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Work-hour limits reduce resident fatigue — and confidence
Restrictions on the number of hours in a week that resident physicians can work have helped decrease fatigue among young physicians but may make them less prepared to practice medicine, according to an Annals of Surgery study published online Oct. 12. Researchers surveyed 216 orthopedic residents before and after the implementation of work-hour rules by the Accreditation Council for Graduate Medical Education in 2003. Residents reported feeling less fatigued as a result of the changes, although the amount of sleep they received did not change significantly. Residents surveyed slept an average of 34.6 hours per week in 2003, compared with 33.7 from 2004 to 2009, the study said. “This really challenges one of the primary assumptions about duty-hour standards — that if you let obviously-tired residents go home earlier more often, that they would sleep more. But they’re not sleeping more,” said Debra Weinstein, MD, senior study author and vice president for graduate medical e [Read more]
High price tag linked to heavy testing by newer doctors
Inexperienced physicians may be contributing to rising costs in the health care system by ordering more care that might not be necessary, but they also might be dealing with sicker patients, according to a RAND Corp. study that appeared in the November edition of Health Affairs. In looking at the cost profiles of more than 12,000 doctors in Massachusetts, the study found that the overall costs incurred by doctors with less than a decade of experience was more than 13% higher than those of physicians who had been practicing medicine for 40 years or more. Cost profiles are used to identify doctors that account for higher spending than others. “By identifying the costliest physicians, health plans and Medicare hope to craft policy interventions to reduce total health care spending,” the study said. The report’s researchers suggested that newer physicians may have more costly practice styles that would help drive up overall health care costs. “Recently trained physicians may [Read more]
Fast food adds 310 calories to a teen’s day
Physicians should encourage parents of young patients to make eating out at restaurants an occasional treat rather than a regular activity, said Lisa M. Powell, PhD, of the University of Illinois at Chicago. Powell’s latest study concludes that children and teenagers consume significantly more soda and other high-calorie foods, and have poorer nutrient intake when they eat out at fast-food restaurants or full-service establishments compared with when they eat meals at home. That general message “is not surprising, but [the study] really starts to quantify how serious the problem is,” said Powell, lead author of the study, which was published online Nov. 5 in Archives of Pediatrics and Adolescent Medicine. Adolescents consume an additional 309.5 calories on days they eat at fast-food restaurants, and children take in an extra 126.2 calories when they dine at such establishments, the study said. “Three hundred additional calories a day is quite serious,” said Powell, p [Read more]
Safety-net hospitals warn of ACA’s uncompensated care crunch
A safety-net hospital advocacy group is projecting a dire outlook for facilities’ ability to handle uncompensated care costs in the event some states fail to expand their Medicaid programs in 2014 and a scheduled reduction in federal indigent care payments takes effect as scheduled. The National Assn. of Public Hospitals and Health Systems compiled data from the Congressional Budget Office, the U.S. Census Bureau and the American Hospital Assn., to estimate that all hospitals, including safety-net facilities, by 2019 will face $53.3 billion in cumulative costs beyond what they would have expected to absorb under original projections for the Affordable Care Act. “Clearly, the report is on target in that if states don’t take up the Medicaid expansion and leave more people uninsured, there’s going to be a need for more uncompensated care. This seems to be a reasonable estimate of what those costs would be,” said Paul Van de Water, senior fellow with the liberal Center on B [Read more]
Decisions doctors must make to avoid Medicare penalties
A physician’s decision not to report Medicare quality measures or participate in paperless prescribing and health record programs in 2013 will be a costly one in the long run. The programs have been voluntary for the past several years. However, federal laws require Medicare rates eventually to be reduced for physicians who do not participate in the physician quality reporting system as well as the electronic health records and e-prescribing incentive programs. The reason why 2013 is such a critical year for doctors is that Medicare officials are using it as a benchmark for future penalties in all of these programs. The American Academy of Family Physicians estimates that participating in these initiatives next year could save a physician $19,000 in avoided penalties. Successfully reporting quality measures and achieving meaningful use of an EHR in 2013 will prevent a doctor’s Medicare rates from being reduced by 3.5% in 2015 for noncompliance. “It might not seem like th [Read more]
Where growth is coming in telemedicine
Two of the most promising tele-health markets are ones that could have a direct impact on the physician-patient relationship. Research from Frost & Sullivan, a global business research and consulting firm, identified the top 20 tele-medicine markets in terms of size and most impact. Topping the list were home health care and disease management monitoring, and remote doctor and specialist services. Frost & Sullivan ranked the various tele-health markets using a scale of 1 to 10 that took into consideration short-term and long-term revenue opportunity, the stability of the business models and the market’s transformative potential. Home health care and remote services had overall scores of 8.5 and 7.6, respectively. While the Frost & Sullivan report did not give specific monetary growth projections for each sector, it said the top five markets combined generate more than $1.9 billion in annual revenue. Zachary Bujnoch, senior industry analyst for Frost & Sullivan, said home health [Read more]
Doctors in shortage state cite consequences of Medicaid expansion
The Oklahoma State Medical Assn. has concerns about adding 200,000 residents to the state’s Medicaid rolls in 2014 and intends to work with the governor to assess whether such an expansion makes sense. Part of the challenge is determining who these new patients are going to see for their care, said Kenneth King, the association’s executive director. The U.S. Census Bureau has ranked Oklahoma 50th in the nation in terms of physician-to-patient ratio, King said. With the work force already stretched to the limits, physicians barely are able to see the patients they have now, he said. “One of the things we want is to have a dialogue with our governor on how the expansion [is] going to work,” he said. “It’s pretty cynical to say, ‘Yes, you’ve got coverage, but you can’t see a doctor for two years.’ So we’re worried about the work force issue.” The effect an expansion may have on physician payments down the road is another issue the medical society wants to [Read more]
Study shows link between chronic disease and sepsis risk
For more than two decades, physicians have tried to combat sepsis by identifying the condition early and treating it aggressively, according to Henry E. Wang, MD, MPH. But it might be more effective to redirect that focus toward preventing the potentially fatal infection, said Dr. Wang, lead study author and associate professor and vice chair for research in the Dept. of Emergency Medicine at the University of Alabama at Birmingham. His recommendation is based on new findings that show there is an association between chronic diseases and an increased risk of getting sepsis later. The strongest connection was exhibited in chronic lung disease and chronic kidney disease, according to the study, published online Oct. 31 in PLOS ONE. Each condition more than doubles a person’s risk of developing sepsis, said the study. Dr. Wang was lead author of the report. The more chronic diseases a person has, the greater the individual’s risk of getting sepsis, data show. A possible [Read more]
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