This interesting essay was written about why it has become so difficult for so many doctors and patients to communicate with each other. “Ours is a technologically proficient but emotionally deficient and inconsistent medical system that is best at treating acute, not chronic, problems: for every instance of expert treatment, skilled surgery, or innovative problem-solving, there are countless cases of substandard care, overlooked diagnoses, bureaucratic bungling, and even outright antagonism between doctor and patient. For a system that invokes a “patient-centered care” as a mantra, modern medicine is startlingly inattentive – at times actively indifferent – to patients’ needs. Today’s physicians see themselves not as the “pillars of any community” but as “technicians on an assembly line.” Doctors today are more likely to kill themselves than are members of any other professional group.” (Atlantic Monthly, Nov. 2014) Click here to read full text.
News You Can Use
Susan Williams, widow of Robin Williams, has written a special editorial for the October issue of Neurology, which was the subject of yesterday’s media newscasts. Her purpose in doing so is to raise awareness and to offer a plea for further (and much-needed research) in the area of Lewy body disease and dementia, the disease which ultimately ravaged her husband’s life. The editorial poignantly describes the last few months of their lives together and the confusion over the diagnosis and treatment. Click here to read full text.
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.
“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. Healthcareby 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, 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, 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 Beneficiariesby 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.