Dr. Reece’s Pieces -24/7, April 29, 2010

Key Words - emergency rooms, ERs, medical homes, primary care, medical specialists, electronic medical records, imaging, CT, EMR, PET scans, Obamacare approval, Obamacare disapproval


EMERGENCY ROOM WOES - MSNBC: In as many as 42% of cases, ER patients give fake or inaccurate phone numbers, making it impossible or difficult for ER physicians to follow-up on patients with serious diseases or injuries when lab or x-ray results are delayed. Problems are due to short-term cell phone contracts, declining use of landline telephones, and patients who fear big bills or checks on immigration status. New York Times – ER use is exploding as millions lose jobs and medical insurance and turn to ER. This leads to long waiting lines and overworked doctors and nurses. New federal funds of $11 billion to 1200 community health centers for low-income patients may help relieve pressure.

SPECIALISTS SAY WE HAVE MEDICAL HOMES FOR PATIENTS TOO -New England Journal of Medicine. From California comes news that 45% of three specialist groups – cardiologists, pulmonologists, and endocrinologists – already serve as primary care physicians- and are therefore skeptical about medical home concept (L. Casalino, et al,” Specialist Physicians Practice as Patient-Centered Medical Home”).

WHO WILL CARE FOR 34 MILLION NEWLY INSURED PATIENTS? KevinMD.com, in “Primary Care Shortage Solutions after Health Care Reform,” Toni Brayer.MD, an internal medicine physician who blogs at EverythingHealth, reports that Obamacare will create access crisis to primary care doctors. Brayer says solutions are: *increase primary care residency program slots effective 2011 at teaching hospitals and pay more for those programs to increase.* Enact forgivable loans for all medical students who choose primary care and practice it for at least 5 years. * Raise the Medicare reimbursement by 40%. Even that may not be enough to turn this ship around. The inequities are just too large.* Allow even higher reimbursement for primary care doctors who practice in rural communities or under served areas. The pressures in those areas are magnified and should be rewarded.* Develop true systems of care where physicians treat the most complicated patients and nurse practitioners handle routine care.

ELECTRONIC MEDICAL RECORDS – "MEANINGFUL" FOR WHOM? -April issue of Health Affairs – “Health IT.: The Road of Meaningful Use.” The Obama administration has put a lot of its eggs, $20 billion worth, in the HITECH basket. When American Recovery and Reinvention Act passed in February 2009, only 6% of doctors and 2% of hospitals had fully functioning EMRs, yet EMRs, says David Blumenthal, MD, national coordinator of HITECH, says EMRs are a critical part of health reform puzzle. Yet what is meaningful to policy wonks and government managers may still be meaningless to doctors in small practices and hospitals. Combination of “free” EHRs, based on outsourcing to Internet , cloud computing concepts, new business models where advertisers pay freight based on Google methodology , and financial installation incentives for doctors and hospitals make constitute breakthrough for increased EMR use. I have always been suspicious when word “meaningful” is used. It usually comes from mouths or pens of self-righteous elites who think they, and only they, have answers to what society needs.

DO CT, MRI, AND PET SCANS REDUCE CANCER DEATH RATES? THESE IMAGING PROCEDURES MAKE UP 57% OF COSTS OF TREATING CANCER. ARE THEY WORTH IT? National Bureau of Economic Working Paper “Has Medical Innovation Reduced Cancer Mortality? Yes, the working paper says. It has caused a 40% drop in cancer mortality between 1996 and 2006 due to imaging innovation, and only 25% decline due to drug innovation. But investigators in Duke study in current JAMA are not so sure about imaging costs and drops in cancer mortality. They say it is impossible to tell if costs of CT, MRI, and PET scans help in reducing cancer mortality. Laurence Baker, professor at Stanford and Head of Health Services Research says, “No one wants to live in a world without MRI or PET scans. We have had a hard time figuring out when to use them and when not to.”

IF OBAMA HEALTH PLAN IS SO GREAT, WHY DO MUST AMERICANS DISAPPROVE? Real Clear Politics, Here are the facts, as shown by average of major polls, of Approval and Disapproval Obama and Democrats' Health Care Plans

Poll, Favor, Oppose, Spread

RCP Average 40.2, 52.7, +12.5

Rasmussen Reports 38, 58, +20

Democracy Corps 42, 49, +7

Quinnipiac 39, 53, +14

Associated Press 39, 50, +11

GWU/Battleground 44, 52, +8

FOX News 39, 54, +15

Conclusion: No Obama bump yet, but it’s a long way from April to November.