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Med students benefit from following patients long-term
Third-year medical students who participated in a program that allowed them to follow the same patients throughout the year performed as well or better than peers who underwent traditional clerkship training, says a study in Academic Medicine. The program was a pilot of the Harvard Medical School-Cambridge Integrated Clerkship at Cambridge (Mass.) Health Alliance, and it since has been made a full program. Instead of traditional clinical block rotations, integrated clerkship students follow a panel of patients representing a wide spectrum of medical conditions through inpatient and outpatient care. They also work continuously during the year with physicians in each of the core specialties. Students develop relationships with patients and faculty and witness the natural progression of illness and treatment outcomes, said David Hirsh, MD, lead study author and the program’s director and co-creator. “They really get to know patients in context so that they aren’t known just by [Read more]
More physicians awarded meaningful use money
For the first time, physicians and other health professionals received more cash in Medicare meaningful use bonuses than hospitals got in a single month. However, Medicare Payment Advisory Commission data show that the vast majority of physicians have yet to collect a dime of government incentives for their use of electronic health records. In February, the latest data available, 12,365 physicians and other “eligible professionals” received $222.6 million in Medicare meaningful use incentives, compared with 84 hospitals getting $129.9 million, according to an April 5 report delivered to MedPAC. Doctors qualifying for Medicare meaningful use incentives in stages over five years can earn up to $44,000 per physician. Hospitals’ incentive terms can vary, but they start with a $2 million base payment. The number of physicians and other professionals qualifying for meaningful use in February, and the amount of incentive money they collected, was about equal to their participation [Read more]
Medicare trustee says health reform law will add to debt
A Medicare trustee who was an economic adviser in the George W. Bush administration has warned that the health system reform law could add between $340 billion and $530 billion in federal deficits during the next decade. The fiscal impact of the reform law that will expand insurance coverage to tens of millions of Americans has not been understood completely, said Charles Blahous, PhD, in a research paper published by the Mercatus Center at George Mason University, a think tank that promotes free-market policy ideas. Overall, federal spending will increase by more than $1.1 trillion from 2012-21 because of the law enacted in 2010. “Relative to prior law, the [reform law] would increase an already unsustainable federal commitment to health care spending, exacerbate projected federal deficits and thus considerably worsen the federal fiscal outlook,” said Blahous, a senior fellow at the Mercatus Center. Previous analyses of the law had predicted that health reforms would exte [Read more]
IRS health reform money gets GOP’s attention
Republican Reps. Dave Camp and Charles Boustany Jr., MD, are pushing the Internal Revenue Service for more information about how much money the Obama administration might be diverting to the agency to aid the implementation of the health system reform law. Camp, who chairs the House Ways and Means Committee, and Dr. Boustany, who chairs its oversight subcommittee, sent an April 10 letter to IRS Commissioner Douglas Shulman requesting the information. The missive was in response to recent reports that the White House has made plans to designate at least $500 million to the IRS to implement the Patient Protection and Affordable Care Act. “These reports are just the tip of the iceberg, as the nonpartisan Congressional Budget Office has warned that the IRS could need up to $10 billion to implement the Democrats’ health care law over the next decade,” the lawmakers said in a statement accompanying the letter. “This expansion of the IRS’ power and reach into Americans’ dail [Read more]
Web-based game tests doctors’ knowledge of sepsis
Jacob had a fever and his health was deteriorating quickly when he was admitted to the hospital. If left untreated, the 27-year-old would have died within two minutes of severe sepsis. Fortunately for Jacob, however, a doctor could cure him just as quickly — and with only a few clicks of a button. Playing Septris is free, and the game is available online. Doctors can take a post-game test to earn CME credits for a standard $20 fee. Septris runs best on iPad/iPhone or Android. On a desktop computer, it requires a Firefox, Google Chrome or Apple Safari browser. Jacob is not a real person. He is a character in Septris, a Web-based medical game developed by physicians at Stanford University School of Medicine in California and released late last year. The game’s goal is to offer doctors an engaging way to test their sepsis knowledge and improve their treatment of patients with the condition. Septris can be played on a computer, mobile phone or tablet. “This is a more v [Read more]
ACOs must choose how to cover potential losses
Accountable care organizations going for higher bonuses from the Centers for Medicare & Medicaid Services are having to consider various mechanisms to cover losses that may result. ACOs can set aside cash reserves in escrow, establish a line of credit, have the amount deducted from future fee-for-service payments or purchase reinsurance to repay the agency if the cost of caring for a patient population grows beyond a certain point, according to the Medicare shared savings program’s final rule. This is required of so-called Track 2 ACOs that will earn 60% of any money saved if quality metrics are met, but would be required to repay the agency if expenses go up more than 2%. The possible charge can run in the hundreds of thousands of dollars and may result if a small number of patients suddenly experience expensive illnesses or go out of the ACO for care. Marketing has begun in earnest by those pitching various options to ACOs. The issue is an important consideration for physi [Read more]
Washington state suspends Medicaid emergency department limits
Washington state emergency physicians are claiming a victory with the governor’s decision to suspend a zero-tolerance Medicaid emergency department payment policy that was scheduled to kick in on April 1. The American College of Emergency Physicians praised Gov. Chris Gregoire for putting a hold on the implementation of the policy, which would have denied Medicaid payment for ED care given to patients diagnosed with one of about 500 conditions deemed by the state to be nonurgent. State legislators approved the limits as a way to cut down on paying EDs for care that patients should be receiving in physician offices or other less costly settings. ACEP and its state chapter warned that the exclusion list was too broad and would apply to many patients who legitimately believed they were dealing with emergency situations when they showed up at EDs. A prohibition on paying for the treatment of sprains in the ED, for instance, would affect Medicaid patients who needed to rule out the [Read more]
Nation’s nutrition is good, but some disparities remain
Deficiencies in nutrients and vitamins often vary by age, gender, race and ethnicity, according to a recent report by the Centers for Disease Control and Prevention. The most significant deficiency involves blacks and vitamin D. Thirty-one percent of that population has insufficient levels of the vitamin, compared with 12% of Mexican-Americans and 3% of whites. The findings were released April 2 in the CDC’s second national report on biochemical indicators of diet and nutrition in the U.S. The study did not examine causes of the reported deficiencies. However, it is known that higher concentrations of melanin in dark skin tend to block the sun’s ultraviolet rays, said internist Raul Seballos, MD. As a result, people with dark skin do not convert as much UV rays into vitamin D as do individuals with lighter skin, which can lead to a deficiency in the nutrient, said Dr. Seballos, vice chair of preventive medicine at Cleveland Clinic. Patients and physicians should be awar [Read more]
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