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GAO questions AMA's role in Medicare rates

The government relies too heavily on advice from the American Medical Association in deciding how much to pay doctors under Medicare, according to a new Government Accountability Office report. Critics have long complained about the role of the American Medical Association/ Specialty Society Relative Value Scale Update Committee in setting Medicare rates, and the report tends to validate some of the criticism, according to The New York Times. The American Academy of Family Physicians has long argued that the AMA panel should include more primary care doctors, as well as consumer representatives, employers and health care economists. (New York TimesGAO report)



Workplace wellness programs expand despite challenges 

More companies are offering workplace wellness programs. The Family and Work Institute's 2014 National Study of Employers found 60 percent of U.S. employers offer some type of wellness program, up from 51 percent in 2008. They are also growing in scope; many include financial health and stress reduction in addition to the more traditional weight-loss and smoking-cessation programs. Increasingly, programs are tailored to the particular needs of a company's population. Entrepreneur relates a couple of success stories that didn't require an exorbitant investment. It also identifies some of the challenges, including privacy concerns and the difficulty measuring ROI. (Entrepreneur)

Similar antibiotic prescribing patterns in telemed, in-person visits
Third-party telemedicine consultations for acute respiratory infections are about as likely to lead to antibiotic therapy as in-person appointments with physicians, according to research published in JAMA Internal Medicine. However, telemedicine consultations were associated with more frequent use of broad-spectrum antibiotics than were in-person visits. Researchers identified inappropriate prescribing of antibiotics in both settings. They also indicated concern about the over-reliance of telemedicine on broad-spectrum antibiotics. They hypothesize telemedicine favored broad-spectrum drugs to compensate for the (comparatively) limited patient information available to them. (Medscape Medical NewsJAMA Internal Medicine)


Innovation & Transformation

Mount Sinai rethinks traditional premed track

Mount Sinai's medical school in New York City has a program, HuMed, to admit students who major in humanities. Too frequently, "if you can't get an A-minus in organic chemistry, you're not going to be a doctor," says Dr. David Muller, Mount Sinai's dean for medical education. And that excludes from medical schools "people...we desperately need." HuMed students are just as successful in medical school as the other students, and they are more likely to enter primary care or psychiatry, both areas of high need. (KQED)



Oncologists looking at new models, including medical home 

Although most oncologists work in a fee-for-service model, some are testing alternative payment approaches, including the medical home, reports Clinical Oncology News. Most alternatives are an amalgam of FFS, global payments and extra incentives based on specific metrics. The oncology medical home aims to coordinate patient care to reduce emergency department visits and hospitalizations. "[W]e are aggressively managing the side effects of cancer and its treatment, and we save money by keeping people out of the emergency department and out of the hospital, which makes patients happy," says Barbara McAneny, MD, CEO, of the New Mexico Cancer Center. (Clinical Oncology News)


Report identifies important roles for community health workers 

A new report from Peers for Progress, a program of the American Academy of Family Physicians Foundation; the Patient-Centered Primary Care Collaborative; and the National Council of La Raza explores the importance of support from peers--specifically, community health workers. Community health workers are especially well-positioned to bridge gaps in access to behavioral health services, as their roles within the community can help patients who are historically difficult to reach, according to the report. But they need adequate training to handle mental and behavioral health issues, which they do not always receive. (FiercePracticeManagement; report)
Consumers & Providers

Commentary: What's good for doctors may not be best for patients 

Doctors' guilds are pushing back against the possibility of the empowerment of nurse practitioners, which would enable NPs to deliver patient care without physician oversight, and release them from their economic subservience. In a recent LA Times opinion piece, Christopher Glazek suggests the longstanding notion that "what's good for doctors is good for patients" may no longer hold true. Un-tethering nurse practitioners may not be a perfect solution, but it could cut patient costs. Legislation under consideration in California would allow nurse practitioners to see patients without the supervision of a doctor. (LA Times



Report highlights need for integrated behavioral health 

Women, those with chronic medical conditions, the poor and those without health insurance are more likely than others to struggle with "serious psychological distress," according to a report issued last week. The report, based on the National Health Interview Survey, also found people with serious psychological distress were more likely to have COPD, heart disease and diabetes. "There has to be integrated care that includes mental and medical health," says Dr. Alan Manevitz, a clinical psychiatrist at New York's Lenox Hill Hospital. "Integrating mental and medical care is a movement that is already underway and needs to be encouraged." (HealthDay News)
Defensive medicine doesn't reduce the likelihood a physician will be sued, Dr. Aaron Carroll, pediatrics professor at Indiana University School of Medicine, writes in The New York Times "The Upshot" blog. "What might help physicians avoid being sued is getting along better with their patients." Likable physicians are less likely to be sued, he observes. Research shows primary care practitioners who "spend time educating patients about their care, more likely to use humor and laugh with their patients and more likely to try to get their patients to talk and express their opinions" are less likely to face lawsuits. (NYT)
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New & Noted   

Humana on the market? Various news outlets, including The New York Times and The Wall Street Journal, suggest Humana may be looking for a buyer. The news drove up the insurer's stock prices last week. (Kaiser Health News)


Employee clinics pay off: Offering employees access to onsite and nearsite clinics has saved Kentucky $723,900, according to an actuarial report. In 2011,Kentucky brought in H2U Wellness Centers to run four primary care health centers in Frankfort. Managing chronic conditions and avoiding hospital admissions, unnecessary emergency department visits and specialist referrals,led to an additional $400,000 each year, H2U estimates. Reduced time away from work and improved productivity produced savings of nearly $200,000.(Reuters)


Texas telemedicine ban on hold: Texas patients can still receive remote diagnoses and treatment. Teladoc won a preliminary court order blocking a new state rule requiring doctors to meet patients before prescribing drugs. (Reuters)


Dr. Leonard Saltz, chief of gastrointestinal oncology at Memorial Sloan Kettering Cancer Center, caused a "mini storm when, on Sunday, he openly criticized the high cost of cancer treatments" at the American Society of Clinical Oncology meeting in Chicago. What made his talk so surprising is that the event was heavily sponsored by the drug industry. Monday, he talked about his presentation with All Things Considered. (NPR)

MarketVoices...quotes worth reading


"[N]urse practitioners are not circus jugglers; they're highly trained professionals who are perfectly capable of providing primary care. The doctors' guilds don't deny this--they just want to make sure that nurse practitioners are tethered to MDs and economically subservient to them." -- Christopher Glazek in an LA Times opinion piece

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Wednesday, June 3, 2015































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