ACA Repeal — the Backdoor Method

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Apparently, the bill to keep the government operating excludes payments to insurance companies that subsidize healthcare for those buying insurance through the Marketplace. The tactic is to force insurers out of the market, thus closing the door on the Affordable Care Act.

In theory, that would cost anyone with a subsidy their healthcare.

We’ll see what happens next.

Continuing Education for Doctors: What Your State Requires

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Medicine is highly dynamic. By one report, there are 4,500 pages of new findings produced every day — that’s a huge amount of material. A conscientious practitioner is going to spend hours each day on homework. Some doctors do, some don’t.

What do states require? There are requirements for continuing education in most (but not all) states in the US. That’s simple recognition of the fact that what one learns in medical school will become obsolete over time.

The states vary from no requirement for continuing education to a requirement of an average of 50 hours per year.  Here are the tiers. (1)

  • No requirement:
    • Colorado
    • Indiana
    • Montana
    • New York
    • South Dakota
  • 15 hours per year (average):
    • Vermont
    • Wisconsin
  • 20 hours per year (average):
    • Arizona
    • Arkansas
    • Delaware
    • Florida
    • Georgia
    • Idaho
    • Iowa
    • Kentucky
    • Louisiana
    • Mississippi
    • Nevada
    • North Carolina
    • North Dakota
    • Oklahoma
    • Oregon
    • Rhode Island
    • South Carolina
    • Tennessee
    • Utah
    • Wyoming
  • 24 hours per year (average):
    • Texas
  • 25 hours per year (average):
    • Alabama
    • Alaska
    • California
    • Connecticut
    • District of Columbia
    • Maryland
    • Minnesota
    • Missouri
    • Nebraska
    • New Mexico
    • West Virginia
  • 30 hours per year (average):
    • Virginia
  • 33 hours per year (average):
    • Kansas
  • 50 hours per year (average):
    • Hawaii
    • Illinois
    • Maine
    • Massachusetts
    • Michigan
    • New Hampshire
    • New Jersey
    • Ohio
    • Pennsylvania
    • Washington

How much is enough? None is probably not good. Even 3 days per year seems light.

The problem is that doctors can’t be counted upon to sign up for training when it isn’t required. In one example, in 2015, to counter the current epidemic of painkiller abuse, the FDA required drug makers to offer opioid training classes for physicians. Unfortunately, only 38,000 of the roughly 320,000 physicians who prescribe these drugs signed up for the classes. (2)

What training has your doctor taken recently?


Sources:

  1. Medscape, “State CME Requirements,” last updated April 2016. http://www.medscape.org/public/staterequirements
  2. Bloomberg, “Undertrained Doctors, Overprescribed Drugs,” 4 May 2016. https://www.bloomberg.com/view/articles/2016-05-04/undertrained-doctors-overprescribed-drugs

Early surgery for hip fractures can save lives

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This is something that any senior or anyone caring for a senior should see.

Researchers at Southmead Hospital (UK) report that surgery within 24 hours of injury save lives among elderly patients with hip fractures.

They analyzed data from 241,446 British patients, measuring the death rate in the 30 days after admission. They found that if surgery were delayed past 24 hours, the death rate increased by 8%. The death rate increased by 20% if surgery were delayed 48 hours.

The concern with elderly patients is whether they need time to stabilize after an injury. It turns out that taking that time can add to their risk.

Has your doctor seen that report?


Sources:

  1. BBC News, “Early Hip Fracture Surgery Will Save Hundreds of Lives,” 20 April 2017. http://www.bbc.com/news/uk-england-bristol-39655669

 

Politicians Take Care of Themselves

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This is either sad or funny.

24/7WallStreet ranked counties in the US on a combination of three measures:

  • Education (economic status of residents)
  • Poverty rate (how the local economy is doing)
  • Life expectancy (a measure of health and medical services)

The top 5 counties in the US (and 7 of the top 10) on these measures are suburbs of Washington, DC, where Congress lives.

  1. Falls Church (Independent City), VA ————————————- (DC metro)
  2. Arlington County, VA ———————————————————– (DC metro)
  3. Fairfax County, VA ————————————————————— (DC metro)
  4. Loudoun County, VA ————————————————————- (DC metro)
  5. Howard County, MD ————————————————————- (suburb of both DC and Baltimore; location of Columbia, MD)
  6. Douglas County, CO (part of Denver metro area)
  7. Los Alamos, NM (Federal nuclear research center)
  8. Fairfax (Independent City), VA ———————————————- (DC metro)
  9. Marin County, CA
  10. Alexandria (Independent City), VA —————————————- (DC metro)

Surprised?

Conversely, the worst counties in which to live are

  1. McDowell County, WV
  2. East Carroll Parish, LA
  3. Issaquena County, MS
  4. McCreary County, KY
  5. Clay County, KY
  6. Holmes County, MS
  7. Quitman County, MS
  8. Jefferson County, MS
  9. Calhoun County, GA
  10. Stewart County, GA

Given what I’ve posted recently on education and healthcare in the South, this list shouldn’t come as a surprise either.


Sources:

  1. http://247wallst.com/special-report/2017/01/13/the-worst-counties-to-live-in/
  2. http://247wallst.com/special-report/2017/01/24/the-best-counties-to-live-in/?utm_source=AOL&utm_medium=CPC&utm_content=the-best-counties-to-live-in&utm_campaign=AOL

ACA Repeal, Again

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According to Bloomberg, the White House wants Congress to vote on a revised bill next week.  There are some proposed amendments to the bill that failed in March in an effort to try to unify GOP House members to support the bill, but nothing has been finalized.

One item being considered is a proposal by Representative Tom MacArthur (R, NJ):

The amendment, reported earlier by Huffington Post, would allow insurers to charge higher premiums to people with pre-existing conditions in states that get a waiver. To obtain the waiver, states would have to provide sick people priced out of commercial insurance access to a so-called high-risk pool run by the federal government, or establish their own, and satisfy other conditions. (1)

A separate commentary on the same issue goes further:

According to a draft of the tentative deal obtained by POLITICO, the latest proposal would allow states to apply for “limited waivers” that would undermine Obamacare’s protections for pre-existing conditions. Under these waivers, states could opt out of Obamacare standards setting minimum benefits that health plans must offer and a requirement — called community rating — forbidding insurers from charging different prices to people based on health status. Both are provisions that the GOP’s ultraconservatives have pushed to eliminate as part of the repeal effort, contending that these coverage mandates drive up the cost of insurance.

What this means in practice is a two-tiered health system based on where people live. People in places like Mississippi and Kentucky that have relatively poor healthcare now, will have less access to healthcare and higher costs in the future. Conversely, states that offer better healthcare will maintain existing benefits. That’s a compromise that could pass, or could just make everyone unhappy.

Overall, this attempt keeps the negatives associated with the bill, and adds one more. Historically, risk pools haven’t worked. They’ve been budget-breakers when they’ve been tried for auto and health insurance in several states. If anything, more people will lose health coverage and costs will escalate as predicted by the CBO.


Sources:

  1. Billy House, Jennifer Jacobs, “White House, GOP leaders at odds over plans for Obamacare vote,” BenefitsPro, 20 April 2017. http://www.benefitspro.com/2017/04/20/white-house-gop-leaders-at-odds-over-plans-for-oba?kw=White%20House%2C%20GOP%20leaders%20at%20odds%20over%20plans%20for%20Obamacare%20vote&et=editorial&bu=BenefitsPRO&cn=20170420&src=EMC-Email_editorial&pt=News%20Alert
  2. Adam Cancryn and Josh Dawsey, “White House plans Obamacare showdown next week,” Politico, 20 April 2017. http://www.politico.com/story/2017/04/20/obamacare-repeal-republicans-new-deal-237397

 

Surgical Safety

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This finding appeared today, and it raises all sorts of questions about the quality of care in some hospitals in the US:

South Carolina saw a 22 percent reduction in post-surgical deaths in hospitals that completed a voluntary, statewide program to implement the World Health Organization Surgical Safety Checklist. (1)

In the South Carolina test, 14 hospitals volunteered to use the checklist, and saw a decline in deaths within the thirty days following surgery. Other hospitals in the state saw a slight increase in deaths during the same period. The trial program was run in these hospitals between 2010 and 2013.

The writers make a point that hospitals need to truly commit to the procedure, not treat it  as “a checkbox.”

There are two items that are shocking about this:

  • That the country with the most expensive healthcare in the world needs to learn this from others, and
  • The checklist has been in existence since 2008. (2)

Has your hospital adopted this checklist? If not, do you want to find one that has?

 


Sources:

  1. Alex B. Haynes, Lizabeth Edmondson, Stuart R. Lipsitz, George Molina, Bridget A. Neville, Sara J. Singer, Aunyika T. Moonan, Ashley Kay Childers, Richard Foster, Lorri R. Gibbons, Atul A. Gawande, William R. Berry. Mortality Trends After a Voluntary Checklist-based Surgical Safety Collaborative. Annals of Surgery, 2017; 1 DOI: 10.1097/SLA.0000000000002249
  2. Institute for Healthcare Improvement, “World Health Organization (WHO) Surgical Safety Checklist and Getting Started Kit.” http://www.ihi.org/resources/Pages/Tools/WHOSurgicalSafetyChecklistGettingStartedKit.aspx

Aspirin and Cancer

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A low dose aspirin regimen may

  • Reduce the risk of heart attack
  • For persons over 50, reduce the risk of certain types of cancer including colorectal.

The risk associated with daily aspirin use is internal bleeding. Thus, for example, its not recommended for people with stomach ulcers. The bleeding risk increases with age, so some doctors are reluctant to recommend an aspirin regimen for people over age 60. A task force has recommended that use over age 60 be left to the individual, and be based on whether an individual is more concerned about the bleed risk or the potential benefits with regard to cancer and heart disease.


Soources:

  1. Arefa Cassoobhoy, MD, MPH, “Aspirin to Prevent Cancer: What to Tell Patients,” Medscape, 14 April 2017. http://www.medscape.com/viewarticle/878567?nlid=114187_1521&src=WNL_mdplsfeat_170418_mscpedit_wir&uac=153634BV&spon=17&impID=1330937&faf=1
  2. Mayo Clinic, “Daily aspirin therapy: Understand the benefits and risks.” http://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/daily-aspirin-therapy/ART-20046797