By Sheri Porter 

Are CMS incentive payments, which are available to physicians who invest in electronic health records, or EHRs, and use them in a meaningful way, taxable by the IRS? That question was asked during the recent AAFP Town Hall meeting in Denver.  

Health-care providers are helping patients kick bad habits and start new regimens by turning the tables on the traditional doctor-patient relationship.

They are using a technique called motivational interviewing, which was developed and used effectively in the 1980s in substance-abuse and addiction counseling. It has since been adapted for chronic-disease management, medication adherence, smoking cessation and weight-loss counseling by health systems and companies including Aetna and Weight Watchers International Inc. 

Instead of telling patients what to do and scolding them when they don't do it, clinicians ask the individual what changes he or she is willing and able to make, and then promote patients' desire, confidence and commitment to following through.

Doctors who lecture or give scary warnings can cause patients to become defensive and disengage, says Stephen Rollnick, a professor of health-care communication at Cardiff University, in Wales, and a founder of the nonprofit Motivational Interviewing Network of Trainers, whose members provide training, coaching and consultation in 35 countries. "When people are struggling, they don't like to be told what to do, and they dislike being labeled and blamed," Dr. Rollnick says. Motivational interviewing "can bring patients back on board and empower them to consider difficult changes."

In workshops and courses, doctors, nurses and health coaches are trained to collaborate with patients on treatment decisions, offering choices rather than prescriptions and avoiding terms like "must," "should" and "have to." They might ask patients why they think they aren't losing weight or taking their medications properly, and they elicit goals from patients, such as being able to dance comfortably at a wedding.

While one aim is to resolve the ambivalence of patients who aren't ready to cooperate, clinicians also learn a technique known as "roll with resistance," which encourages small initial steps toward a goal the patient sets, such as cutting down on sweets or cigarettes a little at a time. Some programs incorporate the motivational interview into interactive online tutorials for patients at home.

Motivational interviewing can help patients control blood pressure and diabetes, lose weight, start exercising and quit smoking, recent studies have found. A large federally funded study with sponsors including the American Academy of Pediatrics is looking at the effectiveness of motivational interviewing by pediatricians who are helping parents of obese children make progress toward a healthier diet and weight loss.

"Many doctors struggle finding the right balance between supporting patient choice and autonomy, and meeting their obligations to make informed recommendations," says Ken Resnicow, a University of Michigan health-behavior and education researcher who is leading the pediatric study. He owns Academic Assistance, a for-profit provider of motivational health-care training based in Ann Arbor. Generally, Dr. Resnicow says, these techniques are most effective with patients "who have low energy for change and a high level of resistance."

By Brad Broker

After a series of 15 consecutive, involuntary,

 rapid fire sneezes, I unofficially declared the beginning of allergy season.  Turns out, the Asthma and Allergy Foundation of America (AAFA) beat me to it by releasing its top 100 list of Spring Allergy Capitals - the worst places to be for allergy sufferers.

The AAFA list ranks cities on pollen score, number of people taking allergy medication, and the number of board certified allergists-per-patient in the region.  "We do this ranking to make people aware of their environment and what they may face," Angel Waldron, a spokesperson for the AAFA, said to USA Today.

Jackson, Mississippi led the way this year, up three places from 2012.  In fact, 15 of the top 25 Spring Allergy Capitals are located in the Southern part of the United States. Jackson's rise to the top was due to very high pollen and a large reliance on allergy medications among allergy patients.

Dr. Gailen Marshall, chief of clinical immunology and allergies at the University of Mississippi Medical Center, told ABC News he wasn't surprised to learn that Jackson was the No. 1  springtime allergy capital in the U.S. "We're caught in a perfect storm," said Marshall. "Right now, it's tree season, and as far as the eye can see [there are] groves and groves of trees. The sheer volume of pollen is huge here."

Northern cities predicted to face a more challenging spring allergy season compared to one year ago include: Buffalo, NY (rising 10 spots to rank #15 out of 100 cities), Springfield, MA, (rising 74 spots to #18), Detroit, MI, (rising 50 spots to #26) and Toledo, OH (rising 57 spots to #29).

Some of the increases in allergies in these regions can be attributed to more severe weather patterns, which "can bring higher temperatures, higher pollen levels and increased exposure to outdoor mold, resulting in spring allergies that can peak stronger and last longer," said Bill Berger, MD, Allergy and Asthma Associates of Southern California. Recent hurricanes, severe storms and tornadoes can also affect the severity of spring allergies. The increased presence of mold in areas damaged by floods can trigger allergic reactions.

Major urban areas and locations with significant construction may also see an increased risk for severe allergies, because pollen from weeds proliferates in places with development projects. The largest top cities on the list cluster from 23-26 include: Dallas, TX; San Antonio, TX; Philadelphia, PA; and Detroit, MI.

The best way for people to manage seasonal allergies is to avoid allergy triggers like pollen and outdoor mold, get properly diagnosed, and use fast-acting, more effective medications to prevent and treat symptoms.

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