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Pain may be contagious--and contracted by smell, according to a new paper published in Science Advances. Lab mice living in the same room as those who are primed to feel more pain end up taking on their roommates' heightened susceptibility. Via smell. Not all pain specialists are convinced, Stat reports. However, if supported, this could mean "almost every mouse lab on the planet needs to rethink its interior design." There are implications for humans. "If the same is true of humans--a big if-- then pain doctors may want to talk not just to their patients, but to their families and roommates, too." (Stat; Science Advances)


Medicaid expansion may not reduce the number of people using emergency departments for primary care, according to research published in the New England Journal of Medicine. ER use among Medicaid patients in Oregon stayed high even two years after people gained coverage. However, more patients did visit doctors' offices. Why Oregon as a case study? It tried an experiment. Oregon's 2008 expansion of Medicaid through random-lottery selection provided the basis for a randomized evaluation. (Kaiser Health News; NEJM)

Less than half of the approximately 27 million uninsured are eligible for federal financial assistance, according to Kaiser Family Foundation analysis. About 2.6 million fall into a coverage gap because they live in a state that didn't expand Medicaid. About 5.4 million are undocumented immigrants. The rest declined employer-sponsored insurance or have an income level too high to qualify for assistance. Roughly 43 percent--11.7 million people--are eligible, but they are not availing themselves of federal assistance. (Morning Consult; KFF analysis)
Innovation & Transformation  
Pharmacists can help control costs and improve patient care by working with primary care teams to optimize medication management, according to panelists at a congressional briefing. "For every dollar we're spending on prescription medications, we're spending another dollar trying to resolve a problem due to that medication," said Mary Roth McClurg, PharmD, MHS, of the UNC Eshelman School of Pharmacy. Medications account for $310 billion in spending in the U.S.; optimizing their use through improved adherence alone could save $290 billion, McClurg explained. Chronically ill patients adhere to their medication regimen only 33-50 percent of the time. One reason: cost. (Medpage Today)
 
Veterans with chronic conditions are receiving next-day and even same-day primary care appointments, no longer waiting weeks to be seen. The reason, explains USA Today, is that they are seeing clinical pharmacists who are able to prescribe drugs, order lab tests, make referrals to specialists and do physical examinations. Physicians are freed to focus on new patients and those with complex or acute needs. A quarter of primary care appointments at the Madison, Wis. VA hospital are now handled by clinical pharmacists[U1] . Other VA hospitals, including those in El Paso, Texas, and Kansas City, Mo., are following suit. (USA Today)
 
Consumers & Providers
Primary care doctors--who may be in the best position to recognize, prevent and/or treat addiction--are sitting out the fight, Stat reports. And addiction specialists are frustrated. "We're just watching the ship sink, even though we have the pumps to easily keep the water out," said Dr. R. Corey Waller, an addiction-treatment specialist who leads the advocacy division of the American Society of Addiction Medicine. But it's not that simple, he adds: There are few incentives to get trained, especially where Medicaid doesn't cover addiction treatment. "[W]e've set [primary care doctors] up for failure." (Stat)
 
 
Mental Health America just released its annual assessment of Americans with mental illness, the treatment they receive and the resources available to them. Among the findings: Twenty percent of adults (43.7 million people) have a mental health condition, and more than half of them do not receive treatment. Among youth, the rates of depression are rising, but 80 percent of children and adolescents get either insufficient treatment or none at all. On the positive side, health care reform has reduced the rates of uninsured adults with mental health conditions. (The Washington PostMental Health America)
During the 2015-2016 flu season, the national average for health care personnel vaccination was 64 percent. However, data show rates in California were much higher. One possible reason: Regional policies that require non-vaccinated health care workers to wear a protective mask during flu season. While 82 percent of health care workers at hospitals with mask policies received flu shots last year, the rate was 78 percent for those without mask policies. (HealthLeaders Media)
  
 
Family physicians may take a comprehensive approach to health care, but Medicare payments fail to adequately account for the attention they pay to social determinants of health, according to AAFP News. A new report from the National Academies of Sciences, Engineering and Medicine identifies ways that Medicare could incorporate several social risk factors into a value-based payment model. The report "provides guidance on data sources for and strategies to collect data on indicators of social risk factors" that could be accounted for in Medicare measurement and payment programs. (AAFP News; the report)
 
New & Noted   
Water beats diet soda: Replacing diet beverages with water is associated with greater weight reduction and improvements in glucose metabolism, according to a study published in Diabetes, Obesity and Metabolism. Researchers studied overweight and obese women with type 2 diabetes. (Physicians Briefing; Diabetes, Obesity and Metabolism)
Gray

What docs think about MACRA:  FierceHealthcare has a roundup of physicians sharing their thoughts on MACRA. There are a few choice words. (FierceHealthcare)

California's secret: California is one place the insurance marketplaces are working. Peter Lee, executive director of Covered California, discusses the indicators of and ingredients for success. (Health Affairs)
 
Multi-media 
When the American Academy of Pediatrics released its latest recommendations for screen time for youngsters, it also provided an online tool parents can use to create their own family media plan. (NPR; AAP tool)
 
MarketVoices...quotes worth reading
 
"I like the extra attention I get here."  --Mike Fonger, 71, a veteran receiving treatment at the Madison, Wisc. VA hospital, on being able to meet with a clinical pharmacist, quoted in USA Today
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Wednesday, October 26, 2016