Category Archives: Doctors

Administration will continue to push Obamacare expansion, HHS chief says

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HHS Sec. Burwell says ‘beat goes on’ as agency seeks to expand health law’s influence

By Mary Agnes Carey
KHN

Official portrait of the Secretary of Health & Human Services Sylvia Mathews BurwellDepartment of Health and Human Services Secretary Sylvia M. Burwell on Friday hailed the health law’s 2016 enrollment gains and said the department was already beginning to gear up for the next enrollment period.

In addition to the health law, Burwell’s agency is juggling many other priorities these days, including coordinating her agency’s response to the emerging threat of the Zika virus, President Barack Obama’s “Moonshot on Cancer” initiative and the growing epidemic of opioid abuse.

“The beat goes on,” she said during a briefing with reporters at HHS headquarters. Continue reading

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Obamacare enrollment tops expectations

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By Phil Galewitz
KHN

2016 Obamacare Enrollment Tops Expectations At 12.7 Million

ACA health reform logoAbout 12.7 million Americans enrolled in private health insurance through the federal and state marketplaces for 2016, the Obama administration said Thursday.

Sign-ups in the third enrollment period for the Affordable Care Act’s online marketplaces — and the last that will be completed while President Barack Obama is in office — easily topped last year’s amount and also beat the administration’s modest forecast.

The 2016 enrollment period began Nov. 15 and ended Jan. 31. Except for limited exceptions such as job losses, Americans will have to wait until mid-November to enroll again.

About 4 million enrollees on healthcare.gov this year enrolled in the coverage for the first time.

The annual Obamacare enrollment numbers routinely draw debate. Supporters boast that millions of people have gained coverage.  Detractors stress millions remain uninsured because they can’t afford coverage and that not enough healthy young adults are enrolling. The latter issue threatens the business case for insurers, causing them to lose money and raise prices or drop out of the exchanges.

Of the 12.7 million consumers enrolling in marketplace coverage, more than 9.6 million came through the federal healthcare.gov exchange that handles 37 states. The rest, 3.1 million, selected a plan through the 13 state-based marketplaces.

About 4 million enrollees on healthcare.gov this year enrolled in the coverage for the first time, according to the Department of Health and Human Services.

At the end of last year’s enrollment period, 11.7 million people had chosen plans,  but that figure dropped to 9.3 million by September because not everyone paid premiums and some found coverage elsewhere, such as through employers.

In October, the White House estimated that 10.1 million Americans would have health care coverage through the exchange at the end of 2016, a figure that counts people who paid and were covered at the end of the entire year.

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Inslee appoints Acting Secretary for DSHS, launches national search for new secretary

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LashwayBioOlympia, Feb. 3 — Gov. Jay Inslee Tuesday announced he is appointing Patricia Lashway, Assistant Secretary for the Department of Social and Health Services’ Services and Enterprise Support Administration, to serve as Acting Secretary of the 17,500-employee agency.

The Department provides assistance to 2.5 million of Washington residents providing behavioral health and developmental disability services, aging and long-term care and child and family support, juvenile rehabilitation, and food and cash assistance.

Outgoing Secretary Kevin W. Quigley, who has served as DSHS Secretary since Inslee took office in 2013, announced his resignation January 5 and will depart the agency on Feb. 22. Lashway’s appointment will begin Feb. 23.

In her current position, Lashway is responsible for day-to-day management of the Department. Prior to that, she was the DSHS Senior Director of Policy and External Relations where she oversaw strategic development, legislative and policy initiatives.

Her career with DSHS began in 1988 at what was then the Aging and Disability Services Administration, where she served for almost nine years as the Director of Residential Care Services.

Her team was responsible for developing a nationally recognized statewide complaint resolution and investigation unit that provided the foundation to serve all long-term care consumers in the state and their families.

Prior to state service Lashway worked in the legal field and has spent her career, including overseas duty as a Peace Corps volunteer.

“This is a critical time for the Department, especially with the challenges surrounding mental health services, and I’m confident our team, with the support of the governor and legislature, will ensure we provide the critical services to those who need them,” said Lashway. “I look forward to this assignment and appreciate the confidence by both the governor and my colleagues.”

Lashway received a bachelor’s degree from the University of Oregon, a juris doctorate from Seattle University and is a member of the Washington State Bar Association.

A national executive search will begin next week for a new DSHS Secretary.

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Hospitals use email ’empathy’ to help doctors and patients keep in touch

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By Barbara Feder Ostrov
KHN

David Larson, 66, at his house in Huntington Beach, Calif., on Tuesday, January 26, 2016. Larson had knee surgery to repair a meniscus tear in December. He used the HealthLoop technology and says it helped detect a blood clot that could have put him back in the hospital. (Heidi de Marco/KHN)

David Larson, 66, at his house in Huntington Beach, Calif., on Tuesday, January 26, 2016. Larson had knee surgery to repair a meniscus tear in December. He used the HealthLoop technology and says it helped detect a blood clot that could have put him back in the hospital. (Heidi de Marco/KHN)

A health care startup made a wild pitch to Cara Waller, CEO of the Newport Orthopedic Institute in Newport Beach. The company said it could get patients more engaged by “automating” physician empathy.

It “almost made me nauseous,” she said. How can you automate something as deeply personal as empathy?

But Waller needed help. Her physicians, who perform as many as 500 surgeries a year, manage large numbers of patients at various stages of treatment and recovery. They needed a better way to communicate with patients and track their progress.

The California startup, HealthLoop, told Waller its messaging technology would improve their satisfaction and help keep them out of the hospital. High satisfaction scores and low readmission rates mean higher reimbursements from Medicare, so Waller was intrigued.

So far, she’s been surprised at patients’ enthusiasm for the personalized — but automated — daily emails they receive from their doctor. Continue reading

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A text from the doctor can prod patients to take their medicine, study finds, but questions linger

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By Shefali Luthra
KHN

A spoonful of sugar may make the medicine go down, but that’s hardly useful if a patient doesn’t remember to take it in the first place.

According to a new analysis, there could be a possible solution: text message reminders sent to patients’ phones from the doctor.

Researchers found that texts could push people to do better at adhering to their drug regimens and, along the way, save the health system a fair bit of money.

The paper, published Monday in JAMA Internal Medicine, reviewed data from 16 studies, all of which explored whether mobile telephone text reminders sent to patients made them more likely to take their medicine.

In total, the studies included in this meta-analysis tracked the behavior of almost 3,000 chronically ill patients, looking at how well they complied with medication regimens, and found the text messages had an impact.

Across the various studies, patients went from having a 50 percent rate of following through on medication to a nearly 68 percent rate.

On its face, that looks like quite a jump.

But readers should view the findings with a degree of caution, the authors noted. They pointed out that several of the studies they examined relied on participants to self-report how faithful they were with their prescription drugs.

Since people often misremember or misreport this kind of information, that measure isn’t always the most reliable.

In addition, the studies included in the analysis lasted on average about three months, though chronically ill people take their medications for years.

Thus, the studies may not have accounted for whether patients eventually experience text message fatigue and consequently paid the reminders less attention.

If that is the case, then text messages could initially be effective but, over time, lose their power in helping people take medicine. Continue reading

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Making the most of military medic’s field experience

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Silhouettes of U.S. Soldiers at night in IraqBy Michael Tomsic
WFAE radio/NPR/KHN

Veteran Dave Manning served two combat deployments in Iraq and was the sole medical provider for more than 100 people on a Navy ship.

But as he contemplated his post-military job prospects, he struggled.

“Nothing I’ve done really translates over [to civilian jobs] beyond basic EMT,” said Manning, who served 15 years in the Navy and five more in the Army. “Trying to find something in the medical field without any credentials, without any licensure is tough. There’s nothing out there.”

Manning is in the inaugural class of a physician assistant training program launched this month by the University of North Carolina at Chapel Hill and geared at recruiting non-traditional students — specifically, veterans, as the country seeks to improve health care by expanding the number of primary care providers.UNC staff worked with Army officials at Fort Bragg to figure out how to translate troops’ medical experience into jobs.

Dave Manning (left) and three other military veterans who will be in the new program’s first class. (Brian Strickland/UNC Health Care)

Dave Manning (left) and three other military veterans who will be in the new program’s first class. (Brian Strickland/UNC Health Care)

Manning’s story is becoming more common as the U.S. winds down wars in Iraq and Afghanistan, and it’s especially important for North Carolina which is home to eight military bases, including some of the country’s largest installations.

Manning has experience that can’t be found in a classroom, and some in the UNC medical community wanted to capitalize on that.

“The medics and the corpsmen are often very skilled in acute medical care of younger people,” said Dr. Paul Chelminski, the director of UNC’s new Physician Assistant Program. “They’re extremely skilled in trauma care if they’ve been deployed.” Continue reading

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States let commercial walk-in clinics grow unregulated

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Blue doctorBy Michael Ollove
Stateline

A patient gives a nurse practitioner his health information at a Walgreens Healthcare Clinic in Wheeling, Illinois. As commercial health clinics have spread, states have largely allowed them to operate without regulation.

When walk-in health clinics started spreading rapidly in the mid-2000s, the nation’s biggest and most prestigious medical organizations voiced objections. They raised concerns about patient safety, gaps in patients’ medical records, conflicts of interest and disruptions of the relationship between patients and their doctors.

Today, there are more than 6,900 urgent care clinics and at least 2,000 retail health clinics, usually wedged inside large retailers such as CVS, Walgreens and Wal-Mart.

Doctors also worried that increased competition from the clinics would hurt their practices, which seldom could match the clinics’ convenient operating hours.

Some state medical societies urged state legislators to impose broad regulations on the clinics, including restricting which medical conditions they could treat and setting the composition of their staffs.

With some exceptions — notably Massachusetts — little restrictive legislation has passed. And as the number of commercial urgent care and retail health clinics has multiplied over the past decade to provide care for millions of Americans, much of the institutional opposition to them by physician groups has softened.

“People want what they want and they want it now,” said John Meigs, a family practitioner in Centreville, Alabama, and president-elect of the American Academy of Family Physicians. Continue reading

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How Denmark dumped medical malpractice and improved patient safety

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Flag_of_Denmark.svgBy Olga Pierce and Marshall Allen
ProPublica

COPENHAGEN 2014 — It was a distressingly close call. A patient had been sent home from the hospital with instructions to take a common medication at a dose that would have poisoned her. When Dr. Ole Hamberg heard about the mistake, he decided to investigate.

Hamberg, the head liver specialist at Rigshospitalet, the Danish national hospital, soon found something troubling. The hospital’s electronic prescribing system was mistakenly prompting doctors to give the drug, methotrexate, for daily use when it is safely taken only once or twice a week.

The doctor was able to rapidly see a dangerous pattern because of something that doesn’t exist in the United States: A comprehensive national program to compensate victims of patient harm and to learn from them by collecting and analyzing the data their experiences provide.

Patients throughout Denmark were being poisoned, Hamberg learned, thanks to the medical error. At his hospital, Hamberg made sure prescribing protocols were fixed and doctors and patients were informed. The problem quickly abated.

Hamberg was able to rapidly see a dangerous pattern because of something that doesn’t exist in the United States: A comprehensive national program to compensate victims of patient harm 2014 and to learn from them by collecting and analyzing the data their experiences provide.

Patients who’d been overdosed filed claims under the compensation program, which makes its data available to hospitals and researchers. “Of course I use this information in my department,” Hamberg said. “We discuss how we can avoid this injury the next time.” Continue reading

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Gonorrhea may soon be untreatable, Britain’s chief medical officer warns – The Washington Post

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A medical illustration of Neisseria gonorrhoeae. (CDC)

The sexually transmitted infection is increasingly caused by strains of Neisseria gonorrhoeae that resist antibiotic treatment. “Gonorrhoea is at risk of becoming an untreatable disease due to the continuing emergence of antimicrobial resistance,” Davies wrote.

The Guardian reports that a recent outbreak of a superbug strain of the disease — one that doesn’t respond to the antibiotic azithromycin — has put Britain on high alert. Davies urged doctors to use proper treatment protocols. A recent study found t

Source: Gonorrhea may soon be untreatable, Britain’s chief medical officer warns – The Washington Post

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Hands off that frozen pizza! Docs advise customers as they shop

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Lisa Tamura discusses her shopping habits with Phil Cecchini, a family doctor who works for St. Joseph Hoag Health in Orange County.  Cecchini spent the afternoon advising shoppers on what foods to buy and what to avoid at the Ralphs supermarket in Laguna Hills, California, on Thursday,  November 12, 2015 (Photo by Heidi de Marco/KHN).

Lisa Tamura discusses her shopping habits with Phil Cecchini, a family doctor who works for St. Joseph Hoag Health in Orange County. Cecchini spent the afternoon advising shoppers on what foods to buy and what to avoid at the Ralphs supermarket in Laguna Hills, California, on Thursday, November 12, 2015 (Photo by Heidi de Marco/KHN).

By Anna Gorman
KHN

When Lisa Tamura goes to the grocery store, she usually picks up a few frozen pizzas for the nights she doesn’t want to cook.

But on a recent Thursday afternoon at the Ralphs supermarket in Laguna Hills, California, she strolled right by the frozen food and headed straight to the fruits and vegetables.

Grocery stores are an ideal place to teach people that they can become healthier by making small dietary changes and eating in moderation.

That’s because she had some help from the ultimate personal shopper – a family doctor named Phil Cecchini.

“What do you like to eat?” he asked.

“Bad food,” she responded, laughing.

Cecchini, who works for St. Joseph Hoag Health in Orange County, spent the afternoon advising shoppers on what foods to buy – and what to avoid.

“If you stick with the periphery, you are probably doing okay,” Cecchini told Tamura, who recently moved from Hawaii to California. “You are avoiding all the pre-packaged, processed foods.”

Hospitals and health clinics around the country are increasing their efforts to promote exercise and healthy eating. They’re offering yoga and cooking classes, sponsoring farmers’ markets and writing prescriptions for fresh fruits and vegetables. Continue reading

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Nurses Ranked No. 1 for Honesty and Ethics (again), Gallup Poll

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Nurses have topped Gallup’s Honesty and Ethics ranking every year but one since they were added to the list in 1999.

With an 85% honesty and ethics rating  nurses have no serious competition atop the Gallup ranking this year.

Pharmacists and medical doctors constitute the next tier, with about two-thirds of Americans viewing each highly, followed by high school teachers at 60% and police officers at 56%.

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Make doctor’s licenses like driver’s licenses? Medical groups say no

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Stethoscope DoctorBy Michael Ollove
Stateline

Nursing graduates at the University of Texas. In half the states, one state license is all a nurse needs to practice in the others. Several medical professions are moving to license portability.

When it comes to licensing, the nursing profession works almost exactly the way it does with driving a car — at least in half the states. A nurse with a license from one of those 25 states can practice in any other state that has signed on to a reciprocal licensing compact.

Contrast that with doctors. A doctor licensed in one state who wants to practice in another still needs a license from the other state. That’s a costly and time-consuming process, especially in an era when many health plans and their employees operate across state lines and the use of telemedicine, in which patients and their providers interact from a distance, is growing.

But the state licensing situation for doctors and other health care professionals — psychologists, social workers, physical and occupational therapists, and mental health counselors — is starting to change.  Continue reading

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Medical training so dark students depict supervisors as monsters – literally

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By Julie Rovner
KHN

How stressful is medical training? So bad that in a class encouraging medical students to express emotion by drawing comics, nearly half depicted their supervisors as monsters.

medical-monster-600

Courtesy of Trey Banbury via JAMA

“In their attempts to make meaning of medical training through images and words, students imagined the workplace as dank dungeons; portrayed patients as ghosts that haunted physicians who had treated them impersonally; represented supervising physicians as fiendish, foul-mouthed monsters; and depicted themselves as sleep-deprived zombies walking through barren post-apocalyptic landscapes,” according to a new article in the Journal of the American Medical Association written by Daniel R. George and Dr. Michael Green, who teach the “Comics in Medicine” class at Penn State College of Medicine.

In one particularly harrowing image, they wrote, a student “depicted his supervising physician screaming at the medical team, causing one intern to urinate herself moments before having her head bitten off for possessing too little information about a patient.”

Continue reading

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Jobs for medical scribes rise, but standards lag

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EscribanoBy Lisa Gillespie
KHN

A national campaign for electronic health records is driving business for at least 20 companies with thousands of workers ready to help stressed doctors log the details of their patients’ care — for a price.

Nearly 1 in 5 physicians now employ medical scribes, many provided by a vendor, who join doctors and patients in examination rooms.

Regulation and training are not rigorous. Scribes are not licensed.

They enter relevant information about patients’ ailments and doctors’ advice into a computer, the preferred successor to jotting notes on a clipboard as doctors universally once did.

The U.S. has 15,000 scribes today and their numbers will reach 100,000 by 2020, estimates ScribeAmerica, the largest competitor in the business. After buying three rivals this year, it employs 10,000 scribes working in 1,200 locations.

Regulation and training are not rigorous. Scribes are not licensed. About a third of them are certified and that’s voluntary, according to the sole professional body for scribes. The American College of Scribe Specialists was created by ScribeAmerica’s founders in 2010.

“This is literally an exploding industry, filling a perceived gap, but there is no regulation or oversight at all,” said George Gellert, regional chief medical informatics officer at Christus Santa Rosa Health System in San Antonio, which uses scribes. Continue reading

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