Category Archives: Doctors

Medicaid’s raise for primary care docs to disappear

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Twenty-dollar bill in a pill bottleBy Michael Ollove
Stateline

A temporary bump in Medicaid fees paid to primary care doctors, an Affordable Care Act provision intended to get more physicians to accept Medicaid patients, will expire at the end of this month.

Congress did not extend the higher rates, so unless states take action themselves or the new Congress revisits the issue, primary care doctors in Medicaid will see their fees fall by an average of nearly 43 percent starting in January, according to a new report from the Urban Institute.

Unless action is taken primary care doctors in Medicaid will see their fees fall by an average of nearly 43 percent starting in January.

Whether the expiration of the fee increase will make a difference in physician participation in Medicaid is unknown. That is because there hasn’t been enough time to analyze whether the hike actually convinced primary care doctors to take Medicaid patients.

“It’s expiring before it’s been evaluated,” said Sandra Decker, a researcher at the National Center for Health Statistics, an arm of the Centers for Disease Control and Prevention.

Decker, who has published widely on the Medicaid physician workforce, said she will analyze the impact of the fee increase, but doubts her results will be complete before the end of next year.

Still, she noted, past evidence indicates that Medicaid pay increases spur participation by physicians. She predicted that the lower fees will make it harder for Medicaid patients to find doctors willing to see them or that they will have to endure long waits to see doctors who accept Medicaid patients.

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Vera Whole Health to run employee clinic for City of Kirkland

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Screen Shot 2014-12-17 at 12.35.36 PMVera Whole Health has signed an agreement with the City of Kirkland to offer primary, preventive and acute care to City of Kirkland employees at a new worksite clinic.

The Seattle-based company offers on-site and near-site health clinics for organizations. Employers pay monthly fee for their employees to receive unlimited primary care, acute care and health coaching.

The company staffs the clinics with physicians, nurse practitioners, medical assistants and health coaches. The goal of the employer-funded clinics is to help employees develop and maintain healthy lifestyles, reversing the trend of rising overall health care costs, the company says.

In the Puget Sound region, the company maintains clinics for Seattle Children’s Hospital, the Bill & Melinda Gates Foundation, Trident Seafoods in Ballard and a Seattle-based investment company.

The City of Kirkland clinic is expected to open in the spring of 2015 and will be located in the Totem Lake area.

 

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As controlled substance use rises in Medicare, prolific prescribers face more scrutiny

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pills-spill-out-of-bottle

By Charles Ornstein and Ryann Grochowski Jones
ProPublica

This story was co-published with USA Today and NPR’s Shots blog.

Despite a national crackdown on prescription drug abuse, doctors churned out an ever-larger number of prescriptions for the most-potent controlled substances to Medicare patients, new data shows.

In addition, ProPublica found, the most prolific prescribers of such drugs as oxycodone, fentanyl, morphine and Ritalin often have worrisome records.

In 2012, the most recent year for which data is available, Medicare covered nearly 27 million prescriptions for powerful narcotic painkillers and stimulants with the highest potential for abuse and dependence.

That’s up 9 percent over 2011, compared to a 5 percent increase in Medicare prescriptions overall.

Even taking into account an increase in the number of Medicare enrollees, the prescribing rate rose slightly for these drugs, which are classified as Schedule 2 controlled substances by the Drug Enforcement Administration.

Twelve of Medicare’s top 20 prescribers of Schedule 2 drugs in 2012 have faced disciplinary actions by their state medical boards or criminal charges related to their medical practices, and another had documents seized from his office by federal agents.

The No. 1 prescriber 2014 Dr. Shelinder Aggarwal of Huntsville, Ala., with more than 14,000 Schedule 2 prescriptions in 2012 2014 had his controlled substances certificate suspended by the state medical board in March 2013. He surrendered his medical license four months later. (Aggarwal could not be reached for comment.)

Prescribing high volumes of Schedule 2 drugs can indicate a doctor is running a pill mill, said Dr. Andrew Kolodny, chief medical officer of Phoenix House, a New York-based drug treatment provider. Government regulators should do more to monitor prescribing patterns and intervene proactively if they appear aberrant, he said.

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How safe are outpatient surgery centers?

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Popularity Of Outpatient Surgery Centers Leads To Questions About Safety

Woman_doctor_surgeonBy By Sandra G. Boodman
KHN and Washington Post

Wendy Salo was alarmed when she learned where her doctor had scheduled her gynecologic operation: at an outpatient surgery center.

“My first thought was ‘Am I not important enough to go to a real hospital?’ ” recalled Salo, 48, a supermarket department manager who said she felt “very trepidatious” about having her ovaries removed outside a hospital.

Before the Sept. 30 procedure, Salo drove 20 miles from her home in Germantown, Md., to the Massachusetts Avenue Surgery Center in Bethesda for a tour. Her fears were allayed, she said, by the facility’s cleanliness and its empathic staff.

Salo later joked that the main difference between the multi-specialty center and Shady Grove Adventist Hospital — where she underwent breast cancer surgery last year — was that the former had “better parking.”

Salo’s initial concerns mirror questions about the safety of outpatient surgery centers that have mushroomed since the highly publicized death of Joan Rivers.

The 81-year-old comedian died Sept. 4 after suffering brain damage while undergoing routine throat procedures at Yorkville Endoscopy, a year-old free-standing center located in Manhattan.

Federal officials who investigated Rivers’ death, which has been classified by the medical examiner as a “therapeutic complication,” found numerous violations at the accredited clinic, including:

  • a failure to notice or take action to correct Rivers’ deteriorating vital signs for 15 minutes;
  • a discrepancy in the medical record about the amount of anesthesia she received;
  • an apparent failure to weigh Rivers, a critical factor in calculating an anesthesia dose;
  • and the performance of a procedure to which Rivers had not given written consent.

In addition, one of the procedures was performed by a doctor who was not credentialed by the center.

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States focus on ‘super-utilizers’ to reduce Medicaid costs

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Sign for an emergency room.By Michael Ollove
Stateline

In health policy circles, they are called “super-utilizers,” but the name isn’t meant to connote any special powers. Just the opposite.

They are people whose complex medical problems make them disproportionately heavy users of expensive health care services, particularly emergency room treatment and in-patient hospitalizations.

At least 15 states, including Washington established “health homes,” or teams of providers responsible for coordinating the care of most complicated and costly of patients.

The cost of treating them is huge: Just 5 percent of Medicaid’s 68 million beneficiaries account for 60 percent of the overall spending on the program.

Using a provision of the Affordable Care Act, many state Medicaid agencies are trying to diminish use of medical services by super-utilizers by better managing their care.

The goal is to not only reduce costs, but to achieve better health outcomes for these patients.

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Is there really a looming doctor shortage?

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Question markSome Experts Dispute Claims Of Looming Doctor Shortage

By Julie Rovner
KHN

You hear it so often it’s almost a cliché: The nation is facing a serious shortage of doctors, particularly doctors who practice primary care, in the coming years.

But is that really the case?

Many medical groups, led by the Association of American Medical Colleges, say there’s little doubt. “We think the shortage is going to be close to 130,000 in the next 10 to 12 years,” says Atul Grover, the group’s chief public policy officer.

While few dispute the idea that there will be a growing need for primary care in the coming years, it is not at all clear whether all those primary care services have to be provided by doctors.

But others, particularly health care economists, are less convinced. “Concerns that the nation faces a looming physician shortage, particularly in primary care specialties, are common,” wrote an expert panel of the Institute of Medicine (IOM) in a report on the financing of graduate medical education in July. “The committee did not find credible evidence to support such claims.” Continue reading

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US to fund $840 million initiative to improve patient care and lower costs

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All interested clinicians are invited to participate in the initiative.

stethoscope doctor's bag chest x-rayUS Health and Human Services Secretary Sylvia M. Burwell today announced an initiative that will fund successful applicants who work directly with medical providers to rethink and redesign their practices, moving from systems driven by quantity of care to ones focused on patients’ health outcomes, and coordinated health care systems.

These applicants could include group practices, health care systems, medical provider associations and others.

This effort will help clinicians develop strategies to share, adapt and further improve the quality of care they provide, while holding down costs.

Strategies could include:

  • Giving doctors better access to patient information, such as information on prescription drug use to help patients take their medications properly;
  • Expanding the number of ways patients are able communicate with the team of clinicians taking care of them;
  • Improving the coordination of patient care by primary care providers, specialists, and the broader medical community; and
  • Using electronic health records on a daily basis to examine data on quality and efficiency.

To learn more about the the initiative go here.

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Even before Ebola, hospitals struggled to beat far more common infections

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Clostridium difficile

Clostridium difficile

This KHN story also ran on NPR.

While Ebola stokes public anxiety, more than one in six hospitals — including some top medical centers — are having trouble stamping out less exotic but sometimes deadly infections, federal records show.

Nationally, about one in every 25 hospitalized patients gets an infection, and 75,000 people die each year from them—more than from car crashes and gun shots combined.

Nationally, about one in every 25 hospitalized patients gets an infection, and 75,000 people die from them each year.

 from themA Kaiser Health News analysis found 695 hospitals with higher than expected rates for at least one of the six types of infections tracked by the federal Centers for Disease Control and Prevention.

In 13 states and the District of Columbia, a quarter or more of hospitals that the government evaluated were rated worse than national benchmarks the CDC set in at least one infection category, the KHN analysis found.

The missteps Texas Health Presbyterian Hospital made this month in handling an Ebola patient echo mistakes hospitals across the nation have made in dealing with homegrown infections. Continue reading

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California Prop. 46, inspired by tragedy, pits doctors against lawyers

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Bob and Carmen Pack with their children Troy and Alana, who were killed by an impaired driver.

Bob and Carmen Pack with their children Troy and Alana, who were killed by an impaired driver.

This story is part of a partnership that includes KQEDNPR and Kaiser Health News.

Troy and Alana Pack had spent the day at their neighborhood Halloween party in Danville.

Ten-year-old Troy went as a baseball player, and 7-year-old Alana was a good witch.

In the afternoon, they changed out of their costumes and set out for a walk with their mother. Destination: Baskin Robbins 31 Flavors.

“Alana, she liked anything with chocolate,” says their father, Bob Pack. “Troy, for sure, bubble gum ice cream, ’cause he liked counting the bubble gums that he would get.”

Bob Pack stayed home. His family made it only half a mile down the road before his phone rang: “I received a call from a neighbor screaming there’d been an accident. And I raced down there.”

An impaired driver had veered off the road and hit Troy and Alana head-on. Pack was doing CPR on Troy when the paramedics arrived.

“I remember telling them I love them, and hang on. Just praying that they could hang on,” he says

I needed to take action for justice.

Troy and Alana were pronounced dead at the hospital. In the months after their death, Pack’s wife, Carmen, retreated into her Catholic faith. Bob Pack was angry.

“I think, for me to get through, I needed action,” he says, “and I needed to take action for justice for Troy and Alana, and also for doing something that I thought maybe I could change to benefit others in the future.” Continue reading

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Price tags on health care? Now in Massachusetts

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Twenty-dollar bill in a pill bottleBy Martha Bebinger, WBUR
KHN / OCT 09, 2014

This story is part of a reporting partnership that includes WBUR, NPR and Kaiser Health News.

Without much fanfare, Massachusetts launched a new era of health care shopping last week.

Anyone with private health insurance in the state can now go to his or her health insurer’s website and find the price of everything from an office visit to an MRI to a Cesarean section. For the first time, health care prices are public.

“Let the light shine in on health care prices.”

It’s a seismic event. Ten years ago, I filed Freedom of Information Act requests to get cost information in Massachusetts—nothing.

Occasionally over the years, I’d receive manila envelopes with no return address, or secure .zip files with pricing spreadsheets from one hospital or another.

Then two years ago, Massachusetts passed a law that pushed health insurers and hospitals to start making this once-vigorously guarded information more public.

Now as of Oct. 1, Massachusetts is the first state to require that insurers offer real-time prices by provider in consumer-friendly formats.

“This is a very big deal,” said Undersecretary for Consumer Affairs and Business Regulation Barbara Anthony. “Let the light shine in on health care prices.”

There are caveats. Continue reading

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Medicare fines hospitals with high readmission rates

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Medicare is fining a record number of hospitals – 2,610 – for having too many patients return within a month for additional treatments, federal records released Wednesday show.

Even though the nation’s readmission rate is dropping, Medicare’s average fines will be higher, with 39 hospitals receiving the largest penalty allowed, including the nation’s oldest hospital, Pennsylvania Hospital in Philadelphia.

The federal government’s penalties, which begin their third year this month, are intended to jolt hospitals to pay attention to what happens to their patients after they leave.

Last year, nearly 18 percent of Medicare patients who had been hospitalized were readmitted within a month.

Around the country, many hospitals are replacing perfunctory discharge plans—such as giving patients paper instructions—with more active efforts, such as ensuring that outside doctors monitor their recoveries and giving supplies of medication to patients who may not be able to afford them.

Others are still struggling to meet the new expectations. Before the program, some hospitals resisted such efforts because they weren’t paid for the services, and, in fact, benefited financially when a patient returned. Continue reading

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ProPublica’s ‘first dive’ into the Open Payments website

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The government’s data on payments to doctors and hospitals by drug and device makers is incomplete and hard to penetrate – but here’s a first look.


Screen Shot 2014-10-01 at 10.26.19 AMBy Charles Ornstein
ProPublica

The federal government unveiled data Tuesday detailing 4.4 million payments made to doctors and teaching hospitals by pharmaceutical and medical device companies.

The launch of the so-called Open Payments website, mandated under a provision of the Affordable Care Act, was far from glitch-free: Some users encountered long delays and sometimes error messages trying to access its seven data tables.

Also, the site didn’t provide consumers with an easy-to-use lookup tool, a single place to search for a doctor’s name and see all results across data files.

It will take a while to dig deeply into this new trove of data, which covers the period of August to December 2013 and includes general and research payments, as well as payments to companies’ physician investors.

All told, according to officials from the Centers for Medicare and Medicaid Services, companies spent a total of $3.5 billion during that period on 546,000 individual physicians and almost 1,360 teaching hospitals.

So what’s interesting at first glance? With the caveats we’ll detail, here’s a few nuggets: Continue reading

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What to be wary of in the government’s new site detailing industry payments to docs

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The government’s new website on drug and device company ties to doctors will be incomplete and may be misleading — for now.

Twenty-dollar bill in medicine bottleBy Charles Ornstein
ProPublica, Sep. 30, 2014, 10 a.m.

The government’s release today of a trove of data detailing drug and device companies’ payments to doctors has been widely hailed as a milestone for transparency.

But it is also something else: a very limited window into the billions in industry spending. Before you dive in and search your doctor, here are five caveats to keep in mind.

Tracking the Money

* The data only covers a fraction of payments

The Physician Payment Sunshine Act, part of the 2010 Affordable Care Act, called for the first public release of this data 18 months ago.

But because of delays writing detailed rules implementing the law, the first release of data will happen today and it will only cover payments for a few months, from August to December 2013.

So if you search for your doctor and you do not find him or her, it doesn’t mean that he or she didn’t receive a payment. Continue reading

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State disciplines health-care providers

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Seal_of_WashingtonPeriodically Washington State Department of Health issues an update on disciplinary actions taken against health care providers, including suspensions and revocations of licenses, certifications, or registrations of providers in the state.

The department also suspends the credentials of people who have been prohibited from practicing in other states.

Information about health care providers is also on the agency’s website.

To find this information click on “Provider Credential Search” on the left hand side of the Department of Health home page (www.doh.wa.gov).

The site includes information about a health care provider’s license status, the expiration and renewal date of their credential, disciplinary actions and copies of legal documents issued after July 1998.

This information is also available by calling 360-236-4700.

Consumers who think a health care provider acted unprofessionally are also encouraged to call and report their complaint.

Here is the September 25th update issued by the Washington State Department of Health: Continue reading

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