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Pediatric specialty shortages cause long waits for care
Shortages of pediatric specialists mean that many young patients must wait weeks and sometimes months to get an appointment, according to data released July 23 by the Children’s Hospital Assn. The organization surveyed 69 children’s hospitals nationwide and found that physician shortages are causing long waits for patients and lost referrals for doctors. For hospitals, the shortages mean widespread vacancies in needed specialties and rising recruitment costs. The effect on families can be devastating, said Mark Wietecha, president and CEO of the Children’s Hospital Assn., which represents 220 children’s hospitals nationwide. “Many children wait far too long to get needed services to diagnose, treat and manage all kinds of diseases,” he said. “When children don’t get timely care, they miss school, they can fall behind, their parents miss work, creating more family stress.” For primary care physicians, the shortages create difficulties in trying to refer you [Read more]
Pertussis outbreak prompts questions about whether booster doses are needed
Waning pertussis immunity from the Tdap vaccine is helping drive the nationwide surge in cases of the bacterial disease this year, the Centers for Disease Control and Prevention said. To help slow the spread of the illness, which has led to the deaths of nine infants since January, researchers are examining Tdap effectiveness and duration of protection among adolescents in California and Washington, said Anne Schuchat, MD, director of the CDC’s National Center for Immunization and Respiratory Diseases. One question researchers are trying to answer is “whether you will need more booster doses during the adult years,” Dr. Schuchat said. The CDC recommends that children receive five doses of DTaP (diphtheria, tetanus, acellular pertussis) vaccine between 2 months and age 6 and a booster of pertussis-containing vaccine (Tdap) between ages 11 and 12. The booster also is recommended for pregnant women and other adults who never received Tdap or can’t remember getting it. [Read more]
One-year Medicare pay freeze proposed in House
A House Republican is urging his colleagues to approve legislation that prevents deep cuts to Medicare payment rates in 2013. Rep. Michael Burgess, MD (R, Texas), is pushing House leadership to schedule a vote on his bill, the Assuring Medicare Stability and Access for Seniors Act of 2012, months before the lame-duck session of Congress that will occur after the November elections. The bill, introduced on July 20, would extend 2012 Medicare and Tricare payment rates through 2013. The legislation offers certainty to Medicare beneficiaries and physicians, Dr. Burgess said. The Centers for Medicare & Medicaid Services estimates the Medicare sustainable growth rate formula will cut physician pay by 27% in 2013. Congress has several other large fiscal issues, such as expiring tax cut provisions and mandatory across-the-board spending reductions, to address during a tight legislative calendar before next year. Virtually all lawmakers agree that the SGR cut should not be allowed to r [Read more]
Groups aim to teach resident physicians to weigh costs in care
With health care expenditures projected to reach nearly 20% of the nation’s gross domestic product by 2020, more physicians need to learn to weigh the costs and benefits of care to patients, say officials with the American College of Physicians and the Alliance for Academic Internal Medicine. The two organizations have teamed up to offer a free curriculum designed to educate internal medicine residents about how to avoid contributing to rising health care costs with unnecessary care. “Physicians receive little specific training about identifying and eliminating wasteful diagnostic and treatment options,” said Cynthia D. Smith, MD, the ACP’s senior medical associate for content development. “Residency training is an excellent time to introduce the concept of high-value, cost-conscious care, because the habits that residents learn during training have been shown to stay with them throughout their professional careers.” The lessons are intended to give residents an un [Read more]
Surgeons balk at withdrawing life support after medical errors
Nearly two-thirds of surgeons are unwilling to honor a patient’s request to end life support after operating on that patient, and they are less willing to do so when a surgical error occurs, said a study in Annals of Surgery in July. Researchers surveyed 912 neurosurgeons, cardio-thoracic surgeons and vascular surgeons who performed an average of 10 high-risk procedures a month about how they would respond to a scenario specific to their specialty. The vignette in the survey concerns a high-risk surgery for a 75-year-old woman with emphysema and stable coronary artery disease who has an intra-operative stroke and weakness in her arm and leg upon awakening after surgery. She struggles post-surgery and is re-intubated twice, and after seven days has developed pneumonia and needs ventilator care. The patient and family request withdrawal of life support, saying her future quality of life is unacceptable. Faced with that scenario, 63% of surgeons said they would be “not at all” [Read more]
Heart condition that puts young women at greater risk sometimes overlooked
Chest pain should not be dismissed in young, fit patients because it could be a symptom of spontaneous coronary artery dissection, which often affects otherwise healthy individuals, a new study says. Women appear to have a greater risk of developing the condition than do men, said Rajiv Gulati, MD, PhD, lead author of the study published online July 16 in Circulation. More research is needed to determine the cause of spontaneous coronary artery dissection, he said. But potential factors associated with the condition include fibromuscular dysplasia, extreme physical activity and hormones (the condition was most common in women during the three months after giving birth). An estimated 800 new cases of spontaneous coronary artery dissection occur in the U.S. each year, the study said. But many other cases go undiagnosed, in part, due to the difficulty of identifying the problem on an angiogram, Dr. Gulati said. “SCAD is not related to plaque buildup that more commonly causes [Read more]
Employers to emulate Medicare by buying quality care
Employers and labor organizations will follow Medicare’s lead in paying physicians and hospitals based on the value of their care, agreeing to purchase health plans for workers that reward health professionals for care quality and efficiency. A coalition of 18 large employers and unions has agreed to align with Medicare’s value-based purchasing programs, such as an initiative to share savings from lowered health spending, through a collaborative called Buying Value. The project offers employers guidance for how to purchase the best health plans that reward quality. The private purchasers will have an active voice in health coverage instead of just paying the bills, said Gerald Shea, assistant to the president of AFL-CIO, one of the participating groups. Although many insurers already have their own quality initiatives, the participants and the Medicare program will establish common measures for purchasing value. “When we started talking about it, everyone thought we shou [Read more]
FDA approves in-home HIV test that gives results within an hour
It takes between 20 and 40 minutes for the OraQuick In-Home HIV Test to deliver results on whether a person is HIV positive, but it took seven years for the test to win Food and Drug Administration approval for over-the-counter sales to patients. FDA officials required the product’s manufacturer, OraSure Technologies, to conduct studies to prove that patients could reliably follow written instructions to use the test, interpret the results and access follow-up care. In July, OraSure won FDA approval. The OraQuick In-Home HIV test, which can detect HIV antibodies, is administered by swabbing the gums and inserting the vial into a solution. Test results will need to be confirmed through laboratory testing. One in every 12 OraQuick tests yields a false negative. Also, the test does not reliably detect HIV until at least three months after the infection. “Knowing your status is an important factor in the effort to prevent the spread of HIV,” said Karen Midthun, MD, director [Read more]
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