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The Call to Be a Primary Care Doctor
By HANS DUVEFELT I suspect the notion of calling in narrower specialties is quite different from mine. Surgeons operate, neurologists treat diseases of the nervous system, even as the methods they use change over time. Primary care has changed fundamentally since I started out. Others have actually altered the definition of what primary care is, and there is more and more of a mismatch between what we were envisioning and trained for and what we are now being asked to do. Our specialty is often the first to see a patient and also the last stop when no other specialty wants to deal with them. We have also been requ...
Source: The Health Care Blog - August 2, 2021 Category: Consumer Health News Authors: Christina Liu Tags: Medical Practice Physicians Primary Care Hans Duvefelt Source Type: blogs

Research and Reviews in the Fastlane 059
This study looked at national survey data from 2009-2010 of patients >18 y/o presenting to the ED (n=44,448 visits) and found that cardiac enzyme testing was performed in 16.9% of visits, including in 8.2% of visits lacking ACS-related symptoms (which includes things like nausea, vomiting, abdominal pain, dyspnea, etc). This begs the question, why then, was a troponin (or ck-mb) ordered? It’s probably not changing management. In an era in which we’re discovering that there are harms to downstream testing, this study calls out just how trigger happy we may be. As more sensitive cardiac assays are used, this m...
Source: Life in the Fast Lane - November 26, 2014 Category: Emergency Medicine Authors: Jeremy Fried Tags: R&R in the FASTLANE airway brain failure critical care Emergency Medicine General Surgery hypothermia Intensive Care prehospital recommendations Review Trauma Source Type: blogs

The Operating System For Value-Based care
Conclusions In order to support the sea change occurring in medicine – moving from fee-for-service to value-based care – the technology platform must also be re-invented. Institution-centered technology, which is the soil where current EHRs have grown, will no longer work. No matter how much effort is put into connecting data silos with record locater services and lowered technology barriers between them – dubbed “interoperability” in current lingo – the solution will not be sufficient. A universal data platform is needed, where patients and care teams can see their information and use it in meaningful ways. Th...
Source: The Health Care Blog - July 20, 2015 Category: Consumer Health News Authors: suchandan roy Tags: THCB The Business of Health Care Robert Rowley value-based care Source Type: blogs

Research and Reviews in the Fastlane 071
This study looks at the effect of institution of duty hour restrictions on the outcome of Medicare patients. Although the study is retrospective and derived from large database information, it gives us a peak into the bigger picture of duty hours regulations: patient outcomes. The study authors found no difference in any important outcomes. It is similarly unclear whether these restrictions have improved resident quality of education or quality of life. Large system wide changes duty hour restrictions should, in the future, be implemented not based on theory but actual data of improved outcomes. An accompanying editorial d...
Source: Life in the Fast Lane - February 18, 2015 Category: Emergency Medicine Authors: Soren Rudolph Tags: Education Emergency Medicine Neurosurgery Pediatrics Resuscitation Trauma critical care examination Intensive Care R&R in the FASTLANE research and reviews Source Type: blogs

How States Can Expand Access To Palliative Care
Conclusion The policies discussed in this Blog post are intended to serve as a framework for policymakers and other stakeholders interested in doing more to support palliative care in their states. Here are a few considerations for those interested in exploring potential options: None of the policies and initiatives described above would have been possible without efforts from key stakeholders such as the state hospice and palliative care associations, and local funders, researchers, and advocates. Champions such as Colorado’s Center for Improving Value in Health Care (CIVHC), the Coalition for Compassionate Care of Cal...
Source: Health Affairs Blog - January 30, 2017 Category: Health Management Authors: Stacie Sinclair and Diane Meier Tags: End of Life & Serious Illness Long-term Services and Supports Medicaid and CHIP Payment Policy Quality California End-of-Life Care Palliative Care States Source Type: blogs

Hospital Closures Pose Challenges to Care
Empty beds in a hospital room. When 10-bed Nye Regional Medical Center, in west-central Nevada, closed abruptly in 2015, it meant that the residents of the former gold-mining town of Tonopah would have to drive about two hours across a hundred miles of desert roads to get to the nearest hospital.  The hospital’s CEO, Wayne Allen, didn’t sugar-coat it. “This is a decision that will ultimately jeopardize the health and well-being of our community and surrounding areas,” he said. Hospital closures over the last decade—most notably in rural areas and in pediatrics, but urban closures as well—have left patients wi...
Source: The Hospitalist - November 1, 2022 Category: Hospital Management Authors: Ronda Whitaker Tags: Business of Medicine Career Pediatrics PHM22 Source Type: research

Billing Critical Care and Discharge On Same Calendar Date?
Can I bill a critical care code and a discharge code on the same day?   That's a question a lot of folks finding The Happy Hospitalist are asking themselves.  I am a hospitalist with over ten years of clinical experience and years of research in evaluation and management (E/M) medicine.   I have a very short answer and one that should lay to rest any question about what code the physician should choose when they provide critical care on the date of discharge. On page 3 of 9 in  CMS document MM6740, we are told In all cases, physicians will bill the available code that most appropriately describes the ...
Source: The Happy Hospitalist - August 12, 2013 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs

The Challenge Of Financing Sustainable Community-Based Palliative Care Programs
Since its publication in September 2014, there has been widespread praise for the Institute of Medicine (IOM) report, Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. It is a masterful piece of scholarship that summarizes the spectrum of issues facing palliative care. We hope the report will influence key decision-makers in medicine and various legislatures to promote the many changes outlined in the document, enabling palliative care to further improve the quality of life for those with advanced illness. Yet, despite the encyclopedic scope of Dying in America, the report did no...
Source: Health Affairs Blog - December 29, 2014 Category: Health Management Authors: Richard Bernstein and Karol DiBello Tags: All Categories End-of-Life Care Medicare Palliative Care Policy Quality Research Source Type: blogs

Can Startups Save Primary Care?
By ANDY MYCHKOVSKY Today, primary care is considered the bee’s knees of value-based care delivery. Instead of being viewed as the punter of the football team, the primary care physician (PCP) has become the quarterback of the patient’s care team, calling plays for both clinical and social services. The entire concept of the accountable care organization (ACO) or patient-centered medical home (PCMH) crumbles without financially- and clinically-aligned PCPs. This sea change has resulted in rapid employment or alignment to health systems, as well as a surge in venture capital being invested into the primary care space....
Source: The Health Care Blog - March 3, 2020 Category: Consumer Health News Authors: Christina Liu Tags: Health Tech Primary Care Start-Ups ACOs Adelade Andy Mychkovsky ChenMed Iora Health Oak Street Health One medical Population Health Privia Health Startups VillageMD Source Type: blogs

Billing Critical Care and Discharge On Same Calendar Date?
Can I bill a critical care code and a discharge code on the same day?  That's a question a lot of folks finding The Happy Hospitalist are asking themselves. I am a hospitalist with over ten years of clinical experience and years of research in evaluation and management (E/M) medicine.  I have a very short answer and one that should lay to rest any question about what code the physician should choose when they provide critical care on the date of discharge. On page 3 of 9 in CMSdocument MM6740, we are toldIn all cases, physicians will bill the available code that most appropriately describes the level of...
Source: The Happy Hospitalist - August 12, 2013 Category: Internal Medicine Authors: The Happy Hospitalist Source Type: blogs

The U.S. Physician Shortage Is Only Going to Get Worse. Here Are Potential Solutions
If you’ve recently had to wait longer to see a doctor than you used to, that may not be entirely because of the COVID-19 pandemic. America is experiencing a physician shortage, and it’s only expected to get worse—a concerning situation that could lead to poorer health outcomes for many patients. Data published in 2020 by the Association of American Medical Colleges estimates that the U.S. could see a shortage of 54,100 to 139,000 physicians by 2033. That shortfall is expected to span both primary- and specialty-care fields. “The physician shortage can justly be characterized as a looming public-heal...
Source: TIME: Health - July 25, 2022 Category: Consumer Health News Authors: Elaine K. Howley Tags: Uncategorized freelance Health Care healthscienceclimate Source Type: news

Physician Payments Sunshine Act: Organizations Respond to CMS
  September 2nd marked the last day for comments on CMS’ proposed rule to eliminate the accredited continuing medical education (CME) exemption from Sunshine Act reporting.  In an overwhelming display of support for the exemption, over 800 comments were submitted encouraging the agency to either maintain or expand the current exclusion. -Total comments supporting maintenance or expansion of the CME exemption:  820 -Total comments supporting elimination of the CME exemption:  approximately 20 -Percentage of comments supporting the CME exemption: 98% We have followed this issue closely, and recentl...
Source: Policy and Medicine - September 8, 2014 Category: American Health Authors: Thomas Sullivan Source Type: blogs

Twenty-First Century Medicaid: The Final Managed Care Rule
With enrollment reaching 74 percent of all beneficiaries, it is clear that managed care has become the standard organizing mechanism for a Medicaid program whose welfare roots are behind it and that now functions as a principal source of public insurance. Given this broad national policy direction, a strong yet flexible regulatory framework for Medicaid managed care becomes a fundamental policy goal, particularly as state programs continue to evolve toward structures capable of managing care for the highest need populations. The modern contours of a 21st century regulatory framework finally came into full view on April 25 ...
Source: Health Affairs Blog - May 5, 2016 Category: Health Management Authors: Sara Rosenbaum Tags: Costs and Spending Featured Health Professionals Medicaid and CHIP Medicare Payment Policy Quality federal regulations MACRA MACRA final rule managed care organizations medical loss ratio Source Type: blogs

Billing For Family Meetings as Critical Care in the ICU Explained.
Discussions:Critical care CPT codes 99291 and 99292 include pre and post service work. Routine daily updates or reports to family members and or surrogates are considered part of this service. However, time involved with family members or other surrogate decision makers, whether to obtain a history or to discuss treatment options (as described in CPT),may be counted toward critical care time when these specific criteria are met:The patient is unable or incompetent to participate in giving a history and/or making treatment decisions, and The discussion is necessary for determining treatment decisions.For family discuss...
Source: The Happy Hospitalist - August 8, 2013 Category: Internal Medicine Authors: The Happy Hospitalist Source Type: blogs