How social determinants can assist to improve pop health approaches

Population health management is a rapid-growing capability within health IT, and handling the growth of country in overall care expenditures will need providers to expend more efforts taking care of underserved populations. This post will let you know that how social determinants can help improve pop health approaches.

Over 43 million individuals in the United States live below the poverty level and their care consumes 67% of healthcare dollars, in accordance to Arthur Kapoor, president at Health EC, a population health management company.

The requirements of this segment of the country have been ignored for a long time, he emphasized, and bringing them into the fold and gathering data on their social determinants is the key to population health success.

Vendors in the population heath arena have massive amounts of information that several providers are not taking benefit of, Kapoor says. Providers are too busy attempting to maximize revenue while being pressed to cut rates, to also massage and observe population health data.

Kapoor analyzes a new way to help burdened providers-- have their vendors bring the data to them.

Social determinants data can assist providers better understand underserved populations and the problems they face. Providers mostly do not know if their sufferers have access to transportation, food and housing, or if they are socially isolated and have no one to take them to doctor appointments. “No one talks to them,” Kapoor stated. “They keep taking medication when they no longer require it because they like it.”

But there is a simple way to reach these sufferers. Almost all of them have a smartphone, Kapoor noted, and population health vendors have tools to assist providers’ better monitor their patients.

For example, a hospital or physician practice can give out grocery cards to assist patients in poverty buy food. HealthEC can track the purchases and notify a physician or case manager if a sufferer bought food that is injurious and harmful to their health. A phone call can educate the patient and gives an opportunity for a quick assessment of current health and requirements, which can determine if the patient should come in for a visit.

Among other problems, population health vendors should offer one electronic health record (EHR) on a patient covering the whole spectrum of care to help providers execute and see the advantages of keeping patients healthy, and give providers quality reports so they can negotiate better terms with insurers and with other providers when forming an accountable care organization (ACO), in accordance to Kapoor.

 

Could healthcare IT be the key sign to improved addiction treatment?

In a latest report on the subject of addiction, the United States surgeon general made an argument for the role of health information technology in making better the treatment of sufferers with drug or alcohol abuse as well as behavioral health issues.
Dr. Vivek Murthy's office emphasized for higher health IT adoption and use by providers of alcohol, drug abuse and behavioral health treatment. But it took no position on a pending federal rule that could relax the present strict privacy protections covering the medical records of several patients getting those treatments.
The report, Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health, mentions a fundamental health IT dichotomy: Patients get better care if their records are shared among providers, but patients will not seek treatment if they consider their data will be widely revealed.

Siemens steps into key population health with IBM

Siemens Healthineers is entering into the key population health with IBM. Siemens Healthineers is entering the population health management market through a partnership with IBM.

The move comes over 2 years after Cerner gained the hospital information systems business line of Siemens Healthcare, while leaving medical imaging and diagnostic laboratories as Siemens’ primary business in the United States of America, with the name replaced and changed to Siemens Healthineers. Siemens Healthineers is stepping into the population health with IBM.

Now, IBM’s Watson Care Manager population health management suite of software and services will be sold by Siemens, as well as providing consulting services.

“We’re at an unprecedented time period in healthcare,” Deborah DiSan zo, general manager for IBM Watson Health, claims. “Mature and developing markets are immensely concentrated on how sufferer results are optimized, quality is standardized among individuals and across populations, and costs are decreased. Siemens and IBM are perfect partners to work at the forefront of this evolution and evaluate personalized healthcare in the United States of America and internationally.”

Watson Care Manager is a population health management system which is utilizing Apple apps to enable clients to gather and share information with clinicians to support patient engagement. Leveraging IBM’s acquisitions of care management vendor Phytel and population health analytics vendor Explorys, Watson Care Manager in the year of 2015 held data on ninety million lives.

Utilizing Apple HealthKit, information and data can be shifted from a device to a cloud application. Using Apple ResearchKit, contributors can better manage the signing up of sufferers for clinical trials. In total, Care Manager supports development of personalized patient engagement programs to make better the individual results, the companies claim.

Executives from both IBM and Siemens are also planning to co-develop latest population health management tools.

 

Low-cost technology might make better the rehab for stroke victims

New technology being established at the Tandon School of Engineering at New York University is made to assist stroke victims more rapidly to regain lost motor qualities compared with traditional therapies.

The technology, projected to charge $1,000 for per unit, can be placed in sufferer homes, negating the requirement for frequent trips to a hospital or clinic for rehabilitation.

The project utilizes “mechatronic devices,” which is a marriage of mechanical and electrical engineering disciplines to generate smart products with embedded intelligence, claims Vikram Kapila, a professor of mechanical and aerospace engineering at NYU’s Tandon School of Engineering. An instance of such tools is airbags in a car, he elaborates. Sensors track a crash, and the bags deploy.

Stroke sufferers mostly lose functionality in their arms and hands; it is complex to choose a glass or to know if sufficient pressure is being placed on the glass to keep it from falling. A sufferer might have lost functionality in the right hand, but has the proposed functionality in the left hand.

The idea behind the project is to begin with the good left hand doing an activity and then transferring data gathered by wearable mechatronic devices to the right hand. These tools involve a jacket to measure arm placement and a glove to measure wrist and finger placement and finger joint angles. Other measures, like grasping force and lifting force, also are gathered.

When a sufferer conducts an exercise, like lifting a water bottle, microcontrollers quantify the action and measure grip strength, with data reflected on a small computer-like tabletop device that enables a sufferer and clinicians to observe the force being applied to lift the bottle or do a different activity.

Wearing a proposed jacket embedded with sensors, a sufferer will utilize the good left hand to lift the bottle with the extreme force of lifting and grasping charted. If too much force is implemented, a ball on the tabletop tool will turn red. If medium correct force is implemented, the ball will turn yellow, and if correct force is implemented, the ball will turn green. The key task is to attempt to replicate those measures with the disabled right hand.

With repetition, doing the activities with the good left hand over time will enable the brain to transfer data from the left hand to the right hand so it can do the similar activity. Data gathered by smartphone also can be transmitted to a physician or physical therapist to detect growth and change therapy processes if essential. There are several separate modules for these exercises covering the hand, arm and fingers.

The emerging technology also has an economical advantage for physicians and therapists, Kapila claims. A clinician can do one rehabilitation treatment at a period in an office and bill once for the treatment. But if various sufferers are at home doing the rehabilitation and sending outcomes to a clinician through email or a text image, the clinician can bill for each of those home-deployed rehab sessions.

The project is presently being performed by students and faculty, but funds are being sought to shift the concept from the lab to a pilot project with rehabilitation clinics and sufferer in their homes, after which feedback will be gathered and any essential improvements will be made. The objective is to have fifty devices being piloted. Entire materials, involving smartphones, lithium batteries and sensors are off the shelf or open source products.

Just in the United States of America, the project has the possibility to serve 300,000 sufferers yearly, Kapila states, and once commercialized the expectation is to get 1 or 2% of that market in the 1^st year after getting regulatory approvals.

 

Why Claims Accuracy Testing, QA Is not proving Useful for Healthcare

Healthcare agencies require getting back to basics when it comes to establishing and implementing their claims accuracy testing and quality assurance programs.

Let’s confront it. Testing is not working.  That is the bitter truth about the healthcare organization and its track record on claims accuracy testing and quality assurance.

The difficult truth is that this problem is costly – with a cost tag of over $275 billion in the United States of America each year, in accordance to the Centers for Medicare and Medicaid Services – and with the latest ICD-10 medical coding and other industry alterations, waste and costly mistakes are potentially even harder.

To start to comprehend the underlying reasons of this multi-billion-dollar issue, we conducted meta-analysis of 78 QA and testing assessments conducted within the healthcare industry dating from the year 2009 through the year 2015.

These 78 distinctive assessments from both the payer and contributor sides covered each phase of life-cycle testing of commercial healthcare data and claims procedure applications and platforms, their changes and customizations, interfaces to other networks that are utilized along the monetary path connecting the healthcare contributors to insurance payers.

Testing issues that invest to or even enable this multi-billion-dollar quality assurance issues appear in every section of testing from functional via systems integration and onto pre-production testing of fixes/patches and updates, and involved the every kind of testing from “black box” to “glass box.”

The meta-analysis disclosed a 40% attempt waste in test activities, ranging from strategy to execution. This waste is attributed to”

1) Missing test coverage

3) Ambiguous and error-laden test scenarios, cases, and scripts

4) Duplication of test coverage and testing tasks

5) Test environment problems

6) Applying the incorrect approach to testing  

The 2014-2015 World Quality Report projected that by the year 2017, 29% of IT spends will be in the proposed testing.

Combine that with the very known 40% attempt waste during the time of testing, and it is possible to observe that approximately one-eighths of the entire healthcare IT spend will be lost on incomplete, insufficient, and error-prone testing/experiments.

 

BCBS of Arizona, McKesson Inaugurate ACO Partner — Four main highlights

In the collaboration and cooperation with Blue Cross Blue Shield of Arizona, McKesson is inaugurating ACO Partner, in accordance to HIT Consultant.

Here are 4 main highlights:

1. Through the ACO Partners, McKesson targets to increase the care management, population health services, physician engagement, and technology.


2. To make better the quality of care and decrease costs, ACO Partner has policies to contract with contributor groups and payers throughout the United States of America.


3. BCBS of Arizona is the 1^st insurance company to have a contract with ACO Partner, and facilitates as a main or primary investor in the ACO via the payer's subsidiary, Trinnovate Ventures.


4. Blue Cross Blue Shield of Arizona and McKesson contributed a lot to develop an infrastructure that will motivate the strategic collaboration between the contributors and physicians. The complex and infrastructure will also work to serve the continual patient engagement.

 

U.S. Healthcare: On the expensive verge

1.The United States spends 16.4 percent of its national GDP – or $2.75 trillion – per year on healthcare costs (as of 2013).

2.Healthcare takes a far greater share of national GDP in the United States than in any other OECD country – at least 50 percent more than in other comparable countries.

3.In Germany, healthcare consumed 11 percent of GDP in the year 2013. France spent 10.9 percent of GDP on it.

4.The 2 countries utilize a tightly regulated and largely non-profit system for health insurance to offer competitive coverage options.

5.The United Kingdom, with 64 million people under a unified and centralized single-payer payment and care system, spent 8.5 percent of GDP on healthcare.

6.Canada, with its single-payer national health insurance system and private care contributors, spent 10.2 percent.

7.The 2^nd most populous developed nation, Japan, spent 10.2 percent of its GDP on healthcare, through non-profit insurance and private hospitals.

8.For all of this money, the United States does not have better health results – rather on cancer treatment.

9.Relative to peer nations, U.S. life expectancy is lower, chronic diseases are more widespread, infant mortality is larger.

US Physicians Suffer More Burnout Than Other Workers

August 22, 2012 — Physicians in the United States suffer from more burnout than other workers in the United States, new research shows.

A national survey of more than 7000 US physicians reveals that close to one half report having at least 1 symptom of burnout.

"The fact that almost 1 in 2 US physicians has symptoms of burnout implies that the origins of this problem are rooted in the environment and care delivery system rather than in the personal characteristics of a few susceptible individuals.

"Policy makers and health care organizations must address the problem of physician burnout for the sake of physicians and their patients," the authors, led by Tait D. Shanafelt, MD, Mayo Clinic, Rochester, Minnesota, write.

The survey findings were published online August 20 in the Archives of Internal Medicine.

First National Study

Extensive data on physician burnout have been published, but to the investigators' knowledge, no national study has yet evaluated rates of burnout among US physicians or explored differences in burnout by specialty.

Burnout among US physicians has also not been previously compared with burnout among US workers in other fields. Dr. Shanafelt and colleagues therefore conducted a national study of burnout among physicians from all specialties using the American Medical Association Physician Masterfile.

Responses from 7288 physicians were compared with those of a sample of 3442 working adults from the general population.

As assessed by the Maslach Burnout Inventory, 37.9% of surveyed physicians exhibited high levels of emotional exhaustion, and 29.4% showed evidence of a high level of depersonalization. In addition, 12.4% had a low sense of personal accomplishment.

Taken together, investigators found that 45.8% of physicians were experiencing at least 1 symptom of burnout, based on a high emotional exhaustion score or a high depersonalization score. More than 6000 of the physicians surveyed were also compared with 3442 control participants who were working in the United States but not as physicians.

On burnout measures, physicians were more likely to have signs of emotional exhaustion compared with population control participants (32.1% vs 23.5%), depersonalization (19.4% vs 15%), and overall burnout (37.9% vs 27.8%; P < .001 for all comparisons).

Comparison of Employed MDs and Employed US Population

	Physicians(n = 6179)	Population Control Participants (n = 3442)
Emotional exhaustion: high score	32.1%	23.5% (P < .001)
Depersonalization: high score	19.4%	15% (P < .001)
Burned out	37.9%	27.8% (P < .001)
Satisfaction with work-life balance ("work schedule does not leave enough time for my personal or family life")	40.1%	23.1% (P < .001)

Burnout by Specialty

"Substantial" differences in burnout were also observed among different specialties.

Burnout rates were highest among physicians on the front line of care access, including family medicine, general internal medicine, and emergency medicine. It was lowest among pathologists, dermatologists, general pediatricians, and those practicing preventive medicine.

Differences between specialties were also documented with regard to satisfaction with work-life balance. Again, those practicing dermatology, general pediatrics, and preventive medicine had the highest rates for satisfaction with work-life balance, whereas those practicing general surgery, general surgery subspecialties, and obstetrics/gynecology had the lowest rates.

Dissatisfaction with work-life balance was also slightly higher among female physicians than among their male counterparts, whereas it was similar for men and women among control participants in the US population. Unlike fields outside of medicine, in which higher levels of education and professional degrees seem to reduce the risk for burnout, having a degree in medicine increased the risk, the investigators add.

On multivariate analysis, the number of hours worked per week was associated with a higher probability of burnout, whereas being older and being married were both significantly associated with a lower overall risk.

"Burnout can have serious personal repercussions for physicians," investigators observe. "When considered with the mounting evidence that physician burnout adversely affects quality of care, these findings suggest a highly prevalent and systemic problem threatening the foundation of the US medical care system."

Funding for the study was provided by the American Medical Association and by the Mayo Clinic Department of Medicine Program on Physician Well-Being. The authors have disclosed no relevant financial relationships.

Arch Intern Med. Published online August 20, 2012. Full article

Specialists Provide Nearly 40% of Primary Care Services

August 21, 2012 — Nearly 40% of primary care services are provided by specialists, according to a research letter published online August 20 in the Archives of Internal Medicine.

Investigators analyzed data from the 1999 and 2007 National Ambulatory Medical Care Surveys, which included 20,959 (n = 8730 from 1999 and n = 12,229 from 2007) primary care visits for adults requiring treatment either for common symptoms and diseases such as fever, nasal congestion, anemia, and asthma or for general preventive medical examinations.

The researchers, led by Minal S. Kale, MD, from the Division of General Internal Medicine, Mt. Sinai School of Medicine, New York City, found a disparity in the provision of primary care for common symptoms and ailments that remained stable during the 8-year period: only 60% of primary care was dispensed by primary care physicians (PCPs; 58.1% in 1999 and 57.2% in 2007; P = .79). The balance for these types of primary care visits was covered by internal medicine subspecialists (9.1% in 1999 and 9.6% in 2007; P = .82), obstetrician-gynecologists (3.4% in 1999 and 2.8% in 2007; P = .36), and other subspecialists (29.4% in 1999 and 30.4% in 2007; P = .73).

The proportion of general preventive exams performed by PCPs and internal medicine subspecialists increased slightly, but neither change was statistically significant (66.3% in 1999 and 71.2% in 2007 [P = .44] and 7.1% in 1999 and 11.9% in 2007 [P = .22], respectively).Commensurate decreases were observed among obstetrician-gynecologists and other specialist physicians (16.1% in 1999 and 10.0% in 2007 [P = .13] and 10.5% in 1999 and 6.8% in 2007 [P = .39], respectively), which were also not significant.

Rebalance Requires Education

"This study highlights the fact that the US healthcare system is out of balance. If you look at research into the quality and cost of other industrialized nations, you see that their systems are based on primary care. In the United States, our physician workforce is approximately 70% subspecialists and 30% primary care physicians. We must work to rectify this and rebalance our system on primary care," Douglas Henley, MD, executive vice president and chief executive officer, American Academy of Family Physicians, told Medscape Medical News.

"Good-quality healthcare stems from that comprehensive approach and ensuring smooth transitions from one health setting to another, which are 2 of the hallmarks of primary care," Dr. Henley added, noting that primary care physicians are the "front door" for the healthcare system, providing diagnoses and treatment for routine and complex/chronic illnesses and coordinating other healthcare team members.

According to the study authors, explanations for the large proportion of specialist visits may include patients' belief that specialists provide superior care for all ailments, as well as the well-documented shortage of PCPs in the United States.

Dr. Henley concurred: "It's possible that people who seek primary care from subspecialists don't understand that subspecialty physicians have a more focused practice and work with particular disease processes, rather than on comprehensive primary care," he said.

"Therefore, they don't provide whole-person care that prevents illness or complications from a chronic condition the subspecialist might be treating. This is at the core of why our healthcare system is fragmented, why we see so much duplication of tests and procedures, unnecessary hospitalizations and re-hospitalizations, and why we have lower-quality outcomes," he concluded.

According to Dr. Henley, implementation of the Affordable Care Act will help the educational and economic environment for primary care physicians, build the primary care physician workforce, and enable Americans to have access to the patient-centered medical home.

To this end, Dr. Henley explains, the act includes provisions for programs such as the National Health Service Corps, which provides financial aid for medical students choosing to practice primary care; implementation of the Primary Care Incentive Program, in which Medicare pays a 10% incentive for primary care services provided by a primary care physician; and the Comprehensive Primary Care Incentive, a patient-centered medical home demonstration in which Medicare, Medicaid, and private insurers pay a per patient, per month coordination fee.

"The Affordable Care Act is moving to reform our health delivery system so that the nation has a strong primary care physician workforce and so that patients understand the invaluable role of the primary care physician in providing comprehensive, coordinated care," Dr. Henley said.

The study was not commercially supported. One author has received compensation as a board member for FAIR Health Inc Scientific and has received grants from Medtronic Inc and Pew Charitable Trusts, the National Institute on Aging, the American Federation of Aging Research through the Paul B Beeson Career Development Award Program, and the Centers for Medicare and Medicaid Services. The lead author is supported by the Mount Sinai Primary Care Research Fellowship, funded by the Health Resources and Services Administration through the Ruth K. Kirchstein National Research Service Award. Dr. Henley has disclosed no relevant financial relationships.

Arch Intern Med. Published online August 20, 2012. Abstract

US Gets Less for Its Healthcare Buck Than Other Nations

August 11, 2011 — Despite outspending 18 other developed nations on healthcare as a percentage of gross domestic product (GDP) in 2005, the United States posted the highest mortality rate among its peers, according to a study published online last month in the Journal of the Royal Society of Medicine Short Reports.

Although the United States reduced its mortality rate from 1979 to 2005, 15 of the other developed countries, including the United Kingdom, did the same thing at a faster clip.

In short, the American healthcare system is one of the least cost-effective, whereas the system in the United Kingdom is the second most cost-effective, doing more with less, write Colin Pritchard, PhD, a professor of psychiatric social work at Bournemouth University in Bournemouth, United Kingdom; and Mark Wallace, BSc, who teaches economics, politics, and philosophy at the Latymer School in London.

Pritchard and Wallace paid particular attention to the United Kingdom's performance because they conducted their study in response to frequent references to the "apparent failings" of the National Health Service during the ongoing healthcare reform debate in the United States.

The other countries in the study are Austria, Australia, Canada, Finland, France, Germany, Greece, Ireland, Italy, Japan, the Netherlands, New Zealand, Norway, Portugal, Spain, Sweden, and Switzerland.

In 1980, public and private healthcare expenditures in the United States as a percent of GDP amounted to 8.8%, ranking it second behind Sweden at 9%. By 2005, the United States had vaulted to first place with 15.3%, Switzerland placing a distant second at 11.6%. The United States also ranked number 1 in average GDP healthcare expenditures — 12.2% — during the entire 25-year time frame.

The authors extrapolated mortality rates per million (PM) from data compiled by the World Health Organization for 2 time frames — 1979 to 1981, and 2003 to 2005 — with separate rates for individuals aged 15 to 74 years, 15 to 34 years, 35 to 54 years, and 55 to 74 years.

The mortality rate in the United States for the comprehensive 15- to 74-year-old age group decreased from 9158 deaths PM to 6660 PM, or by 27% during the roughly quarter-century span, but the nation nevertheless posted the highest mortality rate in 2005 among the 19 developed nations. All but Portugal, Spain, and Switzerland saw their mortality rate decrease at a slower pace. The United Kingdom had the fifth highest mortality rate — 5471 PM.

Likewise, the United States topped the mortality-rate list for the 55- to 74-year-old age groups, whereas the United Kingdom came in at number 6.

Too Many Guns in the United States?

The authors calculated a cost-effectiveness ratio for each country by dividing the level of reduced mortality rates — in the case of the United States, 9158 PM minus 6660 PM or 2498 PM — by average GDP healthcare spending from 1980 to 2005. According to this measure, the United States ranked third from the bottom for the 15- to 74-year-old age group with a ratio of 1:205 vs 1:557 for the United Kingdom, which ranked second behind Ireland. The same pecking order for the 3 countries held true in the 55- to 74-year-old age group.

Several characteristics of the United States might help explain the country's high mortality rate among the 19 nations, according to Pritchard and Wallace. They point to the country's "considerable variation" on a range of socioeconomic and health factors, especially regarding ethnic groups. In addition, the availability of firearms here "impacts upon mortality rates such as homicide and suicide, far more than any other Western country."

The authors attempt to answer the question of why the United States performs so poorly on healthcare cost-effectiveness when the market forces of a largely private healthcare system are assumed to foster efficiency. The US system, Pritchard and Wallace write, has "inherent market failures" such as adverse selection, in which individuals with greater health risks are more likely to obtain coverage from private insurers than individuals with lesser risks, driving premiums upward and discouraging the "better bets" from getting coverage in the first place. Another market failure stems from private insurers charging everyone higher premiums to hedge against "a few individuals that require unexpectedly very expensive medical treatment."

Nations with mostly public healthcare systems, such as the United Kingdom, avoid these pitfalls, according to the authors.

The study authors have disclosed no relevant financial relationships.

J R Soc Med Sh Rep. 2011;2:60. Full text

FDA Plans to Extend Its Global Regulatory Reach

June 20, 2011 — The US Food and Drug Administration (FDA) plans to take a more global approach to ensure the safety and quality of regulated drugs and medical devices, the agency's commissioner announced during a media briefing today.

One prong of the new 4-pronged approach will involve partnering with counterparts worldwide and creating global coalitions of regulators intent on ensuring and improving global product safety and quality, said FDA Commissioner Margaret Hamburg, MD.

"This is a long-term strategy," Dr. Hamburg said. "It cannot be accomplished immediately and will probably take many years to implement, depending upon resources."

One part of the new approach will mean regulators no longer regard borders the same way. "The border can no longer be the nation's primary line of defense against unsafe imported products," she said. "Instead, the border must serve as a final checkpoint on preventive controls throughout the supply chain."

An FDA report, Pathway to Global Product Safety and Quality, describes the new strategy. Most notably, it calls for the agency to change how it conducts business and to take a more global approach to promote and protect the health of US consumers. Highlights of the report include 3 other prongs of the 4-pronged approach:

• The coalitions of regulators will develop international data information systems and networks and increase the regular and proactive sharing of data and regulatory resources across world markets.


• The FDA will build in more information gathering and analysis, with an increased focus on risk analytics and information technology.


• The FDA increasingly will leverage the efforts of public and private third parties and industry and allocate FDA resources based on risk.

Such coalition-type models do not exist in the world of FDA-regulated products, said John Taylor, JD, acting principal deputy commissioner of the FDA, and the FDA does not already have a coalition in place. However, many peer regulators have expressed interest in working more closely together to ensure the safety and integrity of products moving through the global supply chain.

Current Regulatory Authority Outdated

When asked whether the FDA would need new authority from Congress to proceed with the project, Taylor said the agency would move ahead with the strategy regardless of whether it needs new authority to do so. He also noted that the agency's authority relating to medical products is outdated. In 1938, the authority given to the FDA largely grew out of a world where manufacturers of regulated products were based in the United States.

"We've been a domestic agency that works in an international world," he said. "What we need to do is transform ourselves into a global agency that is able to work all around the world and address product issues that arise all over the world."

Taking a more global approach will enable the FDA to better monitor companies in far-flung areas that might otherwise escape regulatory scrutiny as more FDA-regulated products are produced overseas.

Global production of FDA-regulated goods has exploded over the past 10 years, according to Dr. Hamburg. Manufacturers increasingly use imported materials and ingredients in their US production facilities, "making the distinction between domestic and imported products outdated, to say the least," she said.

Products regulated by FDA, Dr. Hamburg said, reflect the globalization of today's economy:

• 10% of all imports into the United States consist of products FDA regulates,


• 80% of active pharmaceutical ingredients in the drugs Americans use come from overseas,


• 40% of drugs themselves are imports, and


• about half of all medical devices used in this country are imported.

Yet the FDA does not have the resources to keep pace with demands created by globalization, according to the report issued today that describes the FDA's new plan. In 2008, the Government Accountability Office recommended that the FDA increase inspections of foreign drug companies, but at current rates, it would take 9 years for the agency to inspect every high-priority pharmaceutical facility just once.

The new strategy would build on changes already made by the FDA. Between 2007 and 2009, the FDA increased the number of foreign drug manufacturing inspections by 27% and opened international offices in several key locations around the world.

The FDA has also collaborated with counterparts in the European Union and Australia on drug inspections, and it has joined an organization of drug manufacturing inspectorates from 39 countries. The FDA and other global leaders are also creating an expanded global regulators forum for medical devices.

More information on the new strategy is available on the FDA Web site.

Primary Care Physicians Boost Income in 2010, Survey Finds

June 15, 2011 — Primary care physicians saw modest increases in their 2010 compensation, while some of their better-paid specialist colleagues lost ground, according to a new survey of almost 60,000 physicians around the United States from the Medical Group Management Association (MGMA).

In the Physician Compensation and Production Survey: 2011 Report Based on 2010 Data, internists were found to have earned a median of $205,379, which is an increase of 4.21% since 2009. Family physicians (without obstetrics) saw their median incomes rise by 2.94% to $189,402, and pediatricians had a compensation increase of 0.39% to $192,148, which did not keep up with the low inflation rate.

Six specialties — anesthesiologists, gastroenterologists, obstetricians/gynecologists, ophthalmologists, diagnostic radiologists, and urologists — have had modest declines in income since 2009. The largest decrease was a drop of 4.66% for urologists, who earned a median of $372,455, the survey found.

Psychiatrists, dermatologists, neurologists, general surgeons, and emergency medicine physicians were among the specialists who reported an increase in median compensation since 2009. The largest percentage increase of 5.65% was for emergency medicine physicians, who earned a median of $277,297.

Orthopaedic surgeons were the top earners in the survey, at a median compensation of $514,659 (up 3.71%), followed by invasive cardiologists ($500,993), diagnostic radiologists ($471,254), gastroenterologists ($463,995), and dermatologists ($430,874).

Physicians practicing in the South reported the highest median earnings, at $216,170 in primary care and $404,000 in specialty care. They were followed by physicians in the Midwest and West. Physicians in the East earned the least, at $194,409 in primary care and $305,575 in specialty care.

"A number of factors may attribute to regional differences in physician compensation," Jeffrey B. Milburn, MBA, CMPE, from the MGMA Health Care Consulting Group, said in a news release. "The supply and demand for primary care or specialty physicians may influence compensation. A high level of competition between groups or specific specialties may provide an opportunity for payers to reduce reimbursement. In states where payers have little competition, reimbursement and subsequent physician compensation may be lower.

"Location desirability is another factor influencing competition and compensation," Milburn noted. "Some areas have a much higher ratio of physicians to population, and one might think this would lead to increased competition and lower compensation. But the usual laws of supply and demand aren't always at work in health care."

MGMA, based in Englewood, Colorado, is an association for professional administrators and leaders of medical group practices. It serves 22,500 members who lead 13,600 organizations nationwide in which some 280,000 physicians provide more than 40% of the healthcare services delivered in the United States, the group says. MGMA notes that its surveys depend on voluntary participation and may not be representative of the industry.

How to Obtain a Medicaid Provider Number

The U.S. Department of Health and Human Services issues Medicaid provider numbers through state health and human services agencies. For instance, if you are a physician in Florida, you must apply for a Florida Medicaid provider number through the Florida Agency for Health Care Administration. Provider numbers represent unique forms of identification. You do not need a number if you will not provide health-related services to Medicaid recipients.

Instructions:

1.       Determine if you are eligible to receive a provider number. For instance, if you are a dentist licensed in New Zealand, you first must obtain authorization to provide dental care in the United States. If you recently have graduated from medical school in the U.S., you need a medical license before you can treat anyone, including Medicaid recipients.

2.      Contact the appropriate health and human services agency and obtain an official application, which usually is available for free through the agency's website. For instance, New York's Department of Health maintains a comprehensive Medicaid provider manual.

3.      Gather such relevant information as your tax identification number, usually your social security number or federal employer identifier number. You must disclose a physical address and phone number to identify your business. If you distribute medical equipment, you need to identify your company's legal name that is registered with your state's secretary of state.

4.      Complete a fingerprint card so that your criminal history can be reviewed, if requested. Some states exempt non-profit or government organizations, such as nursing homes or hospitals, from fingerprint requirements.

5.      Select a reimbursement method. You will not receive money immediately after rendering services, such as through a patient's co-pay. You can either receive payment electronically or file an exception request. To qualify for electronic fund transfers, you must provide your bank account number and routing information.

Tips & Warnings:

• Provider applications often request information about past disciplinary actions. For instance, you must disclose if you were sued for medical malpractice in another state or previously were excluded from receiving a provider number.

 

• Be wary of scam artists who charge high fees to submit provider applications. Procedures throughout the U.S. are simplified so that anyone easily can file a complete application.

Workers of Healthcare responsible for Patients’ Health Literacy

April 21, 2011 — Responsibility for recognizing and addressing the problem of limited health literacy lies with all healthcare professionals, according to a Committee Opinion of the American College of Obstetricians and Gynecologists (ACOG) published in the May issue of Obstetrics & Gynecology. Two related Committee Opinions in the same issue discuss the impact of communications skills and strategies and cultural sensitivity issues on patient-physician communication.

"The problem of health illiteracy is widespread and goes beyond those who can’t read or those who don't speak English," said Patrice M. Weiss, MD, chair of the ACOG Committee on Patient Safety and Quality Improvement, in a news release. "Physicians, nurses, social workers — everyone in the health care field — must make sure that our patients fully understand their health condition and their treatment, as well as the importance of taking their medications exactly as directed. We simply can't assume that a patient understands because she nods her head or because we think she seems educated."

The Institute of Medicine of the National Academies defines health literacy as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Health literacy is limited in nearly half of all people in the United States, resulting in a higher risk for hospitalization, more barriers to getting necessary healthcare, and poor comprehension of medical advice causing morbidity and even mortality.

As part of its commitment to promoting health literacy for all patients, ACOG supports the following recommendations, which were adapted from the US Department of Health and Human Services' Office of Disease Prevention and Health Promotion's Quick Guide to Health Literacy:

• Tailor speaking and listening skills to individual patients. Use open-ended questions starting with the words "what" or "how," and use medically trained interpreters when needed. Especially during the informed-consent process, but also in general, check patients' comprehension by having them restate the health information given in their own words. Encourage staff and colleagues to use culturally sensitive plain language to obtain training in improving patient communication.


• Tailor health information to the intended user by ensuring that it reflects the target group's age, social and cultural diversity, language, and literacy skills. Include the target group in the development (pretest) and implementation (posttest) phases of developing information and services to improve effectiveness of the program. Consider cultural factors, including race, ethnicity, language, nationality, religion, age, sex, sexual orientation, income level, and occupation when preparing health information.


• Develop written materials conveying no more than 4 simple messages per handout. These materials should focus on action and give specific recommendations based on behavior rather than on the underlying medical principle. Use the active voice instead of the passive voice, use familiar language, and avoid jargon. Use culturally relevant visual aids such as drawings or models for key points, use 12-point type size or larger, and leave sufficient white space around margins and between sections.

"Many patients are called 'noncompliant' because they haven't followed their doctor's recommendations, but this may be because they don't understand what is expected of them," Dr. Weiss said. "As physicians, we need to use less complex language with our patients when explaining their health conditions, surgeries, and taking medications. Asking our patients to repeat back to us what they understand is enormously helpful in making sure they really do comprehend."

Obstet Gynecol. 2011;117:1250-1253. Extract

22 Reasons to go Vegetarian‏

Vegetarian food is easy to digest
 Consider making this healthy choice as one of your new year's resolutions. ..
Stacks of studies confirm that a diet full of fresh fruits and vegetables and grains is your best bet for living a longer, healthier and more enjoyable life. There are literally hundreds of great reasons to switch to a plant-based diet; here are 22 of the best:

1 You'll live a lot longer.

Vegetarians live about seven years longer, and vegans (who eat no animal products) about 15 years longer than meat eaters, according to a study from Loma Linda University. These findings are backed up by the China Health Project (the largest population study on diet and health to date), which found that Chinese people who eat the least amount of fat and animal products have the lowest risks of cancer, heart attack and other chronic degenerative diseases.

2 You'll save your heart.

Cardiovascular disease is still the number one killer in the United States, and the standard American diet (SAD) that's laden with saturated fat and cholesterol from meat and dairy is largely to blame. Plus, produce contains no saturated fat or cholesterol. Incidentally, cholesterol levels for vegetarians are 14 percent lower than meat eaters.

3 You can put more money in your mutual fund.

Replacing meat, chicken and fish with vegetables and fruits is estimated to cut food bills.

4 You'll reduce your risk of cancer.

Studies done at the German Cancer Research Center in Heidelberg suggest that this is because vegetarians' immune systems are more effective in killing off tumour cells than meat eaters'. Studies have also found a plantbased diet helps protect against prostate, colon and skin cancers.

5 You'll add color to your plate.

Meat, chicken and fish tend to come in boring shades of brown and beige, but fruits and vegetables come in all colours of the rainbow. Diseasefighting phytochemicals are responsible for giving produce their rich, varied hues. So cooking by colour is a good way to ensure you re eating a variety of naturally occurring substances that boost immunity and prevent a range of illnesses.

6 You'll fit into your old jeans.

On average, vegetarians are slimmer than meat eaters, and when we diet, we keep the weight off up to seven years longer. That's because diets that are higher in vegetable proteins are much lower in fat and calories than the SAD. Vegetarians are also less likely to fall victim to weight-related disorders like heart disease, stroke and diabetes.

7 You'll give your body a spring cleaning.

Giving up meat helps purge the body of toxins (pesticides, environmental pollutants, preservatives) that overload our systems and cause illness. When people begin formal detoxification programs, their first step is to replace meats and dairy products with fruits and vegetables and juices.

8 You'll make a strong political statement.

It's a wonderful thing to be able to finish a delicious meal, knowing that no beings have suffered to make it..

9 Your meals will taste delicious.

Vegetables are endlessly interesting to cook and a joy to eat. It's an ever-changing parade of flavours and colors and textures and tastes.

10 You'll help reduce waste and air pollution.

Livestock farms creates phenomenal amounts of waste. The tons of manure, a substance that's rated by the Environmental Protection Agency (EPA) as a top pollutants. And that's not even counting the methane gas released by goats, pigs and poultry (which contributes to the greenhouse effect); the ammonia gases from urine; poison gases that emanate from manure lagoons; toxic chemicals from pesticides; and exhaust from farm equipment used to raise feed for animals.

11 Your bones will last longer.

The average bone loss for a vegetarian woman at age 65 is 18 percent; for non-vegetarian women, it's double that. Researchers attribute this to the consumption of excess protein. Excess protein interferes with the absorption and retention of calcium and actually prompts the body to excrete calcium, laying the ground for the brittle bone disease osteoporosis. Animal proteins, including milk, make the blood acidic, and to balance that condition, the body pulls calcium from bones. So rather than rely on milk for calcium, vegetarians turn to dark green leafy vegetables, such as broccoli and legumes, which, calorie for calorie, are superior sources.

12 You'll help reduce famine.

It takes 15 pounds of feed to get one pound of meat. But if the grain were given directly to people, there'd be enough food to feed the entire planet. In addition, using land for animal agriculture is inefficient in terms of maximizing food production. According to the journal Soil and Water, one acre of land could produce 50,000 pounds of tomatoes, 40,000 pounds of potatoes, 30,000 pounds of carrots or just 250 pounds of beef.

13 You'll avoid toxic chemicals.

The EPA estimates that nearly 95 per cent of pesticide residue in our diet comes from meat, fish and dairy products. Fish, in particular, contain carcinogens (PCBs, DDT) and heavy metals (mercury, arsenic; lead, cadmium) that cannot be removed through cooking or freezing. Meat and dairy products are also laced with steroids and hormones.

14 You'll protect yourself from foodborne illnesses.

According to the Center for Science in the Public Interest in the US, which has stringent food standards, 25 per cent of all chicken sold in the United States carries salmonella bacteria and, the CDC estimates, 70 percent to 90 percent of chickens contain the bacteria campy-lobacter (some strains of which are antibiotic-resistan t), approximately 5 percent of cows carry the lethal strain of E. coli O157:H7 (which causes virulent diseases and death), and 30 percent of pigs slaughtered each year for food are infected with toxoplasmosis (caused by parasites).

15 You may get rid of your back problems.

Back pain appears to begin, not in the back, but in the arteries. The degeneration of discs, for instance, which leads to nerves being pinched, starts with the arteries leading to the back. Eating a plant-based diet keeps these arteries clear of cholesterol- causing blockages to help maintain a healthy back.

16 You'll be more 'regular.'

Eating a lot of vegetables necessarily means consuming fiber, which pushes waste out of the body. Meat contains no fibre. Studies done at Harvard and Brigham Women's Hospital found that people who ate a high-fiber diet had a 42 percent lower risk of diverticulitis. People who eat lower on the food chain also tend to have fewer incidences of constipation, hemorrhoids and spastic colon.

17 You'll cool those hot flashes.

Plants, grains and legumes contain phytoestrogens that are believed to balance fluctuating hormones, so vegetarian women tend to go through menopause with fewer complaints of sleep problems, hot flashes, fatigue, mood swings, weight gain, depression and a diminished sex drive.

18 You'll help to bring down the national debt.

We spend large amounts annually to treat the heart disease, cancer, obesity, and food poisoning that are byproducts of a diet heavy on animal products.

19 You'll preserve our fish population.

Because of our voracious appetite for fish, 39 per cent of the oceans' fish species are overharvested, and the Food & Agriculture Organization reports that 11 of 15 of the world's major fishing grounds have become depleted.

20 You'll help protect the purity of water.

It takes 2,500 gallons of water to produce one pound of mutton, but just 25 gallons of water to produce a pound of wheat. Not only is this wasteful, but it contributes to rampant water pollution.

21 You'll provide a great role model for your kids.

If you set a good example and feed your children good food, chances are they'll live a longer and healthier life. You're also providing a market for vegetarian products and making it more likely that they'll be available for the children.

22 Going vegetarian is easy!

Vegetarian cooking has never been so simple. We live in a country that has been vegetarian by default. Our traditional dishes are loaded with the goodness of vegetarian food. Switching over it very simple indeed.

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Obama Dedicates $88M More for Health IT

As part of the new Recovery Act funding, President Obama pushes health information technology systems for community health care centers.President Obama is seeding the health care industry with another $88 million in funding for health care centers to adopt new health information technology systems to manage their administrative and financial matters and transfer old paper files to electronic medical records. The initiative is part of $600 million in stimulus money that will go toward improving community health centers across the country.

"These investments won't just increase efficiency and lower costs, they'll improve the quality of care as well –- preventing countless medical errors, and allowing providers to spend less time with paperwork and more time with patients," Obama said Dec. 9.

The new Recovery Act funds are the latest in a series of grants awarded to community health centers, which deliver preventive and primary care services at more than 7,500 service delivery sites around the country to patients regardless of their ability to pay. Health centers serve more than 17 million patients, about 40 percent of whom have no health insurance.

Both programs will be administered by the HRSA (Health Resources and Services Administration), an agency of the HHS (U.S. Department of Health and Human Services).

Obama also directed the HHS to implement a demonstration program designed to evaluate the impact of the advanced primary care practice model on access, quality and cost of care provided to Medicare beneficiaries served by community health centers.

This model, known as the "medical home," promotes accessible, continuous and coordinated family-centered care. Developed and administered by the CMS (Centers for Medicare and Medicaid Services), the demonstration will last three years. CMS anticipates that up to 500 health centers will participate.

According to a Dec. 8 PricewaterhouseCoopers report, the market for personalized medicine in the United States is already $232 billion, and it is projected to grow 11 percent annually.The personalized medical care portion of the market -- including telemedicine, health information technology and disease management services offered by traditional health and technology companies -- is estimated at $4 billion to $12 billion and could grow tenfold to more than $100 billion by 2015 if telemedicine takes off.

"These three initiatives –- funding for construction, technology and a medical home demonstration –- they won't just save money over the long term and create more jobs, they're also going to give more people the peace of mind of knowing that health care will be there for them and their families when they need it," Obama said. "And ultimately, that's what health insurance reform is really about."