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Some doctors shield whole truth from patients, survey shows
A majority of physicians told a patient that his or her prognosis was more positive than the medical facts warranted within the previous year. More than a third say it is sometimes OK to shield significant medical errors from affected patients or hide financial relationships with pharmaceutical companies and device makers from patients. These are just a few of the areas in which at least some physicians say that always telling patients the whole story is not the right way to go, according to a nationwide survey of nearly 2,000 doctors across seven specialties in the February issue of Health Affairs. "Despite widespread acceptance of communication principles and commitments by professional organizations, substantial percentages of U.S. physicians did not completely endorse these precepts, and many reported behaving in ways that deviated from these norms," said the study. For example, 11% of physicians said they might sometimes tell a patient something untrue, and about the same [Read more]
CMS rejects California Medicaid co-pays
Federal health officials on Feb. 6 denied a request by California to charge a variety of co-payments to most of its Medicaid enrollees. The co-pays would have ranged from $3 for prescriptions filled at pharmacies to $100 for inpatient hospital stays. The state expected the co-pays to generate $600 billion beginning in October 2013, said Norman Williams, spokesman for the California Dept. of Health Care Services, the state's Medicaid agency. But the state cannot implement the co-pays under a demonstration waiver, as it requested in December 2011, according to a letter from Centers for Medicare and Medicaid Services acting Administrator Marilyn Tavenner to California's Medicaid agency. The co-pays are neither temporary nor targeted at a specific population, both of which are requirements in federal Medicaid law. California is examining its options, including administratively appealing the federal decision, Williams said. California Medical Assn. President James T. Hay, MD, ap [Read more]
Defensive medicine seeping into physician training, study says
Practicing defensive medicine to avoid medical liability lawsuits may not be a formal part of medical school curriculum, but it's still being taught to medical students and residents, a study shows. A survey of 202 fourth-year medical students and third-year residents at Northwestern University Feinberg School of Medicine in Chicago found that 94% of students and 96% of residents have seen examples of defensive medicine in their clinical training. Nearly two-thirds of students and three-quarters of residents said their attending physician implied that they take medical liability concerns into consideration when making clinical decisions. Nearly half of respondents said their attending directly instructed them to do so, says the study in the February Academic Medicine. Educators should reframe such conversations to focus on reducing liability risk by improving patient safety and communication, said Kevin O'Leary, MD, lead study author and associate professor and associate chief [Read more]
Major employers support flu shot requirement for health professionals
Many of the country's largest companies are telling hospitals to send a message to physicians and other health professionals who refuse influenza immunization: "You're fired." "Transmission of seasonal influenza between health care workers and patients is a significant patient and worker safety issue. Failure to prevent the transmission of seasonal flu between health care workers and patients also increases health costs," said Helen Darling, president and CEO of the National Business Group on Health, at a Feb. 2 news conference. The organization represents 340 U.S. companies, 68 of which are listed on the Fortune 500. Most hospitals that have adopted mandatory policies require all employees to receive the flu vaccination as a condition of employment unless they present evidence of a medical contraindication. If the employees do not get immunized, they are typically required to wear face masks whenever they interact with patients or risk getting a pink slip. "Requiring flu vacc [Read more]
CMS lays out how to appeal meaningful use decisions
The Center for Medicare & Medicaid Services' Office of Clinical Standards and Quality announced the establishment of a two-tier appeals process for physicians who were deemed ineligible for Medicare meaningful use incentive pay, or who thought their pay was too low. There are three types of appeals physicians can file: An eligibility appeal will allow doctors to show that all the requirements to earn an incentive payment were met, but payment was not received due to circumstances outside of his or her control. Eligibility appeals must be filed before March 30 to appeal decisions for payment year 2011. A meaningful use appeal allows physicians to show that they used a certified electronic medical record system and met all meaningful use objectives and measures. These appeals must be filed within 30 days of the physician receiving a demand letter or other finding from the review board. An incentive payment appeal allows physicians to show that they provided claims [Read more]
California tax hike could take pressure off Medicaid
The California Medical Assn. on Jan. 31 endorsed a ballot measure proposed by California Gov. Jerry Brown that would increase certain state income and sales taxes to fund education and public safety programs. In December 2011, Brown proposed two tax increases that would generate nearly $7 billion annually. The first would raise income taxes by 1% to 2% on individuals earning at least $250,000. The second would increase the sales tax by one-half cent. Both tax hikes would expire in 2016. California Medical Assn. CEO Dustin Corcoran said Brown's proposal "is the only viable, balanced plan on the table to address the chronic budget crisis and protect essential health care services." The California Hospital Assn. also supports the measure, said CHA spokeswoman Jan Emerson-Shea. She said the California Hospitals Committee on Issues -- the association's ballot initiative arm -- has contributed $500,000 to the campaign to get Brown's proposal on the ballot. The California Academy of [Read more]
House votes to repeal long-term-care program
The House on Feb. 1 voted to repeal the long-term-care insurance program created by the health system reform law amid Democratic calls to save the coverage plan. House Republicans have been sharply critical of the Community Living Assistance Services and Supports Act, or CLASS Act. Opponents of the provision have called it a broken component of the Democrats' reform law that created the illusion of saving billions of dollars while providing much-needed care for the elderly and disabled. But independent actuarial analysis had determined that the new voluntary insurance program would not be viable over the long term. The House voted 267-159, with some Democratic support, for legislation to repeal the act. "This unsustainable program would have increased federal expenditures and debt and was deemed to be financially insolvent," said Rep. Larry Bucshon, MD (R, Ind.). "Repealing the CLASS Act is important to ensure it is not implemented at a future time, which would have added to t [Read more]
Almost half of preventive services not offered during checkups
The annual checkup is geared toward doing a physical exam, taking a patient's history and using the opportunity to deliver counseling or other preventive services that might be difficult to squeeze in during other office visits. Yet even during these encounters, patients are nearly as likely to miss out as they are to receive guideline-based prevention, says an American Journal of Preventive Medicine study published in February. Researchers audio-recorded 284 annual-checkup visits to 64 Detroit-area general internists and family physicians from 2007 to 2009. They also examined patient records for the preceding five to 10 years and surveyed patients to determine if they were eligible or due for 19 items recommended by the U.S. Preventive Services Task Force and the Advisory Committee on Immunization Practices. Patients were due for an average of 5.5 preventive services such as cholesterol screening, obesity counseling or pneumococcal vaccination. In all, 54% of the services due [Read more]
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