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Family-medicine residents look to widen scope

 

GP

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.


‘Dr. Joe’: Does this familiarity breed contempt?

 

Should patients call their physicians by their first names?

As this Medscape piece notes: “The rules of engagement have certainly changed in the 21st Century. In society as a whole, people and relationships have been getting steadily less formal. ”

“…In neighborhoods from Portland, Maine, to Portland, Oregon, kids call their friends’ parents by their first names. It’s no surprise, then, that this level of informality has crossed over into the medical suite.”

“{U]nfortunately, there are no definitive guidelines on how physicians and other providers should be addressed, how patients prefer to be addressed, or how staff should introduce themselves. Aside from a few small studies, published data remain scant.”


Med students in the ER

 

This study, published  in JAMA, “investigates associations between the presence of medical students in the emergency department and patient length of stay at three urban academic hospitals in the United States.”


FTC opposes big Pennsylvania system merger

 

The Federal Trade Commission  seeks  to block Penn State Hershey Medical Center’s proposed merger with PinnacleHealth System, asserting that the new central Pennsylvania  entity would raise prices and lower healthcare quality in the area.

“The proposed merger would eliminate the significant competition between these hospitals {hospital systems} resulting in higher prices and diminished quality,” said Debbie Feinstein, director of the FTC’s Bureau of Competition.

PinnacleHealth and Penn State Hershey responded by saying:

“We are extremely disappointed that the FTC does not share the enthusiasm of the many employers, community leaders, private physicians, commercial insurance providers and others who have recognized the benefits of our integration and demonstrated their broad support for it.”

The systems have asserted that the proposed merger would create “the depth of services and scale” needed to manage population health at the lowest possible cost.

But  hospital mergers have tended to be associated with higher prices in their regions as a result of less competition.

The FTC’s decision displays its continuing skepticism and frequent opposition to  hospital mergers, especially since 2007.

Deals that would give systems more than 40 percent of the market share  in their regions tend to ignite the agency’s opposition.


Swiss healthcare system: Expensive and good

matterhorn

The Matterhorn.

This piece  in the New England Journal of Medicine looks at how the Swiss healthcare system combines  a strong emphasis on individual responsibility with community solidarity.

It concludes:

“Overall, the Swiss healthcare system is costly and has room for improvement, particularly in terms of accountability for the quality, appropriateness, and cost of health care services. Yet by and large, it has served the Swiss population very well. The combination of ‘liberalism,’ in the classic European sense {personal responsibility}, and solidarity — of respecting choice, autonomy, and individual responsibility while not letting anyone in need of health care suffer or die for lack of financial resources — seems to work, at least for Switzerland.”


This patient-centered counseling didn’t do much

 

This piece in JAMA Internal Medicine looks at the efficacy of promoting patient-centered counseling to reduce use of low-value diagnostic tests.

The mission was  “to evaluate the effectiveness of a standardized patient (SP)-based intervention designed to enhance primary care physician (PCP) patient-centeredness and skill in handling patient requests for low-value diagnostic tests.”

The authors concluded that “An SP-based intervention did not improve the patient-centeredness of SP encounters, use of targeted interactional techniques, or rates of low-value test ordering, although SPs were more satisfied with intervention than control residents.”


The joys of cognitive computing

Anil Jain, M.D., and Kathy McGroddy Goetz, writing in Hospitals & Health Networks, explain how hospitals can benefit from “cognitive computing.”

They explain that cognitive computing can:

·       “Understand and interpret natural language

·       “Extend what humans and machine can do

·       “Help experts to make better decisions by penetrating the complexity of big data — including structured and unstructured data.”

And:

“The volume of biomedical, clinical, psychosocial, personal and research data available continues to grow at an increasingly overwhelming pace.  It is implausible for even the most diligent physicians to keep up with the proliferation of information and, consequently, many providers fail to connect their patients with the best care potentially available to them. If we use cognitive computing systems to give doctors the tools they need to succeed, and empower expertise in every individual caregiver, we can convert information overload into meaningful guidance that allows caregivers to perform at their highest potential.”

Further, “Cognitive computing also can be applied to the challenge of managing the cost of care, by helping organizations to understand where best to apply limited resources. Getting each complex patient just the right care (and avoid unnecessary care) at just the right time requires a careful balance between the a priori knowledge and the interactions of hundreds of factors — a perfect use for cognitive computing. When you have a system that can provide decision support based on intelligent analysis of all of those elements, and can collect and analyze data on which interventions and pathways are most effective, it becomes far easier to meet the demands of tightening margins in the setting of new value-based payment models.”


Healthcare hiring rise may be bad for America

 

Healthcare hiring is up,  reports this Modern Healthcare piece, but that might not be a good thing for the economy because it means that even more money is being directed into what is the  world’s most expensive healthcare sector, per-capita and otherwise. That means less money to address other national needs.

 

 


Using IBM’s Watson to transform healthcare

 

Read this to find out how  IBM’s Watson is using data to transform healthcare.

In this interview,  Deborah DiSanzo, who runs  IBM’s Watson Health unit, says “We’re going to help people track the genome of diseases and patients, and find the best paths to help clinicians treat their patients better. In population health, we’re going to give people and clinicians paths to help them treat their diabetic patients, their congestive heart failure patients, keep patients out of the hospital and help improve their outcomes.

“That’s what Watson Health looks like clearly in five years. Beyond that, I don’t know. Watson Health is only 7 months old, and it has close to 100 million electronic health records, 30 billion images, 100 ecosystem partners. It’s tremendous.”

 


New fund for for integrated care, healthcare-job development

 

HealthAffairs reports that a new loan fund, Vital Healthcare Capital (V-Cap), has been created to address  two critical challenges: “(1) investing in better models of care for vulnerable people such as the frail elderly, people with disabilities, and at-risk children; and (2) investing in better models of employment for the growing ranks of frontline health workers, who are critical to improving the well-being and reducing the overall cost of care for people with complex needs.”

The article says that “V-Cap’s goal is to be a catalyst and to promote integrated care systems that improve health as well as develop high-quality jobs for frontline health care workers in low-income communities.”


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