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Caregivers can be part of physician-patient relationship
The American College of Physicians has issued a position paper to help guide physicians through the ethical challenges that can arise when the physician-patient relationship is broadened to include caregivers. The paper emphasizes the need for respect of patients' dignity, rights and values, and provides guidance for effective communication among all parties. Although many physicians understand that patients' family members and neighbors are important players on the health care team, caregivers sometimes are relegated to the shadows, said Dr. Virginia Hood, chair of ACP's Ethics, Professionalism and Human Rights Committee, which developed the paper. "Although we don't want anything to interfere with the physician-patient relationship, which is still key to all health care, we have to work out ways that caregivers are a part of this process too -- as long as the patient agrees," Dr. Hood said. The paper was endorsed by 10 other professional medical societies. It was publishe [Read more]
Quality improvements being seen at hospitals
American hospitals improved their performance on 25 evidence-based quality metrics in 2008, according to a report released in January by the Joint Commission. In fact, hospitals exceeded 90% compliance on 23 of the commission's 31 measures of heart attack, pneumonia, heart failure, asthma and surgical care. The commission, which accredits more than 3,000 hospitals and other health care organizations, has collected quality data since 2002. This is the fourth annual public report of results (www.jointcommission.org/library/annual_report). "It's not just the average that's getting better," said Joint Commission President Mark R. Chassin, MD, MPH. "It's important to note how many hospitals are achieving really high levels of performance. ... Hospitals have figured out, even with the increasing number of measures they have to work on, how to get close to consistent excellence on these measures of quality." The measures track performance in areas such as giving aspirin and beta-b [Read more]
Teens' kidney function harmed by even low lead levels
Blood levels of lead below those considered elevated by the Centers for Disease Control and Prevention still may negatively impact kidney function in otherwise healthy adolescents, says a study in the Jan. 11 Archives of Internal Medicine. Researchers at the Johns Hopkins Children's Center in Baltimore gathered data from 769 adolescents, ages 12 to 20, who participated in the Third National Health and Nutrition Examination Survey from 1988 to 1994. Nearly all of the participants had blood lead levels below 10 ug/dl (the CDC's threshold for concern), with an average level of 1.5 ug/dl. Researchers found that higher lead levels, which were still below 10 ug/dl of blood, were consistently associated with a lower glomerular filtration rate. "There is a lot of accumulating evidence showing a role of lead [in kidney disease]. ... But I was a little surprised that we saw the association in a relatively small population of healthy kids," said Jeffrey Fadrowski, MD, a pediatric neph [Read more]
Wisconsin high court to rule on liability fund raid
Wisconsin physicians earned another shot at overturning what they say was an illegal $200 million raid on the state's medical liability compensation fund to balance the state budget. The Wisconsin Supreme Court in January agreed to hear the Wisconsin Medical Society's lawsuit contesting 2007 legislation that transferred the money from the Injured Patients and Families Compensation Fund (www.wisconsinmedicalsociety.org/initiatives/lawsuit). In accepting the case, the high court said in a statement that its decision "would have statewide impact." The case is not unique; doctors in New Hampshire and Pennsylvania have engaged in similar legal battles. As in some other states, Wisconsin physicians and other health care professionals contribute annually to a medical liability pool intended to keep insurance rates affordable and compensate injured patients. "There are no taxpayer dollars in the fund," said George M. Lange, MD, chair of the WMS' board of directors. Created in 19 [Read more]
Health reform meetings need closer look, House panel says
The House Energy and Commerce Committee on Jan. 27 approved a bipartisan resolution asking the White House to provide more details about a series of meetings last summer with health industry stakeholders. The talks produced pledges from participants to reduce the growth in health spending by up to $2 trillion over a decade. The meetings were attended by representatives of six organizations: the American Medical Association, the Pharmaceutical Research and Manufacturers of America, the American Hospital Assn., America's Health Insurance Plans, the Service Employees International Union and the Advanced Medical Technology Assn. PhRMA agreed in June 2009 to discount drugs for seniors by roughly $80 billion over a decade. The AHA joined two other national hospital organizations in July 2009 to promise a $155 billion reduction in hospital spending growth over a decade. The committee's resolution, a modified version of one originally drafted by Rep. Michael Burgess, MD (R, Texas), asks [Read more]
Work force issues to be examined in physician survey
About 9,000 primary care physicians nationwide are being surveyed to examine work force matters, medical homes and other practice issues. One goal is to help determine whether there are enough primary care physicians to tend to the nation's needs -- especially if insurance coverage is extended to more people in a reformed health system. "There were discussions of shortages of primary care physicians, and we wanted to understand the nature of the shortage," said Edward Salsberg, director of the Assn. of American Medical Colleges' Center for Workforce Studies, which is reviewing the responses. Reports of long waits to see primary care physicians in Massachusetts after the state extended health insurance coverage to nearly everyone also provided a push for the survey. Physicians in that state have been over-sampled to provide sufficient data to analyze, Salsberg said. Questions on the four-page survey include asking whether physicians plan to work longer hours or hire more sta [Read more]
Obama budget freezes physicians' Medicare pay for 10 years
President Obama promised spending freezes during his first State of the Union address, but his $3.8 trillion fiscal 2011 budget request still would protect physicians from Medicare pay cuts and extend enhanced federal support for state Medicaid programs. Obama's proposal, unveiled Feb. 1, sets aside $371 billion over a decade to pay for the cost of preventing Medicare pay cuts under the sustainable growth rate formula. But the funding would only be enough to turn annual reductions into rate freezes, not to fund pay raises. Also, the president left the specifics of how to prevent the cuts up to Congress, said Jonathan Blum, director of the Centers for Medicare & Medicaid Services Center for Medicare Management. "There's lots of different ways to reform physician payment in the long term," Blum said. Health and Human Services Secretary Kathleen Sebelius said she was confident Congress would prevent the cuts, which are scheduled to begin with a 21.2% reduction on March 1. America [Read more]
Cutting salt cuts heart disease risk
Reducing dietary salt intake by as little as half a teaspoon a day could significantly cut cardiovascular disease risks and health care costs, according to a study published Jan. 20 online in the New England Journal of Medicine. Researchers used the Coronary Heart Disease Policy Model to quantify the benefits of reducing dietary salt intake by as much as 3 g per day. The population-based model is a computer simulation of heart disease in adults ages 35 and older in the United States. The data projected that cutting salt by 3 g each day would lower the annual number of new coronary heart disease cases by approximately 60,000, stroke by 32,000 and myocardial infarction by 54,000. Financially, researchers estimate that the nation would save $10 billion to $24 billion each year in health care costs (content.nejm.org/cgi/content/abstract/NEJMoa0907355v1/). "All those things together suggest it's a good idea to [advance] the efforts currently under way [to reduce dietary salt intake [Read more]
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