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5 people die under new Washington physician-assisted suicide law
Five Washington patients with terminal illnesses ingested lethal doses of medication prescribed for them by physicians under their state's new death-with-dignity law, approved by 58% of voters in a November 2008 ballot initiative. At this article's deadline, 14 patients had made written requests for life-ending prescriptions, according to a Web site updated weekly by the Washington State Dept. of Health. Thirteen lethal prescriptions had been dispensed by pharmacies. In two of these cases, a mental health professional was consulted and filed a compliance form. The psychiatric referral is required if the attending or consulting physician has doubts about the patient's mental competence. The Washington law, which took effect March 5 and is virtually identical to Oregon's first-in-the-nation law, makes physician-assisted suicide available to patients who have been judged terminally ill by two doctors. Patients must make an oral request and a witnessed written request. Another oral r [Read more]
N.J. bill would require certified health IT
A bill introduced in New Jersey would make it unlawful for health information technology systems to be sold or distributed unless they are certified to meet interoperability standards. Assemblyman Herb Conaway Jr., MD, an internist from Willingboro, N.J., who is a strong advocate of health IT, introduced the bill as a way of expediting interoperable health IT systems in the state. The bill initially called for systems to be certified only by the Certification Commission for Healthcare Information Technology. But it was amended at the request of the Medical Society of New Jersey and others. CCHIT more than likely will be the certifying body the federal government chooses as the standard for systems physicians must use to meet "meaningful use" requirements to get incentive funds for electronic health records, but it's not a done deal, said Tim Martin, government relations representative for the medical society. (Those meaningful use requirements have not yet been set.) "If they [Read more]
More refining sought for computerized physician order entry systems
Implementing a computerized physician order entry system helped improve efficiencies at the Mayo Clinic in Scottsdale/Phoenix, Ariz., but did not reduce medication errors. In some cases, the system actually helped create errors, according to a study by Mayo physicians published in the May Journal of the American College of Surgeons (www.journalacs.org/article/s1072-7515(09)00200-2/abstract). According to the study, "Impact of a Computerized Physician Order-Entry System," Mayo's system, installed in stages from May 2007 through April 2008, reduced the time it took for a physician order to be received by a nurse from 41.2 minutes to 27 seconds. This improved process not only allowed patients to get needed medication or tests quicker but also allowed the hospital to reduce staff by 19.6%, saving $445,500. While previous studies have shown that CPOEs decrease medication errors in the hospital setting, the Mayo study looked at those numbers in the inpatient surgical setting. Due to th [Read more]
Health plan requirements cost practices billions, with the per-doctor average near $70,000
Physicians know that the phone calls, faxes and e-mails sent between their practices and health plans take time. Researchers have determined how much time it takes and what it costs. A study published online May 14 in Health Affairs estimates that practices' interactions with insurers cost $23.2 billion to $31 billion a year. The average physician spends 43 minutes per work day -- more than three hours a week -- dealing with health plan administrative requirements. The time physicians, nurses and other practice staff spend interacting with insurers costs an average of $68,274 per physician per year. The survey found that the average primary care physician in a solo or two-physician practice spends 4.3 hours per week dealing with plans, on everything from contracting to reporting quality data. Primary care physicians spent significantly more time, on average, dealing with insurers than do specialists and surgeons. The average primary care physician, across all practice sizes [Read more]
Medicine decries nurse doctorate exam being touted as equal to physician testing
Physician leaders say a new doctor of nursing practice certification exam is being wrongly compared with testing that physicians take. And they fear that patients may be misled into believing nurses who pass the exam share the same qualifications as physicians. Last fall, the National Board of Medical Examiners began offering the voluntary DNP test, based in part on Step 3 of the U.S. Medical Licensing Examination. Step 3 is the final stage in the physician testing series. In January, the Council for the Advancement of Comprehensive Care -- a nonprofit nursing group that contracted with the NBME to develop the exam -- announced the results of the first DNP certification test, with 50% of candidates receiving passing scores. In its announcement, the CACC said the exam "was comparable in content, similar in format and measured the same set of competencies and applied similar performance standards as Step 3 of the USMLE, which is administered to physicians as one component of qualif [Read more]
California physicians push to end Medicaid prior approval
California's budget crisis is leading Gov. Arnold Schwarzenegger to consider massive health care cuts, but the California Medical Assn. has another suggestion -- end treatment authorization review for Medicaid services and save hundreds of millions of dollars. The state's Medicaid treatment authorization program requires physicians to obtain prior approval for certain prescriptions and treatments. The mandate applies to a minority of procedures -- perhaps 15% overall, said Doug Robins, chief of the California Dept. of Health Care Services' Utilization Management Division. The state in 2001 reviewed 9% of Medicaid claims, including 10% of Medicaid prescriptions, 1.4% of inpatient care and 0.4% of physician services, according to a 2003 report by the California HealthCare Foundation, an independent philanthropy committed to improving the way health care is delivered and financed in California. Robins did not provide more current estimates. CMA Trustee Ted Mazer, MD, said the progra [Read more]
5 answers to your recession questions: Tips to keep your practice solvent
The financial questions physicians previously asked consultants were focused on ways to optimize revenue. Now those same questions are being asked so practices can keep from closing their doors. "The recession is fortunate for my practice. I seem to be very busy," said Jamie Claypool, president and founder of J. Claypool Associates, a practice management consulting firm based in Spicewood, Texas. Claypool and other consultants say once-hypotheticals have become real dilemmas for their client physicians as financial solvency has become harder to maintain. "If you're already in a tight economy, making a bad decision can push you over the edge," said Judy Capko, author and founder of her own consulting business based in Thousand Oaks, Calif. The questions physicians are asking haven't changed, but have become more urgent, said Keith Borglum, a medical practice management consultant based in Santa Rosa, Calif. Here are the questions practice management consultants say they h [Read more]
Drug czar pushes Rx monitoring for all states
In his first major speech since his appointment as the so-called drug czar, R. Gil Kerlikowske reaffirmed the Office of National Drug Control Policy's push to expand prescription drug monitoring programs to all 50 states. Kerlikowske, the former police chief of Seattle, delivered an address at the May 20 National Methamphetamine and Pharmaceutical Initiative meeting in Nashville, Tenn. He said it is "essential" that prescription drug monitoring programs are in place across the country. "Just as law enforcement needs to learn from health professionals about addiction and abuse to help us do our jobs, so too must the health community learn from law enforcement about the public safety consequences of excessive prescriptions and the reality of doctor shopping," Kerlikowske said in his address. The American Medical Association supports the expansion of prescription drug monitoring programs as a way of assisting physicians in identifying patients in need of help, rather than for [Read more]
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