July 2009
Volume 3, Issue 12
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InforMed Society

Offical E-Newsletter of the Medical Society

Keeping you InforMed about the latest health care news!
From the President

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 Brian R. Riveland, MD
Factors Affecting the Cost of Health Care
An Internists Perspective

The cost of health care in the US is a daily news item.  It is the major focus of the Obama administration.  Recently "providers" got together and promised to cut health care costs; however, missing in this extensive coverage is a step-by-step outline of just how are we going to do this? 

Let me get this straight right from the beginning.  I have no idea how to fix the problem.  However, I do have opinions as to where, as a practicing internist, I see that health care dollars are wasted. This certainly is not an all inclusive list and each item could be an article in itself.

  1. Improper incentives.  Nothing new here, but it is very clear the system rewards procedures, testing, short office visits, and subspecialty utilization.  The examples are endless and here are but a few.  I can spend 5 minutes discussing the pros and cons of PSA testing with my patient, or indicate he needs to have a PSA test done and order the test in 5 seconds.  This during the same office visit I should be discussing living will, medical power of attorney, lifestyle changes to manage his hypertension, diabetes and heart disease, weight loss efforts, smoking cessation, immunizations, preventative health measures in addition to doing a full history and physical exam and addressing all of his concerns that he has learned on the TV through direct-to-patient marketing by the pharmaceutical companies.  I will not get paid any more for doing any of the counseling or advising once a certain level of visit is obtained.  I also do not believe that negative incentive models are the answer either (i.e. capitation); however, the system does not recognize cognitive services for our patients.  As in a previous article, I also believe the current and worsening supply of primary care physicians will do nothing but make this worse.
Read more...
In This Issue
From the President
ACT Kids Health Fair - VOLUNTEER!
Alcoholic Patients with Special Needs
Annual Meeting Ideas
AMA reaffirms stance in health system reform debate
First draft of EHR "meaningful use" definition unveiled
New guidelines issued for Asthma assessment
US CDC to reinstate booster shots of HiB vaccine
FDA panel votes to eliminate Vicodin, Percocet
Phoenix gets a new med-student program
There is no better exercise for your heart than reaching down and helping to lift someone up.
 
Bernard Meltzer

Featured Business

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Round-up Magazine has been a monthly source of socio-economic information for physicians for over 50 years. 
A $36 value, it is free with membership.


For more information, please visit the MCMS website.

ACT Kids Health Fair - VOLUNTEER!

Thousands of underprivileged kids are given a better chance at life through the ACT Head Start Health Fair.  The Medical Society along with a variety of other agencies will hold the one-day health screening at the Phoenix University School (previously Phoenix Preparatory Academy) on Saturday - September 12, 2009. 
 
The Society needs 50 physicians, physician assistant and nurse practitioner volunteers; 20-30 medical volunteers and 35-45 non-medical volunteers to help with this very worthwhile project.  Three shifts are available to physicians, physician assistants and nurse practitioners - 7:00 am to 12:00 pm, 11:45 am to 3:30 pm, and an all day shift.  Others are required to serve for the entire event (7:00 am - 3:30 pm), due to the training involved.  All volunteers will be asked to stay for their entire shift.  A free lunch will be included. 
 
Portions of the exam can only be performed under the supervision of a physician, physician assistant or nurse practitioner.  Each are assigned an exam booth and an assistant.  All the paperwork and releases are collected beforehand by the Head Start staff so that you can concentrate on what you do best - treating the patient.  It is not necessary to be a primary care physician or a pediatrician.  The examinations are general in nature and most subspecialties qualify to perform them. 
 
We also encourage you to involve your staff (age 18 or older) in this event.  Nurses and medical students are assigned to a booth to assist the examiners or to take blood pressures. Non-medical volunteers will help with heights and weights, assist with traffic, entertainment and child supervision.  We are especially in need of bilingual (Spanish, English and Asian) volunteers, as well as those experienced in administering Hearing Exams and Cleanings. 
 
More than 40,000 children have received medical screenings at this event.  We expect over 2,000 kids to attend this year, which means we will likely perform 800 exams in our area.  Many of these three to five year olds have never seen a physician and about 10% will need follow-up care.
 
Please donate a few hours of your time to this worthy cause.  Not only will you make it possible for the children to enter the Head Start program, you will allow them to get the medical care they need.  Your time can make a difference for these preschoolers.
 
To register:
Non Physician Form
Physician Form

For questions, contact Lisa Silva at 602-252-2015. Please register by August 14, 2009.  Thank you for volunteering your time and we look forward seeing you there! 
Alcoholic Patients with Special Needs
Do you have an alcoholic patient, newly sober or with long-term sobriety, who has special needs affecting their ability to access Alcoholics Anonymous materials, meetings or fellowship support?  Perhaps they have a long term or permanent disability, or are recovering from surgery or an illness, making it difficult or impossible to attend A.A. meetings.  The Special Needs Accessibility Committee of Alcoholics Anonymous (SNAC) in Maricopa County has resources available to alcoholics with special needs.
 
Resources include: 
  1. A.A. meeting tapes and CDs and A.A. literature in Braille or large print for the blind and/or visually impaired
  2. Meetings and videos of the Big Book of A.A. in American Sign Language for the deaf or hard of hearing
  3. Illustrated materials for the developmentally disabled who are disabled from alcoholism or other causes.
SNAC can also provide telephonic or in-person support for chronically ill, or home/facility bound individuals, including bringing A.A. meetings to these individuals in their home or residential facility.
 
If you have an alcoholic patient with special needs, please contact A.A.'s Special Needs Accessibility Committee at aa.specialneeds08az@gmail.com, or call Cynthia K., the Committee Coordinator, at 480-946-1384.  In the alternative, please feel free to share this contact information directly with your patients and their families or caretakers.


Got an idea??

Please join us in October for the Society's annual meeting!  We are currently canvassing different venues in the Valley, and would love to elicit fun/creative ideas from our members!  If you have suggestions, please email Claudia Bair at cbair@mcmsonline.com.

Thanks!
AMA meeting: AMA reaffirms stance in health system reform debate
Addressing what has become the hottest flashpoint in this year's health system reform debate, the American Medical Association House of Delegates at its Annual Meeting in June renewed its existing reform policies rather than declare a position on whether lawmakers should establish a new national federal health insurance plan that would compete with private insurers.

Delegates agreed that the AMA should "support health system reform alternatives that are consistent with AMA principles of pluralism, freedom of choice, freedom of practice and universal access for patients." Both supporters and opponents of the public plan concept wanted the Association to take a definitive stand on the issue. But after AMA Immediate Past President Nancy H. Nielsen, MD, PhD, warned that such a move could handicap the organization as it tries to influence the health reform debate, delegates backed away from those resolutions.

Dr. Nielsen said the resolution that ultimately passed would allow her and AMA President J. James Rohack, MD, to keep the AMA engaged in the debate without restriction but with a clear directive to advocate for choice for both physicians and patients.

Read more...
First draft of EHR "meaningful use" definition unveiled

President Obama's point man on health care information technology has asked a key working group to revise its recommendations on what constitutes "meaningful use" of electronic health records, a pivotal term that will decide which physicians can obtain billions in federal EHR money.

David Blumenthal, MD, national coordinator for health information technology, declined to specify why he asked the Health IT Policy Committee's meaningful use working group to amend the recommendations it released June 16. The panel is tasked with advising the government on a policy framework for the development and adoption of a nationwide health IT infrastructure.

"We had a lively discussion, and it was decided after considerable input on the topic of meaningful use that we would take it back to discussion to work on it a little bit longer," Dr. Blumenthal said. He said the committee expects to unveil revised recommendations by July 16, the date of its next scheduled meeting.

More information...
New guidelines issued for Asthma assessment

The American Thoracic Society (ATS) and the European Respiratory Society (ERS) have released official standards regarding asthma evaluation for clinical trials and practice. The joint statement containing the new recommendations and underlying evidence base was approved by the ATS Board of Directors on March 13, 2009, and by the ERS Executive Committee on November 27, 2008, and it is published in the July 1 issue of the American Journal of Respiratory and Critical Care Medicine.

"In the past, there has been no standard way of assessing asthma," Helen K. Reddel, MB, PhD, from the Woolcock Institute of Medical Research in Camperdown, Australia, and cochair of the ATS/ERS Task Force on Asthma Control and Exacerbations, said in a news release. "This has led to a lot of confusion for doctors who are managing asthma, and in research, it was difficult to compare the results of different studies."

Although evaluation and monitoring of asthma control are crucial to determining treatment response both in individual patients and in clinical trials, there have been a variety of definitions and assessments for asthma control, severity, and exacerbations. The ATS/ERS therefore convened a task force of 24 asthma experts from North America, Europe, South Africa, Australia, and New Zealand.

Read complete article...
US CDC to reinstate booster shots of HiB vaccine

The U.S. Centers for Disease Control and Prevention said on Thursday it plans to reinstate booster shots of the Haemophilus influenzae type b (HiB) vaccine.

The CDC said in a statement it believes manufacturers will have enough supply of the vaccine to resume giving a booster shot to children aged 12 to 15 months.

Merck & Co Inc in 2007 recalled its HiB vaccines because production equipment may not have been properly sterilized. The CDC said HiB vaccine made by Sanofi Pasteur, the vaccines division of Sanofi-Aventis, will increase enough starting in July to allow reinstatement of the HiB booster for children aged 12 to 15 months.

Short supplies of the vaccine will not allow a mass recall of older children who missed their booster, CDC said.
FDA panel votes to eliminate Vicodin, Percocet

Government experts say prescription drugs like Vicodin and Percocet that combine a popular painkiller with stronger narcotics should be eliminated because of their role in deadly overdoses. A Food and Drug Administration panel on Tuesday voted 20-17 that prescription drugs that combine acetaminophen with other painkilling ingredients should be pulled off the market.

The FDA has assembled a group of experts to vote on ways to reduce liver damage associated with acetaminophen, one of the most widely used drugs in the U.S.

Despite years of educational campaigns and other federal actions, acetaminophen remains the leading cause of liver failure in the U.S., according to the FDA.

Panelists cited FDA data indicating 60 percent of acetaminophen-related deaths are related to prescription products. Acetaminophen is also found in popular over-the-counter medications like Tylenol and Excedrin.

"We're here because there are inadvertent overdoses with this drug that are fatal and this is the one opportunity we have to do something that will have a big impact," said Dr. Judith Kramer of Duke University Medical Center.

Read complete article...
Phoenix gets a new med-student program

A new educational partnership at St. Joseph's Hospital and Medical Center could increase the number of medical students who ultimately decide to work as doctors in Arizona.

A partnership with Creighton University School of Medicine, based in Omaha, Neb., will bring 42 Creighton students a year to St. Joseph's in Phoenix for their third and fourth years of training beginning in 2012.

The new program adds another element to a growing central Phoenix presence for health care, research and training.

In 2007, 24 students started classes at the University of Arizona's downtown Phoenix medical school. In 2008, 48 students started the four-year-program, and a third class of 48 will start soon.

Creighton is a Catholic Jesuit institution with 4,000 undergraduate and 2,900 graduate students. Its medical school already sends about six students a month for rotations at St. Joseph's. When the medical school wanted to expand its enrollment, officials wanted to partner with a Catholic hospital for their training. St. Joseph's is Arizona's largest hospital and is owned by Catholic Healthcare West.

More information...
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