Monthly Archives: April 2016

The Doctor to Be In

Thousands of physicians leave clinical practice each year — often because of burnout, family responsibilities, or more lucrative employment opportunities in other areas, but the American Medical Association wants to help them find their way back.

When doctors decide to resume the doctor-patient relationship, they face a number of barriers.

The biggest obstacles are the high cost of recertification and the lack of readily available information on procedures to do so, which vary by state and specialty.

But the AMA has a plan that it thinks can help these second-timers.

As a first step, it released a report calling for policy changes to make the reentry process more transparent and less costly.

Primarily, the physician group wants to see more uniformity in requirements for relicensing and recertification.

“National re-entry policy guidelines must be developed that are consistent and evidence-based,” the AMA urged. “They should specify the length of time away from practice that necessitates participation in a re-entry process and how much clinical care constitutes active practice.”

The group also recommended that physicians in reentry programs be allowed to treat patients under supervision.

Basing policies regarding physician re-entry on clear evidence is another necessary element, the AMA said.

Among the 16 specific recommendations by the AMA were calls for research on “the relationship between time away from practice and maintenance of clinical knowledge,” and on possible “alternative licensure tracks” with a limited scope of practice for returning clinicians.

The AMA said it worked with the American Academy of Pediatrics and the Federation of State Medical Boards — a trade group that represents the medical licensing boards in each state — in developing the recommendations, which it describes as important to insure a future physician work force.

“Demographic changes in the population (and in medicine itself), as well as the passage of health system reform, have led to increased awareness of the need for more physicians in certain disciplines and regions. Easing the re-entry process can help address this concern,” the AMA report said.

The AMA estimates that some 10,000 physicians could resume clinical practice annually if the way back were eased.

Talking as Recovery Health

images-3U.S. Rep. Gabrielle Giffords is walking with assistance, mouthing the words to songs, and speaking simple sentences as she recovers after being shot through the head at a public event on Jan. 8, according to reports from friends, family, and the congresswoman’s staff.

Although doctors have not provided an update on Giffords’ condition since she began full-time rehabilitation on Jan. 26 at The Institute for Rehabilitation and Research (TIRR) Memorial Hermann in Houston, a report in the New York Times noted that she has lip-synched words to several songs and is walking the halls with assistance.

A spokesman from the congresswoman’s office confirmed the information from the Times report for MedPage Today.

Experts contacted by ABC News and MedPage Today said reports of her progress are about what would be expected for someone with a good recovery pattern.

“Her overall recovery seems good but perhaps not overly surprising for someone who regained consciousness so quickly after her injury,” according to Dr. Shari Wade, of the division of physical medicine and rehabilitation at Cincinnati Children’s Hospital Medical Center.

Giffords was reportedly able to respond to requests immediately after the shooting and shortly before undergoing surgery at University Medical Center in Tucson, Ariz., where she was treated before moving to Houston for rehabilitation.

“Duration of unconsciousness is the single best predictor of recovery,” Wade explained in an e-mail, “and someone who is unconscious for a few hours or a few days will recover much more rapidly and more completely than someone who is unconscious for a month or more.”

According to Dr. Gregory O’Shanick, chair of the board of directors of the Brain Injury Association of America, “her recovery curve is somewhat rapid but is what we expect to see when someone has the benefit of a comprehensive inpatient rehab program immediately after their brain injury and receives therapies from an experienced team in an aggressive program.”

Singing during rehabilitation is often used as a way to stimulate language functions, which are largely located in the left hemisphere. The ability to sing is largely located in the right hemisphere. Giffords was shot through the left side of the brain, leaving the right side untouched.

Strikes Down Health Reform Law

A federal judge ruled Monday that the new U.S. health-care reform law is unconstitutional, saying the federal government has no authority to require citizens to buy health insurance.

That provision is a cornerstone of the new legislation, signed into law in March by President Barack Obama.

The judge’s decision was not unexpected, and both supports and opponents of the legislation anticipate the validity of the new health law ultimately will be decided by the U.S. Supreme Court.

The ruling was handed down by U.S. District Judge Henry E. Hudson, a Republican appointed by President George W. Bush who had seemed sympathetic to the state of Virginia’s case when oral arguments were heard in October, the Associated Press reported.

Last week, White House officials said a negative ruling would not affect the implementation of the law because its major provisions don’t take effect until 2014, the AP reported.

Virginia Attorney General Kenneth Cuccinelli, a Republican, had filed a lawsuit in defense of a new Virginia law barring the federal government from requiring state residents to buy health insurance. He argued that it is unconstitutional for the federal law to force citizens to buy health insurance and to assess a penalty if they don’t.

The U.S. Justice Department said the insurance mandate falls within the scope of the federal government’s authority under the Commerce Clause. But Cuccinelli said deciding not to buy insurance is an economic matter outside the government’s domain.

By 2019, the law will expand health insurance access to 94 percent of non-elderly Americans. Advocates say that between now and then, it will also provide Americans with many new rights and protections.

Key provisions include:

  • Health plans may no longer deny coverage to people based on pre-existing health conditions.
  • Health plans that cover dependents must permit children to stay on a parent’s family policy until age 26.
  • Insurers may no longer place lifetime dollar limits on essential benefits.
  • New health plans must offer preventive services such as mammograms and colon cancer screenings without charging a deductible, co-payment or coinsurance. (This provision does not apply to existing plans that are “grandfathered.”)

List for Better Primary Care

Cutting back on unnecessary antibiotics, delaying wasteful imaging for lower back pain and foregoing annual ECG screenings for healthy, low-risk patients are among the actions that could help streamline primary care, experts say.

Perhaps taking a page from David Letterman’s Top 10 list, the authors of a new report came up with a “Top 5” list of action items for each of the primary care disciplines — family medicine, internal medicine and pediatrics — to help save money and conserve health resources.

Many physicians are already behind the suggestions, according to the report, which appears online May 23 in the Archives of Internal Medicine.

“I have seen many instances where I thought clinicians were not making the right and wisest decisions in ways that were not good for patients’ health and not good for prudent use of finite resources,” said Dr. Stephen Smith, one of the report’s authors and professor emeritus of family medicine at the Warren Alpert School of Medicine at Brown University in Providence, RI.

Smith is also a member of the National Physicians’ Alliance (NPA), a group of 22,000 doctors promoting affordable and quality healthcare, which put together the lists.

None of the suggestions are particularly new, having been validated by scores of studies, yet few clinicians seem to be implementing them, Smith said.

Here are the Top Five recommendations for each discipline:

For family medicine:

  • Avoid imaging for lower back pain for six weeks unless red flags are present.
  • Cut back on prescribing antibiotics for sinus infections, since most are viral.
  • Avoid cardiac screening in patients who are low risk and have no symptoms.
  • Do not do Pap tests for cervical cancer in women under 21 or those who have had a hysterectomy for benign disease.
  • Confine bone density scans known as dual-energy X-ray absorptiometry (DEXA) for osteoporosis to women aged 65 and over and for men 70 and older who also have risk factors, such as those who have already had fractures.

Medical Identity Theft

What is medical identity theft? In this serious and growing problem, someone else uses your personal information to obtain medical goods or services. Medical identity theft affects consumers, health care providers, and insurance organization. According to the Federal Trade Commission (FTC), medical identity theft accounts for about 3 percent of all identity theft, and the World Privacy Forum claims it’s the most difficult form of identity theft to correct.

When you are the victim of medical identity theft, incorrect information about diagnoses and treatments may appear on your medical records, potentially affecting your health care providers’ decisions about your care and treatment. Also, in addition to paying for treatment you didn’t receive, in some cases you might be denied treatment or coverage because of fraudulent medical or insurance information.

But there is some good news: HIPAA (the Health Insurance Portability and Accountability Act) regulations and the Identity Theft Protection Act, already in place, give you many of the tools you need to get errors corrected at your doctor’s office and with your insurance provider. Of course, like any crime, you’re better off preventing it from happening in the first place.

Spotting Medical Identity Theft

Among other signs, the FTC states that you may be a target of a potential medical identity theft or fraud if you are charged for medical services you didn’t receive. Keep a calendar to track your appointments, treatment dates, and any hospital admission and discharge dates. If the explanation of benefits from your insurance provider or Medicare isn’t exactly right, clear up the error as soon as possible.

Medical receipts, prescription drug information, health insurance forms, and any documents bearing your health care providers’ names might be all a clever thief needs to begin off-loading other medical claims to you. If you don’t need to keep medical documents, shred or burn them, and peel off labels from your prescription medications before recycling the containers.

Legal Protection to Combat Medical Identity Theft

The Identity Theft Protection Act of 2005 requires any commercial, charitable, educational, or non-profit organization that acquires or uses sensitive personal data to provide significant administrative, technical, and physical safeguards to prevent that data from being mishandled.

The same act that allows consumers to place a freeze on their credit reports also requires any covered entity to investigate suspected misappropriation of personal medical data and to do everything possible to correct resulting inaccurate medical information and billing problems.