Week of April 14 - In Case You Missed It...TOMF Medical News Roundup
April 18, 2014
In Case You Missed It...
April 14, 2014
Good News for a Change
For several decades the Department of Health and Human Services and its predecessor agencies have created decade-long health goals. They call the effort "Healthy People" and then add the year they hope goals will be met.
In the past, results have often been dismal. This time around, things are different.
Healthy People 2020 progress reports show the US is did better than average through March 2014 - and there are still six years to go to reach targets.
Targets reached
Planners hoped to reduce children (ages 3-11) exposed to second-hand smoke from 52.2% to 47%. Stats show exposed children stands at 41.3%
Homicides per 100,000 were targeted at 5.5. They now stand at 5.3/100,000.
Adults meeting federal aerobic and weight training goals was to be increased from 18.2% to 20.1%. It now stands at 20.6%.
Air quality days nationwide have improved 60% over the goal set.
Targets improving
Nearly 60% of adults are getting colorectal screens. The goal is 70.5%.
Under control blood pressure is nearly 50%. The goal is 61%.
Fully immunized children is up from 44% to 68.5%, with a goal of 80%.
Injury deaths per 100,000 are at 57.1 with a goal of 53.7.
Infant deaths per 1,000 stand at 6.1 with a goal of 6.
Preterm births stand at 11.5% with a goal of 11.4%.
84.2% know their HIV status with a goal of 90%.
High school graduates are at 78.2% with a goal of 82.4%.
Adolescents using alcohol or drugs within the last 30
days has declined to 17.4% with a goal of 16.6%.
Adult cigarette smoking is at 18.2% with a goal of 12%.
Targets stuck
Little or no progress has been made with people being covered by medical insurance, people with a primary care doctor, A1c values for diabetics, obesity rates among adults and children, daily vegetable intake, binge drinking rates and rates of adolescent smokers.
Targets going the wrong way
Suicides and adolescent depression are up and only 4 out of 10 people have visited a dentist in the past year.
Hep C Cure - but at a Price
It took 25 years, but a cure for hepatitis C virus was announced in the New England Journal of Medicine. Roughly 15,000 Americans die from the disease every year. Even better, treatment consists of one pill a day and the side effects are as minimal as they can be.
Too good to be true? Almost.
Pills are priced at $1,000 per tablet, meaning only the patients most at risk will get medication.
New Hospital Services in Southern Arizona
Bisbee has a new ER, twice the size of the old one. Oro Valley Hospital now has a certified pediatric ER. Sierra Vista and Green Valley are building new hospitals that will open in 2015.
In Case You Missed It...
April 15, 2014
Good Nights?
Often you just need time. That is as true when you are recovering from a broken heart as when you are a busy ER physician trying to figure out what is wrong with grandma at 2 a.m.
This has led to the creation of observation units in hospitals. Rather than a battery of 2 a.m. tests on grandma, she is admitted to the hospital and evaluated over the course of a day to find out what is going on. Because this is a new, and growing expense, for Medicare, a new rule attempts to brake the profusion.
And the American Hospital Association is suing the US Department of Health and Human Services.
Called the "two midnight rule," admitting physicians must now certify upon admission that a Medicare patient is expected to stay over two midnights in order for the service to be paid as inpatient. "The two midnight rule undermines medical judgment, "says AHA President and CEO Rich Umbdenstock, "and disregards the level of care needed to safely treat patients."
The hospital association has time...to sue, that is. The rule was delayed for six months by a provision in the Doc patch legislation next month.
Who Cares About Doc Judgment?
If the two midnight rule undermines physician judgment, what are we to make of this year's laws passed by a handful of states? For example, New Hampshire just passed a rule for physicians to over-prescribe antibiotics for Lyme Disease, a practice of which no medical organization approves.
In Arizona, Legislative (and court) debate rages about use of drugs in medical abortion in non-FDA approved methods, while others want Arizona to require non-FDA approved use for drugs in cancer and children's' diseases and Marijuana use for seizures and PTSD.
After World War I French premier Clemenceau said, "War is too important to be left to the generals." Is our society saying disease is too important to be left to the doctors?
Jury is out.
Preventive or Not?
Wow!
We are getting many calls about what is free preventive care and what triggers a charge and patient co-pay. It stems from the federal health law that promises preventive care at no charge.
So we schedule a physical (no co-pay). During the physical we tell all about our aches and pains, that depressive episode at Christmas, as well as the blood pressure readings our doctor has been following since before health reform was a gleam in the Democratic Party's eye. Wham! Co-pay.
This isn't a good media to explain all this. Just know that preventive care is defined by statute. Our old conditions -- and new ones we bring up -- trigger "evaluation and monitoring" concepts, rules and charges.
It's part of the new game. Be aware.
In Case You Missed It...
April 16, 2014
Mental Illness and Jail Time
Miss your meds with a medical problem and you could end up in the emergency department of your local hospital. Miss your meds when you are mentally ill and you could end up in jail.
There are ten times the number of mentally ill in county jails, state prisons and federal penitentiaries than there are in state mental hospitals. To see the report, click here.
In Case You Missed It...
April 17, 2014
You Get to Decide
Next November Arizona voters will decide if terminal patients have the "Right to Try" medications that have made the first cut of patient safety in the FDA process.
The Arizona Senate passed the bill to put the referendum on the ballot yesterday. It was a bill written by the Goldwater Institute and will allow physicians to use experimental drugs on dying patients.
Far from a last gasp, this effort can add to the information about drug efficacy even if it does not save lives.
Conference Coming
The 23rd Southwestern Conference on Medicine® is coming to JW Marriott Starr Pass Resort & Spa next week and there is still time for you to sign up if you are a DO, MD, physician assistant or nurse practitioner.
It is presented by Tucson Osteopathic Medical Foundation in joint sponsorship with Cleveland Clinic.
Call 299-4545 or go to www.tomf.org/cme to register