Friday, May 20, 2011

How Would You Like Some Health Policy News with Your Flash Thunderstorms?

Hello again, and welcome to Arthritis Awareness Month! (Terribly fitting, wouldn't you say, for all the UB First-Years finishing up their musculoskeletal unit next week.) I'm sorry it's been so long without any updates, but this should tide you over for a few days.

1. Here are a few things you need to know, or maybe you just forgot: Health care reform is affecting future doctors by emphasizing primary care and by paying them differently (but goodness knows how, at the moment); Kids who watch a lot of TV may grow up to get CVD; Old people who exercise may get fewer age-related complications; Hospitals are being forced to deal with too many patients, drug shortages, and reimbursement problems; Uninsured patients rack up a whole lot of money for everyone involved ($49 mil annually in unpaid medical bills).

2. A few weeks ago, the AMA testified to Congress regarding the planned 29.5% physician pay cut for 2012 due to the proposed SGR (sustained growth rate) to deal with Medicare funding/reimbursement. AMA Pres Cecil B. Wilson said to 1) repeal the SGR (no one, in medicine at least, likes it), 2) setup a 5-year period of positive Medicare payments (aka increased, not decreased, reimbursement), and 3) figure out a better way to deal with the "Medicare problem" without resorting to a "one-size-fits-all formula." Essentially, Wilson campaigned for a transition to multiple payment models.

3. iScrub App: Anyone who's taken a microbiology class knows that the biggest infection problem in hospitals comes from staff slacking in the hand-washing department. Dr. Atul Gawande dedicates a chapter to this in his book "Better" (2007; check it out): He writes about Ignaz Semmelweis, the doctor who virtually eradicated so-called puerperal/childbed fever by getting other doctors to wash their hands. No easy feat, Semmelweis supposedly stood guard near the ward's one sink and hounded all passersby. Too bad there's no one to do that in today's hospitals -- but wait! The ingenuity of a new iPhone application, the iScrub, records and analyzes hand hygiene observations in hospitals and provides real-time feedback without the need for transcribing anything. Best of all, research shows that it does increase hand hygiene compliance!

4. This week marks the first Medicare EMR incentive payments! This applies to all doctors/hospitals/etc. that have met the CMS's meaningful use stipulations and other program requirements once they surpass a $24,000 threshold. Where these early bird EMR users will receive benefits, those who do not have systems in place by 2015 will be penalized by lower Medicare and Medicaid payments. But, there are still lingering concerns over remaining security gaps, including unencrypted wireless connections, easy passwords, and "a taped-over door lock on a room used for data storage" at one of seven large hospitals investigated. Fixing the problems is the responsibility of the Office of the National Coordinator in HHS (which sets the standards) and the Office for Civil Rights (which guards the privacy and safety of medical records).

5. How to best coordinate health care? Accountable Care Organizations (ACO) seem to be the wave of the future. They're essentially medical home systems, just applied to Medicare and therefore federally organized. The goal is, obviously, to coordinate care for patients with multiple providers in multiple settings, and the Medicare population is overall in great need of such organization. Additionally, ACOs are designed to achieve cost savings for Medicare, employers, and patients (payment models are currently being "tested"). Despite the promise of ACOs, physicians don't seem to be too gung-ho about similar federal models: No states have opted into a Medicaid health home program after five months of recruitment. Maybe it's that states have their own systems in place (some do), but a big problem is poor physician reimbursement.

Just for my own amusement:
Botox regulations for minors pass NJ committee: Apparently, this is a thing found outside of that one Bones episode about the 10-or-whatever-year-old beauty pageant contestant. The article doesn't say whether the Botox is used for minors outside of beauty pageants, but the stats are >12,000 injections in minors as of 2009, almost double the number from 2008. And as a South Shore Long Island native, I get to say this: Obviously this is in New Jersey.

San Fran to vote on male circumcision ban: The group advocating for the bill looks to "protect ALL infants and children in San Francisco from the pain and harm caused by force genital cutting," citing autonomy over one's body -- and the US ban on female genital mutilation -- as the need for such a law. Needless to say, Jews are upset, anyone concerned about spreading STDs and HIV is upset, and the chief of pediatric urology at UCSF calls it "a bunch of nonsense."

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