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Insurers weigh a simpler, cheaper treatment for artery disease: supervised workouts Print E-mail
Written by Eric Boodman | STAT   
Monday, 20 March 2017 00:00

When Char Zinda's doctors discovered that she had had a couple of small, undiagnosed heart attacks, their instructions were to start walking.

She was game. She tried going to the local university's indoor walking track near her house. But she couldn't even walk two-tenths of a mile. "The bottoms of my feet just felt like somebody had taken a sharp pencil and was poking it in," said the 64-year-old, who lives in Morris, Minn. The pain was so bad it made her cry.

That was a telltale sign of peripheral artery disease, which affects an estimated 8 million Americans. Zinda had a number of treatment possibilities, but the cheapest and least invasive has generally not been covered by insurance, despite years' worth of evidence that it can be as effective as other options.

That is on the cusp of changing, experts say...

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Last Updated on Tuesday, 21 March 2017 18:13
PCMH recognition process isn't easy but it is becoming more relevant and less burdensome Print E-mail
Written by Yul Ejnes, MD | American College of Physicians via KevinMD   
Friday, 03 March 2017 18:29

When the American College of Physicians (ACP) and the other primary care societies introduced the Patient-Centered Medical Home (PCMH) over 10 years ago, the model was untested. Here's a look at how the PCMH recognition process has evolved and how my experience seeking recognition helped me in my role on the PCMH 2017 Advisory Committee that was established to guide the National Committee for Quality Assurance (NCQA) on the next update of the recognition program.
Last Updated on Tuesday, 14 March 2017 18:33
Overcoming Back Pain: New Doctor Recommendations Print E-mail
Written by Jeffrey Herschler   
Tuesday, 28 February 2017 00:00

According to an American College of Physicians (ACP) press release posted 2/14/17 and entitled ACP Issues Guideline for Treating Nonradicular Low Back Pain:

<The ACP>...recommends...that physicians and patients should treat acute or subacute low back pain with non-drug therapies such as superficial heat, massage, acupuncture, or spinal manipulation.

“Physicians should reassure their patients that acute and subacute low back pain usually improves over time regardless of treatment,” said Nitin S. Damle, MD, MS, MACP, President, ACP. “Physicians should avoid prescribing unnecessary tests and costly and potentially harmful drugs, especially narcotics, for these patients.”

I had a chance to catch up with Sandra Doman, DC of Aventura to learn more about the new guidelines, how the updated protocol affects the approximately one quarter of U.S. adults who have reported having low back pain lasting at least one day in the past three months, as well as the providers who care for them.

JH     Why is this good news for patients?

SD    These therapies are safer, more effective, and less expensive in the long term. They allow a patient to take on-going responsibility to decrease their back pain and improve their overall health. Combining meditation-based movement therapies like yoga and tai chi along with other non-drug approaches such as spinal manipulation, acupuncture, and massage have provided unbelievable breakthroughs and sustained relief for back pain sufferers.

JH     In my experience medical doctors are skeptical of alternative therapies. Is this some long-sought validation for alternative practitioners?

SD    Reasonably good evidence in favor of these approaches has been available for more than a decade depending on the specialty. That being said, it takes a long time to shift the establishment and maybe even a crisis, like the opioid epidemic, that forces thought leaders to take a closer look at safer alternatives. MDs and alternative care providers can now work together more formally towards the common goal of delivering excellent and safe outcomes for patients.

JH     Let's say you are a patient who suffers from lower back pain. You go to an orthopod who recommends an interventional approach: pharmaceutical pain medications and an eventual surgery. You then go to an osteopathic physician or a chiropractor who recommends a non-interventional approach: nutrition, yoga, acupuncture, meditation, etc. How do you resolve the conflicting treatment plans?

SD    The decision always falls with the patient. It is incumbent now upon the orthopod or managing MD to discuss the new recommendations with the patient and hopefully provide resources. The new ACP recommendations illustrate that lifestyle-based therapies that improve your physical and emotional health ARE the most effective for reducing low back pain. Medical intervention is best for emergencies, not for restoring health. 
JH     If the ACP recommends it, eventually the payers will be compelled to cover it. Alternative medicine practitioners often enjoy the benefits (higher reimbursements, less red tape, less regulatory oversight) of cash driven practices. If alternative medicine becomes increasingly mainstream, does that threaten to spoil it for alternative practitioners by bringing in the insurers and regulators?

SD    Chiropractors, acupuncturists and massage therapists are already highly regulated and covered by most payers! The other movement therapies are working on more stringent regulations as we speak. For example the International Association of Yoga Therapists (IAYT) governs over a longer, more intensive training protocol geared towards health care than previously available. Insurance companies are in for a big win to include these natural therapies, thereby decreasing the need for expensive surgeries.

Last Updated on Wednesday, 01 March 2017 17:49
ICU patients' outcomes improve when hospital staff also pay attention to families of the sick Print E-mail
Written by Meredith Cohn | The Baltimore Sun   
Monday, 06 February 2017 00:00

When her sister was in and out of intensive care last year, Theodora Peters noticed she no longer had to push so hard for information about her sister's condition and treatment, or to stay by her bedside after visiting hours.

"There seemed to finally be recognition that we were part of the team," Peters said about the way the medical staff treated her and her sibling. "There was recognition we all needed to work together to get the best outcomes."

For decades, hospital intensive-care units focused on facilitating the care provided by doctors and nurses to the gravely ill, while access was limited for patients' families, partly so they wouldn't get in the way. That's beginning to change under a new approach known in medical circles as "family-centered care" that's gaining traction in ICUs as hospitals look for ways to improve care and cut costs.

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Medicare establishes 5 percent incentive for practices in the advance payment model under MACRA Print E-mail
Written by Accountable Care Options, LLP   
Thursday, 26 January 2017 00:00

The Centers for Medicare and Medicaid Services finalized rules for its payment program on Nov. 2. They affect practices in advanced alternative payment models, including accountable care organizations, or ACOs.

Practices can earn annual incentives up to 5 percent if they are in ACOs that accept a financial risk for excessive costs in return for a greater percentage of the savings generated. That category includes Medicare Shared Savings Tracks 2 and 3, Next Generation ACO models, Comprehensive ESRD Care Model, Comprehensive Primary Care Plus model and Oncology Care Model.

Practices that receive 25 percent of Medicare payments or see 20 percent of Medicare patients in 2017 through an advanced payment model are eligible to receive a 5 percent incentive payment in 2019.

The good news is that practices in those ACOs have most of the reporting work done for them. Physicians can focus their time and attention on delivering effective, efficient care. They will still need to attest what's called Advancing Care Information measures; they replace meaningful use.

The best way to score well in this area is to perform a security risk analysis - a HIPAA analysis of electronic health records. Evaluate the integrity of your system and the structures that house them. If you discover a security risk, then establish a plan and act on it.

To do well overall, a practice should align itself with an ACO that ranks in the 90th percentile or higher in quality and had a positive 2015 adjustment in the value modifier; the latter was based on measures of quality of care and cost containment.

Practices in the advanced payment model that efficiently treat specific cases and diseases and have also generated shared savings will also earn a positive adjustment. The incentive payment will be delivered directly to the practitioner.
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