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Study cites a Calif. house-call program’s success

 

A recent study in HealthAffairs says that house calls can help reduce the number of emergency room visits and hospital readmissions.

It looks at  how since 2009 Torrance, Calif.-based HealthCare Partners Affiliates Medical Group has provided its House Calls program to recently discharged high-risk, frail and psychosocially compromised patients.  The idea is to provide and manage care for the group’s Medicare Advantage and commercially insured HMO patients.

The study says that  after being involved with the program for three months, patients were admitted to the hospital less often–and per-month use and spending continued to decrease.

Nurse practitioners  are the key to the program: They develop patients’ care plans while monitoring them and  sending updates to primary-care physicians. Meanwhile, social workers assess patients in their home environments. There, they identify  such potential issues such as fall risks, medication organization, social isolation and financial concerns and provide nutrition coaching.

 

 

 

 

 

 


Family-medicine residents look to widen scope

 

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This JAMA study compared the intended scope of practice for family-medicine residents with  the reported scope of practice among currently practicing ones.

If concluded that “family medicine residents reported an intention to provide a broader scope of practice than that reported by current practitioners. This pattern suggests that these differences are not generational, but whether they are due to limited practice support, employer constraints, or other causes remains to be determined.”

In any event, government and private-sector initiatives will continue to direct more resources than in the past to primary-care physicians compared to specialists. However, this will be diluted by more authority being given to nonphysician (and cheaper) primary-care clinicians — primarily nurse practitioners and physician assistants.


Bill would extend Sunshine Act to PAs and NPs

 

A bill in the U.S. Senate  would fill a gap in the Sunshine Act —a section of the Affordable Care Act that orders drug and medical-device makers to inform the government when they give stuff to physicians. The bill would extend this reporting mandate to  cover physician assistants, nurse practitioners and other kinds of advanced practice registered nurses.

After all,  many of them can prescribe the products above and they, like physicians, may receive cash and in-kind payments from  the medical-products industry as incentives to do so.

As states give PAs and NPs more  prescribing authority and as they take over more of primary care,  it seems past time to fix that gap.

 

 


Open your mouth for the dental therapists

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Text and WGBH podcast:

What has been happening with  the rise of such non-physician clinicians as nurse practitioners and physician assistants is now  happening in dental care, too, with the appearance of “dental therapists”. They work in the space between dentists and dental hygienists.

It’s a matter of healthcare access and cost.

Many middle-class patients forgo dental care because it is very expensive, in part because dentists have demanded and gotten very high incomes. Consider that the average net income for a general dentist exceeds $180,000 — more than the average of around $170,000 for primary-care physicians. In some places poorer people on Medicaid can get dental care, though such access can vary quite a bit across America.

Further hurting access is that dental insurance, if you have it, usually provides very skimpy coverage, forcing most patients to make very large out-of-pocket payments. It’s enough to scare a lot of people away from getting the treatment they need. And course poor dental care can lead to other health problems, including heart disease.

So  some states,  although often opposed by dentist organizations fearful of reduced incomes for their members, are authorizing a new classification called “dental therapists” to provide routine care at considerably lower prices than those charged by dentists.

We’d bet that pressure from payers will lead to a rapid expansion in the number of this new kind of dental practitioner. We may even see them soon in retail clinics run by CVS and other drugstore chains.

 


Partners invading urgent-care-clinic business

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Prestigious Partners HealthCare,  whose flagship is the Massachusetts General Hospital, will  open as many as a dozen urgent-care clinics over the next three years, in Massachusetts, in a move that helps highlight the more general moves in U.S, healthcare from inpatient to outpatient services and from the use of very expensive physicians to cheaper nurses, nurse practitioners and physician assistants.

It also poses a threat to nearby, Rhode Island-based CVS, whose drugstores are rapidly adding urgent-care centers. The prestige of Partners’  famous hospitals may take some business away from CVS’s urgent-care centers, which it calls MinuteClinics. It may also lighten the load a bit in some area hospitals’ emergency rooms.

Partners is late to urgent care in Massachusetts. Steward Health Care System, Beth Israel Deaconess Medical Center, Lahey Health, and others are already in the business, either directly or with partners, The Boston Globe reports.

But, The Globe reports, “Partners has advantages in its size and reputation. It is the parent of 10 hospitals, including Massachusetts General and Brigham and Women’s, and has 6,000 doctors, the largest network in the state. It also is planning more urgent care locations than most of its competitors.”

“This is more than a pilot for us,” said Dr. Gregg S. Meyer, chief clinical officer of Partners, told The Globe.  “These are meant to be extensions of availability and convenience for patients. We know we are not always as available as possible for our patients.”

 

 

 

 

 

 


NPs do well vs. physicians in diagnostics study

 

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A comparison of the diagnostic abilities of physicians and nurse practitioners in New Zealand found that  the latter were almost as good in diagnosis as the doctors in a complex inpatient case of a seriously ill man.

The correct diagnosis was made by 61.9 percent of physicians and 54.7 percent of NPs. The correct problem was identified by 56.3 percent of physicians and 53.3 percent of NPs. The correct actions were identified by 34.4 percent of the physicians and 35.8 percent of the NPs.

The study concluded that NP diagnostic reasoning in a complex-case scenario compared favorably with that of physicians.

Such studies, of course, give more firepower to U.S. hospital C-suites seeking to use more NPs and fewer physicians because the former, while well paid, aren’t anywhere nearly as well compensated as physicians. The latter are by far the highest paid doctors in the world.


In the pipeline of nonphysician clinicians

 

Here’s an update of data from Edward Salsberg, writing in HealthAffairs, on the pipeline of nurse practitioners,  physician assistants  and pharmacists needed to address America’s growing primary-care needs.


New strategies for mental-healthcare

A Wall Street Journal story looks at the shortage of U.S. mental-health providers, which is becoming ”more acute as people are encouraged to seek treatment, or find they are able to afford it for the first time as a result of new federal requirements that guarantee mental-health coverage in insurance plans.”

“That’s prompting a sea change in attitudes among mental-health advocates, who are starting to look at solutions that are broader than just training more psychiatrists.”

Among the strategies:

“{W}orking more closely with nurse practitioners and physician assistants, after a long history of protectiveness over its members’ powers. ”

And:

”California health centers are also gaining acclaim for their efforts to merge primary-care and behavioral-health services under one roof, which often ensures that many aspects of mental health can be addressed by providers other than psychiatrists.”

And help from techn0logy, such as:

”Robert Bosch Healthcare Systems Inc. says it has developed a device that providers can use to monitor patients with bipolar disorder and major depression, to make sure they are managing their illness through medication and behavioral therapy.”

 

 

 

 


Healthcare hiring to increase — except at hospitals

 

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Modern Healthcare reports in this useful, if  with  rather predictable findings, tour d’horizon that hiring will pick up in the U.S healthcare sector this year — except in hospitals.

It reports:

“The outlook for growth in hospital employment—healthcare’s largest employer—is modest at best. Many hospitals will be reducing head counts. Others are holding the line on adding new employees since the federal government plans to keep a tight rein on reimbursement while private insurers are pushing more participation in risk-based contracts. ”
“Hiring at outpatient facilities and ambulatory surgical centers, on the other hand, is expected to continue its rapid growth as technological changes and financial pressures push the locus of care from inpatient to outpatient settings.”

And, it said:  {F}inancial pressures on hospitals will {continue to} shift their recruitment focus to finding skilled nurses and primary-care physicians.”

The hunt for the latter might fade a bit as more nurse practitioners and physician’s assistants take on more and more primary-care jobs in coming years After all,  an increasing number of states are now letting NP’s and PA’s do things once restricted to physicians. New York State, for one, just did this.

 

 


The old and outpatient future of healthcare

 

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Christmas in a nursing home.

To see the future of healthcare, think old and think outpatient.

An article in The Boston Globe predicts that while healthcare will continue to be a “reliable engine for job growth in coming years” that growth will slow as payers seek to control costs.

”More important, the aging population is increasing demand for nurses, physical therapists, nursing assistants, and home care workers,” the article says.

“The wave of the future is going to be geriatrics,” Tammy Retalic, chief nursing officer at Hebrew Rehabilitation Center in {Boston’s} Roslindale, a division of Hebrew SeniorLife, told the Globe.

The paper also reported that in the state’s ”two-year forecast for 2013-2015, the state projects 6.8 percent job growth in outpatient healthcare services, compared with just 1.4 percent for hospitals. Meanwhile, the shortage of primary care physicians is increasing demand for nurse practitioners and certified midwives.”

“{C}linical documentation, medical coding, billing, and information technology” are seen as among the big growth areas.

 

 


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