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Request by Texas to broaden Medicaid managed care on track
Federal health officials have given a tentative thumbs-up to a request by Texas to expand risk-based Medicaid managed care to 28 counties in rural parts of the state. But the Texas Medical Assn. is concerned that the state will not provide managed care plans enough resources to ensure that Medicaid enrollees have adequate access to care. Final federal approval for the waiver could arrive at any time, according to a Sept. 14 letter to Texas' Medicaid agency from Cindy Mann, director of the Center for Medicaid, CHIP and Survey & Certification at the Centers for Medicare & Medicaid Services. CMS and the state still were working on a formula to reinvest any savings from managed care into delivery system reforms, among other items. "We commit to doing whatever we can to expedite the process," Mann wrote. Texas Medicaid covers more than 3 million people, 1.9 million of whom already are in risk-based managed care. The waiver expansion would shift nearly all of the remaining 1.1 milli [Read more]
IOM spells out antibiotics strategy in an anthrax attack
To prepare for a potential wide-scale anthrax attack, state and local health officials should determine how antibiotics should best be stored in their communities. One approach may be to dispense antibiotics to first responders, physicians and other health workers, said a Sept. 30 report by the Institute of Medicine. They would store antibiotics and distribute them to patients when appropriate. This strategy may be beneficial for those who cannot travel to distribution points to receive antibiotics because of a medical condition. Such prepositioning strategies may provide antibiotics more quickly and efficiently. Prepositioning refers to the storage of medical countermeasures, such as antibiotics, close to or in the possession of people who need rapid access. This could include local stockpiles, workplace caches and home storage. "Delivering antibiotics effectively following an anthrax attack is a tremendous public health challenge," said emergency physician Robert Bass, MD, c [Read more]
Heart attacks can occur in women whose angiograms show open arteries
Physicians should not overlook myocardial infarction as a diagnosis for female patients with symptoms but who show no signs of obstructive coronary artery disease on an angiogram, a study says. The study, published online Sept. 26 in Circulation, found that a rupture or ulceration of cholesterol plaque in a coronary artery is common among these patients. The plaque disruption can lead to the blockage of an artery and cause a heart attack, the study authors said. By the time an angiogram is performed, however, the blood clot can break up, leaving the appearance of a normal or near-normal artery. These women "often are not treated for [myocardial infarction] and are often told that they did not have [a heart attack] based on the finding of open arteries in the angiogram," said lead study author Harmony R. Reynolds, MD. "Primary care physicians need to know that if a patient presents with myocardial infarction and has open arteries, that's still a myocardial infarction, and they [Read more]
Physician shortage in Massachusetts continues to squeeze primary care
Massachusetts is facing severe or critical shortages of doctors in eight specialties, including a deficiency of primary care physicians for the sixth year, a survey shows. Internal medicine, psychiatry and urology are seeing critical shortages, according to the 2011 Massachusetts Medical Society's "Physician Workforce Study," released in September. Dermatology, family medicine, general surgery, neurosurgery and orthopedics are seeing severe shortages, according to the 10th annual MMS report, which evaluated 18 specialties. Researchers surveyed practicing physicians, residents and fellows across the state. Neurosurgery is the only specialty new to the shortage list this year. However, three specialties on the list in 2010 did not make it this year: emergency medicine, neurology and vascular surgery. MMS President Lynda M. Young, MD, said a long-term goal is to have more physicians enter primary care. Doctors and others are working toward that goal in various ways. For example, [Read more]
Female smokers at greater risk after a heart attack than other patients
Women who smoke and have had an acute coronary syndrome event should be closely monitored, because they are more likely to develop subsequent cardiovascular problems than other patients. A study published online Sept. 19 in The American Journal of Cardiology found that 55% of female smokers experienced at least one cardiovascular problem within six months of having an acute coronary incident compared with half of nonsmoking women. The figure was 42% for nonsmoking males and 33% for male smokers. "Smoking is not good for men or women, but our analysis shows that women who smoke do worse six months after a heart attack than men," said senior study author Elizabeth Jackson, MD, MPH, a cardiologist at the University of Michigan Cardiovascular Center. She recommends that primary care physicians "be aggressive about secondary prevention in female smokers [by] treating them with evidence-based medication such as aspirin and statins." Dr. Jackson said secondary prevention also shou [Read more]
U.S. still faces public health preparedness gaps 10 years after 9/11
A decade after the Sept. 11, 2001, attacks and the anthrax scare that same year, the United States still is not adequately prepared to respond to public health threats, experts say. A report issued Sept. 1 by Trust for America's Health and the Robert Wood Johnson Foundation shows that significant public health improvements were made following the 2001 events. Such improvements include developing clear emergency response plans, bolstering laboratory staffing and bio-testing capabilities, and implementing more effective disease surveillance systems in state health departments. But during the past 10 years, the report says these efforts have been losing effectiveness, due largely to public health budget cuts. The cuts are leaving many departments across the country with too few staff members to adequately implement the measures. For example, some local and state health departments might no longer be able to properly staff their laboratories should there be an infectious disease o [Read more]
Stroke-related hospitalizations rising among teens and young adults
Primary care physicians who educate their adolescent and young adult patients on healthy behaviors could help slow the rising number of stroke-related hospitalizations in people age 15 to 44, says a CDC physician. Such healthy behaviors include eating the proper amount of fruits and vegetables, exercising regularly and not smoking cigarettes, said Mary G. George, MD, MSPH, lead study author and medical officer in the Centers for Disease Control and Prevention's Division for Heart Disease and Stroke Prevention. The study, published online Sept. 1 in Annals of Neurology, found that hospitalization rates due to ischemic stroke in people age 15 to 44 rose by as much as 37% between 1995 and 2008. Stroke risk factors, such as diabetes, hypertension, obesity and tobacco use, also increased during the study period among this age group. "It's very worrisome that those traditional risk factors for stroke, which we normally associate with older people, are very prominent in this young ad [Read more]
Michigan appeals court upholds statue of limitations in liability case
Refusing to make an exception to the state's statute of limitations on pursuing medical liability lawsuits, a Michigan Court of Appeals said a patient could not go forward with a case against Henry Ford Health System. The decision reversed a trial court ruling that said the lawsuit could go forward even though it was pursued more than six months after Mary O. Dennis discovered that she may have a medical liability claim. The lawsuit arose after Dennis was hospitalized for an unrelated issue on Sept. 11, 2008, and physicians told her she had colon cancer that had existed for at least five years, court documents show. When Dennis asked doctors why the cancer wasn't detected during a colonoscopy two years earlier, the physicians did not answer the question, according to court records. She filed her notice of intent to sue -- the first step plaintiffs must take when filing a medical liability suit in Michigan -- about a week after the six-month filing deadline. Dennis argued that [Read more]
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