, and using cocaine. At the same time, the patient’s hospital costs decreased by 60%. Dr. Gawande wrote about Dr. Brenner’s strategy in a January 2011 article in the New Yorker.

Dr. Emanuel, a recognized expert on health and chair of the department of medical ethics and health policy at the University of Pennsylvania, Philadelphia, said rising health care costs threaten many aspects of American society, particularly education, workers’ wages, and the nation’s position in the world, as well as by putting an economic squeeze on middle class. Dr. Emanuel also served as special adviser for health policy to the director of the White House Office of Management and Budget from January 2009 to January 2011, where he helped craft the Affordable Care Act.

Dr. Ezekiel Emanuel / Frances Correa/Elsevier Global Medical News

“If you care about how our kids are going to educated in the future, you have to care about heath care costs,” Dr. Emanuel said, adding that increased health care costs directly affect tuition rates. For example, from 2001 to 2011, employer contributions to health insurance increased by 113%, according to the Kaiser Family Foundation. Meanwhile, tuition for public universities increased 72% over the past decade, according to the College Board. Dr. Emanuel projected that, as health care costs continue to rise, states will be forced to take the money from other programs, leaving education and health care at the greatest risk.

“We can reduce costs without sacrificing access … [doctors] have to be committed to doing that,” Dr. Emanuel said.

Leave a comment

Filed under Family Medicine, Health Policy, health reform, IMNG, Practice Trends, Primary care, Uncategorized

Medicare, Good News and Bad News: The Policy & Practice Podcast

Medicare officials are touting  a smaller-than-average increase in Part A and Part B premiums, adding that in some cases seniors will even pay less in 2012 than they did this year.  Officials are linking the smaller increase to the slower spending growth for health services for seniors, due in part to the Affordable Care Act.

(c)JoKMedia/iStockphoto.com

Meanwhile, a new survey details potential cuts in access to care if the looming 29.5% Medicare pay cut goes into affect. Among the more than 2,000 physician group practices surveyed, more than half said they’d  be taking fewer new Medicare patients.

For details on that and more, listen to this week’s Policy & Practice Podcast.


Stay tuned next week for details on the physician fee schedule for 2012.

– Frances Correa (@FMCReporting)

1 Comment

Filed under Health Policy, health reform, IMNG, Podcast

ACO Details Are Out: The Policy & Practice Podcast

After much anticipation, the Centers for Medicare and Medicaid Services finally released the final rule on accountable care organizations. As physician and hospital groups were initially wary of ACOs, CMS said they’ve considered the suggestions and the rule was adjusted accordingly. Among other changes, interested physicians will now have more time to get an  ACO up and running.

Dr. Don Berwick discusses the future of Medicare. Courtesy the Bipartisan Policy Center

Meanwhile, other parts of the new health law haven’t has the same success. The administration has cancelled CLASS, the law’s long-term insurance program, calling if financially unsustainable.

The decision has given GOP lawmakers ammunition for arguments against the ACA.

For details on that and much more, listen to this week’s Policy & Practice Podcast.


–Frances Correa (@FMCReporting)

Leave a comment

Filed under Health Policy, health reform, IMNG, Podcast

Concussion Training, Research on the Rise

As awareness and understanding of traumatic brain injury has grown among the military and deployed soldiers, closer to home, it’s athletes of all levels who are feeling the hit. From Little League to the NFL, concussions are on the rise. At a hearing held by the Senate Committee on Commerce, Science, and Transportation, witnesses testified that the community isn’t always aware of the severity of the illness.

(c)nycshooter/iStockphoto.com

Alexis Ball, a former soccer player at the University of New Mexico, testified that she sustained 10 concussions over 8 years of playing competitive soccer. Despite repeated concussions, Ms. Ball said she continued to play because she and her family did not understand the severity of her injuries.

Because of sequelae from her repeated injuries, Ms. Ball was medically disqualified from playing collegiate sports in 2009. Today, she has permanent impairments to her vision and balance.

While pro football and hockey players are often saddled with multiple concussions , sometimes ending their career, concussion is most commonly seen among young athletes. According to data on concussion-related emergency room visits, researchers have found that about 40% of the time, the patient is between the ages of 8 to 13.

While concussions are a common occurrence on the field, most doctors lack the proper training in the treatment and diagnosis of the condition, according to Dr. Jeffrey Kutcher, chair of the sports neurology section of the American Academy of Neurology, who also testified before the Senate committee.

Dr. Kutcher said that most physicians don’t understand that concussions must be handled differently for every patient, as opposed to a “cookbook” approach.

While little is known about the complexity of the condition, researchers are working to change that. At the annual meeting of the American College of Emergency Physicians, a team doctor for the San Francisco 49ers discussed a new tool for gathering data on sports-related concussions. By using mouthguard-based accelerometers, physicians aim to learn about the type of hits that cause concussions, and hopefully find ways to protect players against future head injuries.

Physician groups are also working to improve their training on diagnosing and treating concussion. AAN’s Dr. Kutcher said his group is working to incorporate concussion training at the residency level for neurologists, as well as primary care and emergency physicians. The AAN is also developing sports neurology fellowships and developing CME on concussion. The group has also released a Sports Concussion Toolkit for providers, including basic sports concussion guidelines.

–Frances Correa (@FMCReporting)

1 Comment

Filed under Emergency Medicine, Family Medicine, IMNG, Neurology and Neurological Surgery, Pediatrics, Practice Trends, Sports Medicine

Pushing the Supercommittee: The Policy & Practice Podcast

The AMA launched a multi-million dollar ad campaign to push for an SGR fix now. Courtesy AMA

As the Joint Select Committee on Deficit Reduction, or the Supercommittee, works behind closed doors to find more than a trillion dollars in debt reductions, the American Medical Association is pulling out all the stops to get a permanent fix to the Sustainable Growth Rate Formula on the agenda. Whether the committee chooses to address the SGR issue, they have until Nov. 23 to get their recommendations out.

Meanwhile, the Obama administration has awarded nearly $300 million in scholarships and loan repayment to physicians willing to spend two to four years working in rural communities. The initiative is aimed at boosting the physician workforce shortage in under-served areas.

For more on that, take a listen this week’s Policy & Practice Podcast.


Stop in next week to hear more about the legal wranglings of the Affordable Care Act and physician pay concerns.

– Frances Correa (@FMCReporting)

Leave a comment

Filed under Family Medicine, Health Policy, health reform, Podcast, Practice Trends, Primary care