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Implementing MACRA: Implications for physicians and physician leadership

by jmiller on September 12, 2016

In this Viewpoint (NEJM, June 14), “MACRA (Medical Access and CHIP Reauthorization Act), will overhaul Medicare’s physician payment system starting in 2019, placing most physicians in the Merit-Based Incentive Payment System (MIPS), a pay-for-performance system that adjusts payments based on measures derived from prior care.  Physicians can be exempt from MIPS and receive bonus payments by demonstrating sufficient participation in advanced alternative payment models (APMs), which are intended to support greater flexibility in care delivery alongside greater accountability for efficiency and care improvement.  The proposed rule has begun the historic and complex undertaking of reforming physician payment.  Despite its size and scope, the rule leaves many questions unsettled, including certainty about the best pathways forward for many types of physicians, and how much influence the reforms will leave on quality of care and spending for Medicare beneficiaries.  Click here to read full text.

Evolutionary pressures on the Electronic Health Record: Caring for complexity

by jmiller on August 16, 2016

“There is building resentment against the shackles of the present EHR; every additional click inflicts a nick on physicians’ morale.  At present, the spectacular effects of computers in science and in the secular world are not reflected in the EHR, which for physicians remains burdensome, all-consuming, and far from intuitive:  this is not surprising when the dominant EHRs are designed for billing and not primarily for ease of use by those who provide care.  In fact, a measure of successful EHR evolution may be that physicians spend much less time with the EHR than they do now.  Deimplementing the EHR could actively enhance care in many clinical scenarios.  Simply listening to the history and carefully examining the patient who presents with a focused concern is an important means of avoiding diagnostic error.”  (JAMA, Aug 15)  Click here to read.

JAMA: United States Healthcare Reform: Progress to Date and Next Steps, by Barack Obama; and Editorial: The Affordable Care Act and the Future of U.S. Healthcare

by jmiller on July 12, 2016

(JAMA early online publication) A special communication from President Obama presenting a summary of the Affordable Care Act, describing the successes, the challenges ahead and the policy implications of the ACA’s legislative history. The article concludes: “Policy makers should build on progress made by the Affordable Care Act by continuing to implement the health insurance marketplaces and delivery system reform, increasing federal financial assistance for marketplace enrollees, introducing a public plan option in areas lacking individual market competition, and taking actions to reduce prescription drug costs. Although partisanship and special interest opposition remain, experience with the Affordable Care Act demonstrates that positive change is achievable on some of the nation’s most complex challenges.” Click here to read full-text.

Alzheimer’s & Dementia: MIND Diet Associated with Reduced Incidence of Alzheimer’s Disease

by jmiller on July 7, 2016

(Alzheimer’s & Dementia, Nov 2015) “In a previous study, higher concordance to the MIND diet, a hybrid Mediterranean-Dietary Approaches to Stop Hypertension diet, was associated with slower cognitive decline. This study related three dietary patterns to incident Alzheimer’s disease (AD). High adherence to all three diets may reduce AD risk. Moderate adherence to the MIND diet may also decrease AD risk.” Click here to read the full article.

NEJM: Early Performance of Accountable Care Organizations in Medicare

by jmiller on July 5, 2016

(NEJM, June 16) “The first full year of Medicare Shared Savings Program (MSSP) contracts was associated with early reductions in Medicare spending among 2012 entrants but not among 2013 entrants. Savings were greater in independent primary care groups but not among 2013 entrants. Savings were greater in independent primary care groups than in hospital-integrated groups.” Click here to read full text.

JAMA: Pharmaceutical Industry-Sponsored Meals and Physician Prescribing Patterns for Medicare Beneficiaries

by jmiller on July 5, 2016

(JAMA Intern Med, June 20) The article concludes: “Receipt of industry-sponsored meals was associated with an increased rate of prescribing the brand-name medication that was being promoted. The findings represent an association, not a cause-and-effect relationship.” Click here to read full text.

The Shadow Doctors: The Underground Race to Spread Medical Knowledge as the Syrian Regime Erases It

by jmiller on June 27, 2016

“In the past five years, the Syrian government has assassinated, bombed, and tortured to death almost seven hundred medical personnel, according to Physicians for Human Rights, an organization that documents attacks on medical care in war zones.”  A United Nations commission concluded, “Government forces deliberately target medical personnel to gain military advantage, denying treatment to wounded fighters and civilians as a matter of policy. In meetings, the U.N. Security Council strongly condemns such violations of international humanitarian law.  In practice, however, four of its five permanent members support coalitions that attack hospitals in Syria, Yemen and the Sudan.  Despite the onslaught, doctors and international NGOs have forged an elaborate network of underground hospitals throughout Syria.” To read this entire chilling article from this month’s New Yorker , click here.

From JAMA Surgery: “Revisiting nursing’s effect on surgical quality and cost” and “Comparison of the value of nursing work environments in hospitals across different levels of patient risk”

by jmiller on June 22, 2016

When nursing is the focus of a major medical journal, it deserves considerable attention, particularly coming from this month’s JAMA Surgery.  The article concludes: “Hospitals with better nursing environments and above-average staffing levels were associated with better value (lower mortality with similar costs) compared with hospitals without nursing environment recognition and with below-average staffing, especially for higher-risk patients.  These results do not suggest that improving any specific hospital’s nursing environment will necessarily improve its value, but they do show that patients undergoing general surgery at hospitals with better nursing environments generally receive care of higher value.”  “Improvements in surgical safety remain an important focus of hospitals and clinicians.  With nearly 100,000 patients dying per year in the United States after undergoing elective surgery and mortality rates varying from 2-fold to 10-fold across hospitals, excess surgical mortality qualifies as a significant public health problem.  Unfortunately, the precise means to improve surgical safety remain elusive.  The authors evaluate differences in patient outcomes and cost between hospitals with better nursing work environments, determined by Magnet status and higher nurse-to-bed ratios, and matched controls.  Two key findings: first, hospitals with better nursing environments have a nearly 20% lower failure-to-rescue rate than control hospitals, and second, the overall value of care delivered was superior to that of control hospitals. To read full-text, click here.

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