The need is expected to grow locally and nationwide. Studies released last month predict a significant shortage of doctors across the country over the next 15 years. At the same time, Virginia has a more difficult time retaining new doctors than many other states, with only about a third of graduates from the state's medical schools choosing to stay in the commonwealth, according to a study from the state's Healthcare Workforce Data Center. That ranks Virginia 30th out of 45 states in the percentage of physicians remaining in state after medical school" (Trent, 10/25). 

The Wall Street Journal: "New Jersey health officials may let specialized nurses sedate patients in hospitals without a doctor present, an idea that has angered many physicians statewide. Current rules require nurse anesthetists to work under direct supervision of an anesthesiologist. Now the state health department is proposing to let the nurses work unassisted, provided there's a plan to reach a doctor if necessary. Professional medical associations argue that nurse anesthetists - who are registered nurses with graduate degrees - don't have enough training to know how to handle every emergency when a patient is sedated. Amending the state rules, they say, would invite complications and put patients at risk. ... About 30 states let nurses with specialized training in anesthetics work without physician supervision and 17 have some supervision requirement, either in hospital, nursing or medical licensing laws or regulations, said Christopher Bettin, spokesman for the American Association of Nurse Anesthetists" (Sataline, 10/23). 

MSNBC reports on the rise of urgent care clinics amid increasing demand on primary care physicians and emergency rooms. MSNBC describes urgent care as "the health care equivalent fast food" and examines quality issues around the care (Costello, 10/24).

Crain's Detroit Business: "Detroit Medical Center has formed its first ever physician-hospital organization and has applied for the physician group incentive program with Blue Cross Blue Shield of Michigan. More than 500 doctors, including private physicians on the DMC medical staff and about 75 physicians employed by DMC, paid a $250 annual fee to join the new DMC PHO, said Steven Grant, M.D., its executive director and DMC's executive vice president of physician partnerships. ... The DMC PHO, which is a joint venture between DMC and participating physicians, is designed to engage in business ventures and quality improvement efforts" (Greene, 10/24).

This information was reprinted from kaiserhealthnews.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery at kaiserhealthnews.org.

© Henry J. Kaiser Family Foundation. All rights reserved.

Article URL: http://www.medicalnewstoday.com/articles/205774.php

In an election conducted by the National Labor Relations Board, Doctors Hospital of Sarasota RNs voted by 91 to 52 to join the National Nurses Organizing Committee-Florida, NNU's Florida affiliate. NNOC-Florida will represent about 200 RNs at Doctors. 

NNOC-Florida now represents more than 5,000 Florida RNs in 13 hospitals around the state. Ten of the hospitals, including Doctors Hospital of Sarasota, are a part of Nashville-based HCA (Hospital Corporation of America), the biggest U.S. hospital system. 

Nationally, NNU represents 8,000 HCA RNs at 20 HCA hospitals in Texas, Nevada, Missouri, Kansas, and California as well as Florida. 

The election at Sarasota also follows a wave of NNOC-Florida election wins late last year at other HCA hospitals in Florida. The HCA RNs met last week in Tampa to begin negotiations with HCA on a collective bargaining agreement. 

"We voted to improve quality of patient care," said Doctors RN Geneice Hunt. "Collectively, my colleagues and I are making a clear statement that it is time for our voices to be heard and respected. We won the right to collectively bargain and we intend to bargain in good faith for contract guarantees." 

"We are excited to join other RN colleagues who have started bargaining already to improve quality of care and raise standards to recruit and retain experienced RNs," said Doctors Sarasota RN Dawn Edwards. "The RNs at Doctors are thrilled to join the national movement of RNs to improve quality of patient care." 

Source: 
National Nurses UnitedArticle URL: http://www.medicalnewstoday.com/articles/218603.php

Main News Category: Nursing / Midwifery

An award-winning study by Martin Were, M.D., of the Regenstrief Institute and colleagues reports on the success of a physician decision-support tool they developed to overcome these barriers and to complement physician-to-physician communication processes already in place. The computer tool facilitated convenient flow of information, providing both the specialists and the patient's primary-care physician with detailed information on the patient and the advice sought at the right time and place. They found that when using the new computer tool, medical recommendations from geriatrics consultants were implemented 30 percent more frequently than when it was not used.

"Consulted specialists might not have the full clinical or most current picture of the patient. For example, they might not know all medications the patient is taking, the patient's allergies, or the most current results of tests ordered by others. The decision-support system provided by our computer tool eliminated these problems. We alerted the specialist when a drug he was contemplating prescribing conflicted with another medication the patient was taking. Automatic electronic notification of the exact specialist recommendations eliminated the need for the patient's primary doctor to leaf through a thick medical file to see the specialist's recommendations and the details of these recommendations. The tool also lets the specialists know if their recommendations have been implemented by the patient's primary doctor. All these benefits can be very important for patient safety," said Dr. Were, who is an internist.

The study, entitled "Using Computerized Provider Order Entry and Clinical Decision Support to Improve Referring Physicians' Implementation of Consultants' Medical Recommendations," earned Dr. Were the American Medical Informatics Association's 2008 prize for Best Student Paper and is published in the March/April 2009 issue of Journal of the American Medical Informatics Association.

Dr. Were developed the physician support tool during his fellowship in medical informatics at the Regenstrief Institute under the mentorship of Michael Weiner, M.D., IU School of Medicine associate professor of medicine and a Regenstrief Institute research scientist.

"Although medical specialists provide critical advice about diagnosis and treatment, up to half of their recommendations are not implemented," said Dr. Weiner. "This work, based at Wishard Health Services, showed that electronic facilitation of consultants' recommendations is not only valued by physicians but can markedly improve the chance that the recommendations will be followed."

According to Dr. Were and Dr. Weiner, use of the new clinical support tool may save health-care dollars by decreasing delays in care, improving patient safety, and prioritizing specialty treatment. The next step is to see how big a difference implementation of the system makes in patients' outcomes, duration of hospitalization and costs of care.




Source: Indiana University

U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) Administrator Pamela S. Hyde, J.D. said: 

"People who begin drinking alcohol before the age of 15 are six times more likely than those who start at age 21 and older to develop alcohol problems. Parents and other adults need to be aware that providing alcohol to children can expose them to an increased risk for alcohol abuse and set them on a path with increased potential for addiction."

In the past month alone, more than 200,000 kids were given alcohol by a parent or other adult family member, according to a report from SAMHSA. 

Peter Delany, director of SAMHSA's Center for Behavioral Health Statistics and Quality continues: 

"About 5.9% of 12- to 14-year-olds have used alcohol in the past month. That's a pretty large number. And almost all of these kids got that alcohol for free. Anecdotally, parents say, 'Well, at least they are drinking at home and not on the street, or at least they are not smoking marijuana' -- all kind of silly things. If you want to have a big impact on preventing problems with youth alcohol use, it starts at home. This is a wholly preventable behavior."

In fact, about 45% got alcohol from a parent or other family member or they took it from their home without permission, Delany added. About 15% of these kids just took the liquor, but 15.7% got it directly from that parent or guardian and another 14% got it from another relative. 

Dr. Gwen Wurm, an assistant professor of clinical pediatrics at the University of Miami Miller School of Medicine adds: 

"This is something we have known: kids do get their alcohol at home. As parents we need to guide our children into the kind of appropriate choices they can be making."

2003, the average age of first use of alcohol was about 14, compared to about 17.5 in 1965. People who reported starting to drink before the age of 15 were four times more likely to also report meeting the criteria for alcohol dependence at some point in their lives. 

As children move from adolescence to young adulthood, they encounter dramatic physical, emotional, and lifestyle changes. Developmental transitions, such as puberty and increasing independence, have been associated with alcohol use. So in a sense, just being an adolescent may be a key risk factor not only for starting to drink but also for drinking dangerously. 

A major unmet need exists in the treatment of alcohol use disorders. In 2002, 1.4 million youth met the criteria for alcohol abuse or dependence, but only 227,000 actually received any treatment for these problems. 

Moreover, much of the treatment available today does not address the specific needs of adolescents. For example, most young people prefer easy access to treatment, with strategies tailored to their age group, and treatments that do not remove them from their home or academic settings. Youth perceive traditional services (e.g., alcoholism treatment programs, Alcoholics Anonymous) as less helpful than brief interventions tailored to their concerns. Consequently, alternative formats, attention to developmental transitions, and social marketing are needed to better address alcohol problems that emerge during adolescence. 

Source: U.S. Substance Abuse and Mental Health Services Administration

Written by Sy Kraft, B.A. 
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today 

Article URL: http://www.medicalnewstoday.com/articles/216956.php

Main News Category: Alcohol / Addiction / Illegal Drugs

You may also want to check whether the physician is certified in his or her subspecialty, like treating heart disease or arthritis. Some specialties require recertification every six or eight years. You can check on certification status with the American Board of Medical Specialties, the organization that oversees 24 specialty boards (www.abms.org), and at Web sites like HealthGrades.com and Docfinder (docboard.org).

If you’re uninsured, you may be able to negotiate with a doctor and agree on a reduced fee, but remember that you will also be responsible for the cost of lab tests, blood work, X-rays, procedures and medications. These costs are more likely to be covered or charged on a sliding scale at a community health center or hospital clinic. (To find a location, seewww.hrsa.gov under “Find Help,” or the Families USA Web site, www .familiesusa.org, under “Resources for Consumers.”)

Other factors to consider are whether the doctor has evening and weekend hours, whether the office leaves time open to schedule same-day appointments for urgent care, whether waiting times are reasonable and whether the doctor is in solo practice or a group practice. (Some experts say that group practices tend to be more efficient and that doctors in groups are more likely to stay up to date on current medical practice.) If the doctor uses electronic records, that’s a plus, some experts say.

On the crucial question of whether you are comfortable with the doctor you’ve chosen, you won’t know that until you meet with the doctor. Pediatricians will usually agree to an interview; busy internists often won’t.

Some physicians are posting video clips of themselves on the HealthGrades Web site, so patients can get a feel for their personal style; Angie’s List (angieslist.com) has started consumer ratings of A to F for doctors; and Consumers’ Checkbook (checkbook.org) provides detailed consumer ratings of physicians in seven metropolitan areas. (All of these sites require payment.)

If you have not already experienced denials, you should expect denials from UnitedHealthcare shortly for the following codes:

• S9083 Global fee urgent care centers
• S9088 Services provided in an urgent care center (list in addition to code for service)

Most urgent care centers are aware that CMS created HCPCS code S9088 at the request of private payors. S9088 is an “add-on” code that allows urgent care centers to receive reimbursement for a portion of the increased costs they incur in rendering urgent care services.

Compared with the cost of rendering the same services in a typical primary care physician office, the cost for outwardly identical services is generally be significantly higher when these services are rendered in an urgent care clinic. The reasons for this increased cost include:

You may want to contact UnitedHealthcare to explain to them that as an urgent care center, your facility incurs costs that are not incurred in the typical physician office. Compared with the cost of rendering the same services in a typical primary care physician office, the cost for outwardly identical services is generally significantly higher when these services are rendered in an urgent care clinic. The reasons for this increased cost include:

• Downtime: Because an urgent care sees patients on an unscheduled basis, patient flow in the urgent care center is unpredictable and uneven. Thus, the urgent care center will sometimes be open for hours, while no patients walk in. So although the center is incurring the expenses of salaries, benefits, heating/cooling, etc., the center is generating no revenue during these hours.
• Higher Wage Costs: Primary care physician offices generally are open for patient visits during the day on weekdays. On the other hand, urgent care centers deliver services on weekends, holidays and evenings. Thus, in order to hire qualified staff, an urgent care center must offer higher hourly compensation. This results in the urgent care center incurring higher wage costs for the same staffing levels as a primary care office.

You may want to contact your UnitedHealthcare representativeand explain that as an urgent care center, your facility incurs costs that are not incurred in the typical physician office. You may want to ask the representative how UHC plans to give reasonable compensation to your urgent care center for the additional costs of delivering these services.

Note: UnitedHealthcare may point out that Medicare currently does not pay on these codes. Of course, S codes are never reimbursed by Medicare, and these codes have been specifically made to enable private payors to reimburse healthcare providers for costs not included in the CMS RBRVS system. It is important to note that very few (if any) urgent care centers can deliver true urgent care services at Medicare rates, and that this code was specifically created for payors in the private sector to compensate urgent care centers for these increased costs.
http://www.urgentcarenews.com/vol1_1/S9088.php