The Daily Briefing

News for Health Care Executives

Should doctors 'fire' unvaccinated patients?

Physicians say vaccine refusers may endanger other children

February 16, 2012

More physicians are turning away families who refuse to vaccinate their children, but some health care experts argue that the practice violates a physician's responsibility to those patients, the Wall Street Journal reports. 

According to the Journal, many pediatricians consider preventing disease through immunizations a primary goal of pediatrics. Although CDC data show that certain immunization rates increased between 2009 and 2010, officials have partly blamed lower inoculation rates for recent U.S. outbreaks of whooping cough and measles.

However, parents may decide not to immunize their children for various reasons, including concerns about autism and vaccines' potential impact on a child's immune system. In all but two U.S. states and the District of Columbia, parents may opt out of school-mandated vaccines based on religious beliefs.

USA Today reports that legislators in seven states currently are considering bills to relax opt-out requirements to include philosophical exemptions. Nineteen states currently allow such exemptions.

Should physicians turn unvaccinated patients away?
As they grapple with parental resistance, many physicians over the past decade have adopted a stricter stance on inoculations.

A study published last year found that 30% of 133 Connecticut physicians had asked a family to leave their practice for refusing immunizations. Another recent study found that 21% of 909 Midwestern pediatricians asked families to leave for the same reason.

In comparison, American Academy of Pediatrics surveys found that in 2001 and 2006, only 6% of physicians "routinely" and 16% of physicians "sometimes" asked families to leave over refusals. "There's more noise among pediatricians, more people willing to argue that it's OK to do this versus 10 years ago," says Douglas Diekema, a professor of pediatrics at the University of Washington.

According to the Journal, physicians might dismiss unvaccinated patients because they think they could endanger other infants or children who cannot be fully inoculated. David Fenner, a physician at New York-based Children's Medical Group, notes that if a family still refuses to vaccinate after a comprehensive discussion, "there are so many things we're not going to see eye-eye on."

However, other health care professionals say physicians should strive to provide the best care for their patients regardless of their vaccination stance. "The bottom line is you should try to do whatever you can to maintain the family in the best care," says Michael Brady, the chair of pediatrics at Columbus, Ohio-based Nationwide Children's Hospital. "If they leave your practice, they're probably going to gravitate toward another practice with unhealthy practices" (Wang, Journal, 2/15; Ellis, USA Today, 2/15).

GOP senators to unveil Medicare overhaul plan

Lawmakers say the plan could save $200B to $500B over 10 years

February 16, 2012

Republican Sens. Tom Coburn (Okla.) and Richard Burr (N.C.) on Thursday will unveil a Medicare reform plan that would raise the eligibility age, hasten the transition for many beneficiaries into private insurance plans, and increase premiums for high-income beneficiaries, AP/U-T San Diego reports.

Overall, the lawmakers estimate that the plan, which has not been analyzed by the Congressional Budget Office, would save between $200 billion and $500 billion over 10 years. Coburn says they hope the plan will spur a "grown-up" conversation in Congress about the changes necessary to Medicare, which is "our biggest problem."

According to AP/U-T San Diego, the Coburn-Burr plan is unlikely to advance in Congress during an election year. However, several of its components have previously drawn bipartisan support from two debt committees, House Budget Committee Chair Paul Ryan (R-Wis.), and President Obama. Those components include:

  • Limiting private supplemental insurance for seniors;
  • Raising premiums for high-income beneficiaries; and
  • Overhauling copayments to provide additional protections against catastrophic costs.

Like Ryan's 2011 Medicare overhaul plan, the Coburn-Burr plan would gradually raise the Medicare eligibility age to 67.

Burr said his plan also would create "a competitive bid model much like Part D," adding that under the proposal, "some seniors would go for lower premiums and some for higher premiums and richer benefits."

The Coburn-Burr plan would begin the beneficiaries' transition to private insurance plans earlier, in 2016. The plans would compete with a revised version of the existing Medicare program. Although benefit requirements would not be explicitly laid out for the private plans, they would have to meet a test of basic insurance value (Alonso-Zaldivar, AP/U-T San Diego, 2/16).


Two simple tests may predict your dementia, stroke risk

Walking speed, hand grip strength correlated with cognitive function

February 16, 2012

Walking speed and hand grip strength during middle age may help predict an individual's dementia and stroke risk, according to new findings that are slated to be presented at the American Academy of Neurology annual meeting in April.

For the study, Boston Medical Center researchers analyzed data for 2,410 participants—average age 62—who had not previously been diagnosed with dementia or had a stroke. The researchers examined the participants' walking speed, grip strength, and cognitive function, and performed MRI scans of their brains.

During the 11-year follow-up, 34 participants developed dementia and 70 individuals experienced a stroke.

Walking speed
According to the findings, participants who had a slower walking speed at baseline were 1.5 times more likely to develop dementia than participants with faster walking speeds.

The study also showed that slower walking speed correlated with lower cerebral brain volume and poorer memory, language, and decision-making capabilities.

Hand grip
Meanwhile, participants who were aged 65 or older and had a stronger hand grip at baseline had a 42% lower risk of stroke or mini-stroke than individuals with a weaker grip. However, participants younger than age 65 did not experience the same difference.

Stronger hand grip correlated with higher cerebral brain volume and cognitive function.

Reaction and next steps
Noting the need for additional research, the authors concluded that "walking speed and hand-grip strength might serve as clinical markers of the need for a more detailed assessment of brain function."

According to lead study author Erica Camargo, "[t]hese are basic office tests [that] can provide insight into the risk of dementia and stroke and can be easily performed by a neurologist or general practitioner."

According to Dr. Marshall Keilson, director of neurology at New York City-based Maimonides Medical Center, "at the very least...This research suggests novel approaches to early identification of dementia and stroke risk. It would be interesting to test an even younger patient population with the same protocol" (Preidt, HealthDay, 2/15; Bankhead, MedPage Today, 2/15; HealthDay/US News, 2/15).

Done deal? Lawmakers strike doc fix accord

Agreement would delay physician pay cuts for 10 months

February 16, 2012

Lawmakers on Wednesday finalized an agreement to delay scheduled Medicare physician pay cuts for 10 months, prompting backlash from physicians who vehemently called for a permanent fix.

Congressional negotiations concluded with about an hour to spare before a midnight deadline to prepare a bill for a House vote on Friday. Leaders of the conference committee hope the bill will be ready for President Obama's approval before the congressional recess starts at the end of this week.

The agreement includes a 10-month "doc fix," which would allow Medicare to maintain current physician reimbursement rates, delaying a 27.4% reduction in fees slated to start on March 1. To offset the $20 billion cost of the doc fix, the agreement would:

  • Cut $5 billion from the prevention and public health fund created by the federal health reform law;
  • Reduce aid to hospitals when Medicare beneficiaries do not pay for services; and
  • Reduce Medicaid funding to Louisiana, which received increased funding from the overhaul.

Physicians criticize conferees for missed opportunity on SGR
Physicians groups criticized the committee for failing to permanently repeal the sustainable growth rate (SGR) formula, Modern Healthcare reports.

American Medical Association President Peter Carmel said the group is "deeply disappointed that Congress chose to just do another patch—kicking the can, growing the problem, and missing a clear opportunity to protect access to care for patients."

The American Osteopathic Association said the "scenario was avoidable," and criticized the group for rejecting a "fiscally responsible proposal that would have repealed the SGR and placed Medicare on a more stable financial path" by using war savings to offset the costs (Reichard, CQ HealthBeat, 2/15 [subscription required]; Steinhauer/Pear, New York Times, 2/15; Goldfarb/Weyl, CQ Today, 2/16 [subscription required]; Taylor, AP/Boston Globe, 2/15; Bendavid/Hughes, Wall Street Journal, 2/16; Zigmond, Modern Healthcare, 2/15 [subscription required]).

Joint Commission unveils tool to avoid wrong-site surgeries

Tool helped pilot sites cut wrong-site surgery risks by nearly 50%

February 16, 2012

The Joint Commission on Tuesday unveiled a tool that aims to help health care providers reduce the risk of wrong-site surgery, Modern Healthcare reports.

Wrong-site procedures may occur when a physician confuses a patient's left and right sides or performs the wrong operation. The Joint Commission estimates that wrong-site surgeries occur up to 40 times per week.

The Targeted Solutions Tool was developed by the Joint Commission Center for Transforming Healthcare in coordination with eight hospitals and ambulatory surgical centers (ASCs). Using Robust Process Improvement methods—which incorporate Lean Six Sigma and change-management methodologies—the organizations identified 29 main causes of wrong-site procedures that stemmed from organizational culture or occurred during scheduling, preoperative holding, or in the OR.

Participating pilot sites were able to use the tool to reduce the number of surgical cases with wrong-site risks by 46% in the scheduling area, by 63% in preoperative areas, and by 51% in the OR.

The Targeted Solutions Tool is available to all Joint Commission-accredited organizations via its extranet (McKinney, Modern Healthcare, 2/14 [subscription required]; AHA News, 2/14; Joint Commission release, 2/14). 

Drugmaker warns hospitals, physicians of fake cancer drug

Counterfeit Avastin missing active ingredient

February 16, 2012

Roche Holding on Tuesday warned that a counterfeit version of Avastin, its widely used cancer drug, has been distributed on the U.S. market.

The company and its U.S. biotech unit Genentech said they were informed of the fake drug by a health authority outside the U.S. Roche said the counterfeit product was produced in a foreign country, which it did not disclose. The company added that the counterfeit version did not contain Avastin's active ingredient.

According to a Roche spokesperson, the fake drug already has been distributed to U.S. health care facilities. It is unclear how much of the fake drug is in circulation. Roche is unsure if any patients have received the counterfeit drug, a Genentech spokesperson said.

FDA is investigating the issue and has sent letters to 19 medical practices across the country that might have purchased the fake drug. Roche and Genentech in a statement said they "are working with the FDA and law enforcement to aid their evaluations, determine the source of the counterfeit drug, and prevent its further distribution" (Rockoff/Weaver, Wall Street Journal, 2/15; Berkrot, Reuters, 2/14; Perrone, AP/U-T San Diego, 2/14).

Hospital prices play key role in health spending variation

Researchers: Most price variation attributable to 'unexplained' differences

February 16, 2012

Hospital and provider price differences account for one-third of overall health care spending variation among insured U.S. residents, according to a new Center for Studying Health System Change (HSC) study.

For the study, researchers examined 2009 claims data for 218,000 active and retired nonelderly unionized autoworkers and their dependents. Overall, they found that health spending per enrollee varied significantly across 19 communities despite essentially uniform benefits.

The researchers determined that two-thirds of overall spending variation could be attributed to differences in service quantities. Although those differences mostly could be explained by demographic factors, the researchers found that about 18% of variations in service quantities occurred for unexplained reasons. 

Meanwhile, researchers attributed the remaining third of overall spending variation to differences in provider prices.

For example, they determined that average hospital inpatient care prices were 55% higher on average for insured autoworkers than for Medicare patients. However, that percentage varied significantly by community: autoworker prices for inpatient care in Syracuse, N.Y., and St. Louis were only 30% higher than Medicare prices, while autoworker prices in Lake County, Ill., were two-and-a-half times higher.

According to the study, most of the variation in provider prices was unexplained and could not be attributed to the cost of doing business (HSC release, 2/15; Evans, Modern Healthcare, 2/15 [subscription required]).

HHS, DOJ recovered record $4.1B in 2011

DOJ convicted more than 700 health care fraudsters in 2011

February 16, 2012

HHS Secretary Kathleen Sebelius and Attorney General Eric Holder on Tuesday announced that their agencies recovered a record-high $4.1 billion in health care fraud judgments in 2011, about 50% more than in 2009.

Federal officials on Monday said the increased recovery rate can be attributed to new fraud-fighting tools. The Department of Justice (DOJ) and HHS said they have strengthened enrollment requirements and that both agencies are more thoroughly screening health care providers. About 1,400 people were charged with fraud in 2011, leading to more than 700 convictions.

Investigators also are conducting site visits to ensure that moderate-risk providers have legitimate offices. Meanwhile, high-risk providers are subject to background checks and fingerprinting. The officials also noted that they are doing a better job of sharing data between agencies.

Holder said fraud strike force teams in fraud hot spots such as Miami, Detroit, and Los Angeles "reflect a strong, ongoing commitment to fiscal accountability and to helping the American people at a time when budgets are tight." DOJ officials also praised judges for increasing sentences for fraudulent activity from an average of 42 months in 2010 to more than 47 months in 2011 (Carlson, Modern Healthcare, 2/14 [subscription required]; AHA News, 2/14; AP/Washington Post, 2/13).

ACO roundup: Key news from Feb. 10-Feb. 16

Report makes recommendations for ACO health IT infrastructure

February 16, 2012

The Daily Briefing editorial team rounds up the top accountable care stories of the week.

  • ACO health IT infrastructures should be flexible, secure, and able to support analysis and patient care coordination, according to a recent report by the eHealth Initiative's accountable care council. For example, the report notes that ACO health IT infrastructures should allow for secure, HIPAA-compliant data exchange, collection of data from clinical workflow, and use of telehealth (Evans, Modern Healthcare, 2/12 [subscription required]).
  • Struggling to explain ACOs to patients? WBUR's "CommonHealth" has created a cartoon to explain the accountable care concept in simple terms (Goldberg, "CommonHealth," WBUR, 2/10).
  • Writing in Modern Healthcare this week, Mike Murphy, President and CEO of San Diego-based Sharp HealthCare, explained why his organization pursued Pioneer ACO status. Despite the potential risks, Murphy says Sharp is "committed to the exploration and development of innovative payment models that are aimed at delivering coordinated, patient-centered care." According to Murphy, Sharp sees ACO models "as a vehicle to expand our significant existing managed-care infrastructure and experience to patients who have not been engaged with their providers along the entire continuum of care" (Murphy, Modern Healthcare, 2/11 [subscription required]).
  • Oregon: The state Senate this week voted 18-12 to approve a key component of Gov. John Kitzhaber's (D) health care plan that will create a system of "coordinated care organizations" to manage Medicaid benefits. "The vote today brings us one step closer to creating a more sustainable health care system through improved health and reduced waste and inefficiency," Kitzhaber says (Giegerich, Portland Business Journal, 2/14).

Reserve your copy of the Health Care IT Top 10

February 16, 2012

On Tuesday, Feb. 21 at HIMSS12, we’ll be releasing limited copies of our new 2012 publication, Health Care IT Top 10: Upping Your Act, Again, in 2012. 

Please reserve your copy in advance for pick-up at the Advisory Board Company Booth [7310].

Daily roundup: Feb. 16, 2012

Bite-sized hospital and health industry news

February 16, 2012

  • California: Gov. Jerry Brown (D) this week signed legislation reinstating California's Board of Registered Nursing, which was disbanded earlier this year. Last fall, Brown vetoed a bill that would have extended by four years the board's powers to license and discipline California's 400,000 RNs. As a result, the board disbanded Jan. 1 after operating for 106 years. The new bill that Brown signed into law reinstates the board through 2015 (Siders, "Capitol Alert," Sacramento Bee, 2/14). 
  • Georgia: Mercer University plans to open a medical school campus in Columbus through a partnership with The Medical Center and St. Francis Hospital. Mercer will place as many as 80 third- and fourth-year medical students on the new campus, which will open with about a dozen staffers and faculty members (Atlanta Business Chronicle, 2/10).
  • Illinois: Cleveland Clinic has reached its first adult oncology affiliation deal with Cadence Health. Per the deal, Cadence will pay a fee to the Clinic to use its resources for clinical purposes and its name for marketing purposes. The affiliation is part of a larger Cleveland Clinic effort to expand its network (Glenn, MedCity News, 2/13).
  • Rhode Island: The state's myocardial infarction hospitalization rate has decreased by 30% since Rhode Island implemented a smoking ban in public places in 2005, according to a state Health Department study. However, the study found no change in asthma rates (Freyer, Providence Journal, 2/14). 

Looking for a new shrink? Your smartphone will see you now

The New York Times this week highlighted several recent studies that examined how smartphone- and computer-based applications may help address conditions like anxiety and depression.

The apps use an approach called cognitive bias modification, which seeks to "break some of the brain's bad habits," according to the Times.

Recent research has examined a program developed on the premise that people with social anxiety tend to focus subconsciously on hostile faces in a crowd of people with mostly neutral expressions.

The program shows users two faces: One with a neutral expression and one that looks hostile. A split-second later, the images disappear and a letter flashes on the screen. Users push a button to identify the letter, and the action aims to help teach users to ignore the hostile faces. The researchers say that with repeated practice, users' eyes can be trained to automatically look away.

Nader Amir, a psychologist at San Diego State University, conducted a series of experiments and found that about 50% of patients with an anxiety disorder who used the program for about 30 minutes twice a week over four to six weeks showed enough improvement that their anxiety diagnosis was no longer accurate.

While such programs might have some success in treating anxiety, they do not appear to have the same effect on depression, according to University of Pennsylvania researchers, who last year analyzed several bias modification studies.

Meanwhile, researchers from Harvard University and Boston University found conflicting results in the largest study to date on the programs. For the study, 338 participants with mild to severe anxiety symptoms completed more than 4,000 sessions of the two-face program and found that anxiety levels among a placebo group and those using the program fell by the same amount.

Phil Enock, a study researcher and graduate student at Harvard, said, "We're not exactly excited about that finding; we have no idea what it means," adding, "We certainly have shown that you can deliver treatments on smartphones, you can put attention and bias modification tools literally in people's hands, and there's no reason to hold back" (Carey, Times, 2/13).