Sermo » Practice Management

How Meaningful Use Mandates Lost Their Purpose

marketingsermowpuser — Wed, 25 Feb 2015 13:00:46 +0000

~ by Linda M. Girgis, MD

The meaningful use program began as part of the HITECH stimulus bill, part of the initiative to get all healthcare providers on EHR systems. The meaningful use (MU) program was established to provide an incentive for compliance. In the early stages, physicians who met reporting requirements were given a cash bonus. This year, however, doctors are now being penalized if they haven’t qualified. Penalties are being taken out of the reimbursements we receive when we provide medical care to patients.

Many doctors certified for the first two steps of Stage 1 MU but his stumbling blocks with Stage 2. MU2 implementation has been delayed several times due to software issues with poor reporting metrics and hospital IT departments struggling to get their infrastructure up to speed. Hospitals and private practices are pouring money into integration solutions while doctors lament the MU changes are irrelevant to clinical practice. EHRs should improve medical outcomes of patients; many doctors don’t think this objective is being met.

Why do doctors think MU is meaningless to patient care?

The metrics doctors are required to report often bear no relevance to the patient we are treating. For example, we are supposed to record a patient’s smoking status at every visit. It seems ridiculous to most doctors to record smoking status on infants. But, that is an MU requirement.
Pertinent information is often buried in a patients’ record, cluttered by some many metrics that aren’t relevant. This eats into patient/doctor time and can delay treatment. Often the tedious task of checking boxes doesn’t promote good clinical outcomes.
Doctors now spend an unprecedented amount of time just charting. But it’s more about fulfilling MU requirements than recording necessary patient information. Doctors want more face time with patients, not less.
To meet the requirements of MU stage 2, patients need to communicate with their physician through a patient portal. Many doctors had trouble getting their portals active because the software vendors had difficulty interfacing the portal to the practice’s EHR system. Some patients simply do not want to communicate through portals, should we force an unwanted system of communication on them? However, a practice gets dinged if a patient chooses not to use the portals, even among patient populations that don’t have emails such as the very poor and the elderly.

Complying for MU in a large system is difficult, costly and time-consuming. But, hospitals and large networks have whole IT departments with staff devoted to that task. Imagine what it is like for smaller practices, many who are already struggling to stay afloat financially. We do not have IT departments nor extra staff. I have a storage closet with three routers networking all my systems. When one goes down, so does my practice. In order to comply with the first stage, we had to devote one of our staff full-time for several weeks. Our employee was not an extra hand we had on deck, but someone we had to pull from her usual duties. We ran our practice short-handed, and it was stressful for all involved. The bonus we received barely compensated for our lost time with that employee.

Those of us in the white coats, practicing medicine daily, see MU2 as a barrier to improved patient care. While we can see the potential, doctors MUST be more involved in the design. Big data in medicine is a big deal, we hope aggregated information via the EHR system will provide valuable insights in the years to come. But it must be a real-world, workable system that always keeps the patient foremost in mind.

Bio

Dr. Linda Girgis MD, FAAFP is a family physician in South River, New Jersey. She has been in private practice since 2001. She holds board certification from the American Board of Family Medicine and is affiliated with St. Peter’s University Hospital and Raritan Bay Hospital. She teaches medical students and residents from Drexel University, UMDNJ, and other institutions. Dr. Girgis earned her medical degree from St. George’s University School of Medicine. She completed her internship and residency at Sacred Heart Hospital, through Temple University. She has appeared in US News and on NBC Nightly News.

The post How Meaningful Use Mandates Lost Their Purpose appeared first on Sermo.

Medical Data Breaches: What Should We Do?

marketingsermowpuser — Wed, 18 Feb 2015 18:13:01 +0000

~ by Dr. Irving Loh, MD

Unless you’re a health care practitioner who’s been in a coma or a survivalist just now emerging from a cave, you’re aware of the sophisticated hacker attack on Anthem’s information technology network that exposed about 80 million current and former subscribers. You might think about going back into that cave.

This is the largest known and reported (possibly important caveats) illegal intrusions into a healthcare company (America’s second largest) gaining personal information such as names, addresses, social security numbers, medical IDs, email addresses, income and employment records. Exactly who perpetrated is still unknown, but the usual suspects of state or organized criminal hackers are most likely.

In the letter we received from Anthem’s CEO, Joseph Swedish, the company found no evidence that credit card or personal medical data were compromised, but that is of little solace since hackers have enough to create identity theft headaches for years to come. Personal medical data may be used by criminals to fabricate insurance scams or extort monies from patients with sensitive medical data. State sponsored entities might pay to know the medical history of important individuals. Regardless, these are the trees and the problem is the forest. The data was vulnerable and apparently unencrypted. More on that in a moment.

The Health Information Trust Alliance, a data security collaborative known as HITRUST, reports that Anthem adopted “strong information security controls” and participated in “cyber preparedness exercises” that were “crucial in their ability to detect, analyze, remediate and collaborate swiftly and effectively.”

Wait. The horse did leave the barn. This sounds more like a PR damage control statement.

After recent cyberattacks on Target, Home Depot and Sony, healthcare companies with their huge repositories of sensitive information should have gone into warp drive to secure their data. The most affected state insurance commissioners (CA, NY, OH, GA, etc.) and the U.S. government are now launching a nationwide investigation to focus on whether Anthem heeded earlier warnings about their security weaknesses and whether encryption should have been implemented.

Anthem’s Track Record

Other sectors, such as finance, have upped their security for years, but Anthem faced breaches before:

In 2006, personal information of 200,000 members were stolen from a vendor’s office.
In 2008, the insurer offered free credit monitoring after 128,000 members’ personal data were inadvertently placed online.
In 2013, federal regulators identified an Anthem data breach involving 612,000 customers which prompted a penalty of $1.7 million.
In 2014, the FBI sent out a healthcare industry-wide warning to tighten up their security measures.

Anthem stated encryption would not have blocked the cyberattack as the hackers had obtained a system administrator’s log-in. Fair enough, but the data obtained could have been encrypted at a level that dynamic decryption keys on the other end would be required to make any sense of those stolen data. From the subscriber vantage-point, perhaps higher levels of encryption with more complex passwords, perhaps randomly generated, or biometric markers, need to be in place. A problem with biometric data is that you are stuck with them…if they get hacked (as they may be in the future), you can’t change your fingerprints, retinal scan, or earlobe metrics (OK, our plastic colleagues can mess with the ears).

To its credit, Anthem intends to notify patients with compromised data, and provide credit monitoring and identity protection services at its expense. It is unclear for how long, although California law requires at least one year. Anthem also provided a hotline and website for queries.

Should HIPAA apply?

Alexis de Tocqueville saw in Americans the cultural character trait of fair play. Since the advent of that necessary evil, HIPAA, healthcare practitioners have been subject to large penalties for each proven HIPAA violation. Even without the specific medical data, the personal information compromised by this mega-hack fall under the jurisdiction of HIPAA. Take that penalty times eighty-million, and the Department of HHS will have made a dent in paying down the national debt. And forensic accountants need to make sure that any levied penalties are NOT cleverly passed through to their subscribers, but should come out of company profits and executive bonuses. THAT would go a long way towards ensuring future data security. Write your congressman. Not a phone call or a blast fax, but write…it carries ten times the weight because members of Congress and their staffs are aware of the effort involved in creating it.

What do you think?

Bio:

Dr. Irving Kent Loh MD, FACC, FAHA (Epidemiology & Prevention), FCCP, FACP is a board certified internist and sub-specialty board certified cardiac specialist with an emphasis on preventive cardiology. He founded and directs the Ventura Heart Institute, which conducts education, research and preventive cardiovascular programs. Dr. Loh is a former Assistant Professor of Medicine at UCLA School of Medicine. He is Chief Medical Officer and Co-founder of Infermedica, an artificial intelligence company for enhancing clinical decision support for patients and healthcare providers.

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Webinar: Physicians and Social Media

marketingsermowpuser — Fri, 30 Jan 2015 15:22:58 +0000

Doctors are in a unique position when it comes to social media. HIPAA concerns, administrative gaffs and more mean a physician’s career can end with just one tweet. Join Dr. Kevin Campbell, MD, FACC and FOX Medical Expert and our SERMO medial advisor Dr. Linda Girgis, MD, (DocLMG) to discuss the potential and pitfalls of social media.

February 10^th, 8:30- 9:30 pm EST

Physicians and Social Media, we’ll discuss:

The six ways physicians use social media
The benefits of social media
How to use social media channels to benefit your career or practice
Proper “Netiquette”
How a blog can benefit your career or practice

You will have the opportunity to ask questions and get answers from our experts!

Dr. Kevin Campbell has over 100,000 Twitter followers and has built a successful career as a cardiologist combining his expertise with television appearances and through social media. He is a regular medical contributor to FOX News. He’ll talk about his successes and what social media means to him.

Dr. Linda Girgis, started a Twitter account 18 months ago and has become one of the most influential doctors on social media. Her presence online has benefited her practice and given her the opportunity to speak on behalf of other physicians about such topics at vaccinations and MOCs. She is currently a columnist with Physicians’ Weekly and has appeared on NBC News and other media outlets.

Join us for a lively and informative discussion!!

Even if you can’t make the live webinar, sign up and we’ll notify you when the video is uploaded and viewable. If you’re an M.D. or D.O. you can read more information inside the community here.

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Financial Planning for Doctors: Four Ways to Improve Your Financial Life

marketingsermowpuser — Wed, 28 Jan 2015 13:00:42 +0000

By James M. Dahle, MD, FACEP / Editor of The White Coat Investor

I have a noticed a persistent and pervasive pessimism among physicians when they are talking amongst themselves, whether in a doctor’s lounge or on a virtual forum such as SERMO. One of the best antidotes I have found to feeling pessimistic about the future is the optimization of a doctor’s personal financial situation. When doctors feel their financial lives are under control, it is much easier for them to cut back on their hours or even walk away from a job they don’t like for whatever reason. In short, doctors who work because they want to, not because they have to, are happier, both at work and at home. No study supports this yet, but I suspect financially secure doctors render higher quality, more compassionate care to their patients. There are four ways to optimize the financial lives of physicians:

# 1 Retire Student Loans

I have found physicians who still owe money for their educations to be particularly unhappy about their financial situation. Although many of these physicians are young, a surprising number of those who still have a substantial student loan burden are ten or even twenty years out of residency. There are two basic strategies for eliminating student loans—obtain forgiveness or pay them off. There are a number of programs that will pay off your student loans under certain conditions. The three main programs are run by the federal government. The most significant, Public Service Loan Forgiveness, allows for tax-free forgiveness after ten years of payments for physicians working for a 501(c)3 organization. Two other programs not only help to lower your payments, but also allow for taxable forgiveness after either twenty (Pay As You Earn) or twenty-five (Income Based Repayment) years. Payments made during residency and fellowship count toward these totals.

If you are unable to obtain forgiveness for your loans, it is best to pay them off before you get used to your attending level income. “Live Like A Resident!” is the best advice I can give to a doctor who still has student loans. Keep living expenses low, so a large percentage of your newly acquired high income can be directed toward your student loans. Using this plan, and despite ever-increasing student loan burdens and high-interest rates, most physicians should still be able to pay off their loans within 2-5 years of finishing training. It is now possible to refinance student loans with several private lenders, and these lower interest rates can assist you in paying off those loans even faster.

# 2 Have a Definitive Plan for Retirement

It is important for physicians to have a spending plan (aka budget), an insurance plan, an estate plan, an asset protection plan, and an investing plan. When it comes to making physicians happier, nothing compares to have a realistic plan laid out for retirement. Some physicians have the knowledge, desire, and temperament required to do this themselves, but most will need to enlist the assistance of a competent, low-cost advisor to complete this task. A retirement plan will show you how much you will need each year in retirement, how much you need to save each year until then, and about when you will be able to retire. A good retirement plan will also lay out which investments and retirement accounts you should use. Using the best available options will increase the likelihood of success and decrease the amount of time required to reach financial independence.

# 3 Reduce Financial Costs

In my experience, the typical physician is paying too much in insurance premiums, too much in taxes, too much in mortgage-related costs and too much in financial advisory costs. The sum of these often totals tens of thousands of dollars per year. By redirecting this wasted money toward a retirement portfolio, financial independence can be reached years earlier. For example, consider the difference between a physician paying 0.5% of his portfolio in financial advisory fees each year versus one paying 1.5 percent. If he saves $50,000 per year, the portfolio makes 5 percent after inflation but before advisory fees, and he needs $3 Million to retire, the physician with the lower fees will be able to retire in 29 years. The physician paying higher fees, however, will need to work more than three years longer. Other examples of wasted money include physicians paying Private Mortgage Insurance (PMI) and doctors mistakenly investing in a taxable account instead of funding a backdoor Roth IRA. Special “doctor mortgage loans” essentially eliminate PMI, even for physicians who put down less than 20% on their homes. The Backdoor Roth IRA is a little-known loophole that allows doctors to still contribute to a Roth IRA each year, despite their high income.

# 4 Spend Your Money on What Makes You Happy

We each value different things in our lives. One doctor may value early financial independence while others may value flashy cars, nice clothing, eating out frequently, or expensive vacations. Each time you consider a purchase, evaluate it in terms of how much happiness it brings you. If you are like most, you may realize you are spending a considerable percentage of your income for goods and services that are not increasing your happiness. Be generally frugal in most things, but selectively extravagant in those areas that bring you the most happiness. If you don’t enjoy a $100 meal twice as much as a $50 meal, quit buying it. Be aware that the psychology literature shows that purchasing experiences, especially those shared with friends and family, seems to bring far more happiness to most people than purchasing consumer items.

By optimizing your personal finances, you can increase the enjoyment of your career, reduce stress at home, and feel more optimistic about the future. The first step is obtaining the financial education you never received in medical school or residency. While this does require some time and effort (though far less than it takes to practice your specialty), it can be obtained very inexpensively online or by reading a handful of high yield books available at low cost or even free through your local library. This “Continuing Financial Education” may end up paying you more in the long run than your medical education.

James M. Dahle, MD, FACEP is the author of The White Coat Investor: A Doctor’s Guide to Personal Finance and Investing and blogs at http://whitecoatinvestor.com. He is not a licensed financial adviser, accountant, or attorney and recommends you consult with your advisers prior to acting on any information you read here.

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EHRs Tied to Physicians’ Licenses: A Bad Idea

marketingsermowpuser — Wed, 17 Dec 2014 13:00:53 +0000

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~ by Linda M. Girgis, MD, FAAFP

Starting in January 2015, all physicians in Massachusetts must use an electronic health record system or face disciplinary action that could result in the loss of their license to practice medicine. Doctors fear these laws will spread to the rest of the country. While law makers are devising regulations and laws enforcing EHR use and metrics recording, doctors are saying enough. According to a survey on SERMO 97% of doctors polled felt that medical licenses should not be tied to compliance with meaningful use requirements.

EHR technology has great potential, but most doctors don’t feel the technology is meaningful or an effective as a tool in patient care. This fact alone makes tying our medical licenses to compliance with the requirements absurd. One internist wrote “ I have had the opportunity to use multiple EMRs through my residency and fellowship training. My feelings are:

they always slowed me down
took my attention away from patients and their issues/questions
often confused me on what medications the patient was on when multiple people could input medications
found the diagnoses were often confusing for the same reason as #3. EMRs should not be mandatory for physicians who provide efficient and quality care for their patients.”

According to one urologist: “Physician productivity and contact with patients is compromised. Physicians turn into coders and data entry clerks. The physicians I know who have worked with a certain EHR system are especially unhappy and frustrated.“

An ER doc went so far as to say, “EHR is a triumph of politics and cronyism over common sense. It is lining the pockets of those who are part of the new medical computer industry. It is antithetical to the art of medicine and will do nothing to improve the quality of medicine we practice.”

Not only do physicians find the EHR time-consuming and confusing, some have simply quit medicine because of it. One ER doctor said “The whole system is cumbersome, slow, and stupid to the point or surreality. I quit in October. Three other hospital staff members have also quit.”

EHR costs prohibitive

Cost is another big factor in EHR adoption. While it may not be difficult for hospitals and large healthcare systems to purchase pricey systems, it is wrecking havoc on small practices and private doctors. One ophthalmologist said, “We figured out the cost of EHR – extra staff to scan things, IT support and an amortization of the license. I would have had to increase my medicare volume by 30x to come out even.”

Overhead costs are soaring while our incomes are shrinking or at least remaining stagnant. It is difficult for already financially strained practices to meet this added expense.

While doctors object to purchasing and using inadequate EHR technology, they are more opposed to the meaningful use requirements recently imposed. Initially, it was set into place as a bonus program. Over a few years, the government is now rolling out penalties in reimbursement to doctors who fail to meet requirements. Politicians now tell us how to use EHRs to improve patient care with little physician input. Surely, doctors know more of what goes on in an exam room than our elected officials who are far more likely to be lawyers than doctors. As a result of reporting all these metrics, doctors are spending more time looking at their computer screens than with eye-to-eye contact with patients.

One orthopedist wrote, “EMR can’t replace the back-and-forth of an exam. Checking boxes is not the same as a hand-written notation such as the patient likes to crochet and likes the color blue (for whatever reason).” We are losing this personal knowledge of our patients by computerizing them. A Clinical Medicine lab specialist goes on to say, “Patient care is not just a science…it’s an ART. For the Art part, it has to be an up-close and personal event; you just can’t fill in a form, follow an SOP and hope for the best.”

The criteria put forth does not reflect quality patient care in many doctors opinions. “An ophthalmologist stated, “MU requirements get tougher, and the work to keep up with them is extremely time-consuming. I doubt we will make it through this year’s Stage 2, Year 1. I made it through the others, but this one seems to be beyond me. Is there any evidence to support that EHRs improve patient care? They certainly don’t improve patient flow or satisfaction”.

Physician compensation is sometimes pinned to the absurd. According to an endocrinologist, “ You know what “meaningful use” means to me? Every visit with an infant, or child with diabetes, or hypothyroidism, or short stature begins with the phrase, “the government requires me to ask you if Johnny started smoking since your last visit.” And if I don’t ask, I am not in compliance and my ‘quality’ metric goes down.”

Some of these measures are not even in the control of the doctors required to report them. A urologist informed us, “the criteria are not necessarily based on patient care, especially as one current parameter is a certain percentage of patients have to contact you electronically. No one can control whether or not your patient:

has internet access
has an email address
knows how to use a portal system

It makes absolutely no sense to tie licensure to whether or not a physician follows all the MU use rules, especially since the rules keep changing.”

With all this, imagine how enraged doctors are to have their licenses tied to proper implementation and usage. An occupational medicine doctor writes, “State boards are usually tasked with assuring public safety. I in no way see this as a public safety issue and therefore it should not be within the scope of a state medical board.”

“Licensure is and should be linked to education, competence, and a commitment to maintaining one’s knowledge. I cannot agree with even the suggestion that issues related to record-keeping, no matter what it is used for, have any place in consideration of a professional license of any kind,” wrote one general surgeon.

While patients are feeling they are not getting enough time with their doctors, these mandates are prying us further from the human contact they need and want. EHRs are a time drain, far from improving patient care, they are making it more difficult.

Doctors Do Not Stand Alone

Doctors are not alone in their stance against medical licenses being tied to EHR use and compliance with the accompanying regulations. According to Ken Congdon, Editor in Chief of Health IT Outcomes, “Although I am a supporter of the MU program and what it is trying to accomplish, requiring a physician to adhere to MU (or HER use) or lose their license is ridiculous. While there are several benefits to using the technology effectively, many physicians will never be comfortable using the tool. Does this mean they should be forced out of practice? Absolutely not. However, over time, patients may demand the benefits EHR technology facilitates (e.g. health record access, care continuity, patient portal, etc.). However, a provider’s patient base should drive this adoption. The state or other government body should not enforce licenses this way. Just because a physician doesn’t use an EHR doesn’t mean they’re not a good physician or valued caregiver.”

While the potential of EHRs is tremendous, the technology as it currently stands is failing us. This intrusion is unwanted and is decreasing the value of healthcare. We should test mandates efficacy before we tie physicians’ licenses to them. They should meet quality tests and minimum levels of clinical usefulness. We do not feel EHRs improve patient care, but rather they erode the doctor/patient relationship.

To mandate their use at this stage is ludicrous. To tie it to our medical licenses is insulting. There is no way a doctor’s competency could or should be determined by their ability to use an EHR or to compliantly check metric boxes.

Does anyone truly want a doctor whose quality is determined by their data entry skills? Patients deserve caring, astute doctors in exam rooms, delivering the best treatment options. Let’s focus on giving them the best of our knowledge and experience, not our secretarial skills.

Bio

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Doctors Face Tough Challenges in the Workplace

marketingsermowpuser — Mon, 01 Dec 2014 20:43:44 +0000

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Being a doctor isn’t what it used to be; crazy busy schedules, wrangling with computerized records, trying to remember what your children look like after another long week.

We asked our physicians what is the hardest problem they face in their practice. While no one is surprised about Work/Life balance being number one at 52 percent, the fact that 21 percent of physicians name EHRs as their biggest work headache is telling.

EHR challenges led to a new niche in medicine. A medical scribe is a person with knowledge of medical terminology who follows a physician throughout their day and enters EHR information for them. Medical scribes are a small but growing part of medicine.

Another new challenge facing physicians is the increased demands of MOCs (maintenance of certifications). Doctors now need continuing education credits more frequently and often the MOCs are tied to their ability to work in their specialty. If MOCs aren’t kept up-to-date physicians can lose hospital privileges or worse.

Work Life Balance for Doctors

We asked doctors earlier this year about physician burnout and what contributed to it. The top answers included:

Lack of control
Dysfunctional workplace
Extremes in work (boredom/chaos)

As a physician what is the hardest thing for you about your practice? What would you change? Do you agree with the poll or do you think there’s something important missing?

If you’re an M.D. or D.O. you can join our free, physician-exclusive community. Come on in and contribute to cases, vote on polls like this one and more.

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How Long Does Your Doctor Really Spend With You?

marketingsermowpuser — Fri, 14 Nov 2014 20:33:45 +0000

by Linda M. Girgis, MD, Family Practitioner

I often hear patients complain their doctor barely spends time with them at their appointments. Many feel rushed in and out, dumped on the curb, their wallets lighter by a co-pay. But, the truth is far from assembly line medicine. Patients rarely stop to consider the time we spend outside the exam room on their behalf, and it is hours a day.

Prescriptions eat up hours

Pharmacies often call us when a patient’s insurance rejects a prescribed medication. Instead of letting our patients battle it out with their insurance companies, we do the task ourselves. We spend time trying to find equally effective alternatives that may be on their insurers formularies. If not, then we are condemned to do the dreaded prior-authorization. The whole process can take up to half an hour of just being on hold waiting to speak to a living person. Or it can mean filling out prior authorization paperwork required by a particular insurance company. The patient just sees the prescription waiting for them at the pharmacy and not the work that went into getting it into their hands.

Diagnostic testing causes headaches

Authorizations for diagnostic testing can take hours, sometimes days, occasionally months. It includes a phone call to the insurance company, or a case management company as many now use. These calls can take 30-45 minutes of hold time to reach the responsible party. Office notes need to be faxed over for review. Often, the decision is made for a one-on-one peer consultation before approvals are granted. This means the doctor has to have a phone discussion with the medical director of the insurance company. Usually, this is a 15-minute call but can be longer.

When I’m fighting insurance companies, I can’t be in the exam room. These days the majority of my time is stolen by people with checklists following up on the work I do. They never see a patient or understand the nuances of a case. Doctors simply cannot examine patients and do these tasks at the same time. Every day, there are more and more regulations requiring us to do more paperwork and record more metrics.

EMRs and my former personal time

Doctors do not have the leisure to go home at the end of the day and just put our feet up and relax. Many days, I take my laptop home to work on patient charts after hours. To ensure we’re using our chart software in a meaningful way, the government dictates what information is important (even if we don’t agree). We are often filling in data points that are useful to the government for tracking purposes, but not to our individual patients. While we may spend 15 minutes with a patient in the exam room, recording that visit often takes longer. So, while most people go home and put their jobs down for the day, many of us are spending more time with patient charts.

On Call Is Still A Way Of Life

Doctors must be available 24/7 for patient care. Many of us take call hours and are available all night for calls and emergencies. We often sleep with phones next to us in case we’re needed, regularly jolted by a 4 am call. While this is not time in the exam room, this is time available to our patients to provide them better care. Yes, I’ve even taken a call at 3 am on Christmas morning, my children dreaming of Santa and presents.

Patients might feel they are at war with us as they try to get more face-to-face time. We feel we are in a war of paperwork and insurance bureaucracy to make sure our patients get the care they need. All we ask is for patients to take a little time and think about what happens outside of the exam room. That’s medicine too. Maybe if we work together we can reform the system, tame the paper tigers and put us back where we belong, with our patients.

Bio

credit: Linda Girgis, MD

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Doctors Support Mandatory Flu Vaccines

marketingsermowpuser — Mon, 10 Nov 2014 20:18:28 +0000

A recent Sermo Physician Poll supports medical personnel receiving flu vaccines to protect both employees and patients.

The question asked, “Do you support mandatory flu shots for medical personnel?” The results:

70% Yes
30% No

Why Flu Shots Matter

One endocrinologist who worked in a hospital commented, “The interest is not in minimizing sick days but in protecting immunocompromised or frail patients who come for care. All hospitalized patients are also offered immunization though I would assume there are no negative consequences to refusal.”

As we reported earlier, some facilities, like Johns Hopkins, require the flu shot or terminate the employee. Another doctor noted a more novel approach for compliance. “The flu vaccine is mandatory for all employees. If anyone refuses, they would need to wear a face mask at work for the entire flu season. Not surprisingly, we have 100% compliance.”

Population Compliance

The CDC tracks the numbers annually of the general population receiving the flu vaccine. Last flu season was a five-year high for compliance rate. Across the U.S., 58.9 percent of children and 42.2 percent of adults received vaccinations. The CDC added:

Based on a study of the 2012–13 flu season, flu vaccination … prevented an estimated 6.6 million illnesses, 3.2 million medically attended illnesses, and 79,260 hospitalizations.

Compliance did vary greatly by state. South Dakota had the highest compliance rate of 57.4 percent and Nevada had the lowest at 36.4 percent.

Some theorize the increase in vaccination could be due to the anti-vaccination movement which supports other immune-boosting strategies such as eating well and avoiding sick people. Sermo columnist Linda Girgis, MD, family practitioner recently debunked many of the myths common in the “anti-vaxx” movement.”

A Warning for This Year’s Flu Season

Early indicators suggest the predominant strains for the 2014 – 2015 flu season will be influenza A (H3N2) and influenza B. However, Ascel Bio Vice President and Infectious Disease Forecaster, James Wilson, M.D. said there is an issue with the nasal spray vaccine (“FluMist”) this season, it might not be as effective against H1N1 (swine flu) as in prior years:

“As forecasted, we are seeing an H3N2-dominant type A season, so concerns about whether the vaccine will protect against H1N1 infection is not looking relevant at this moment in the season. We will of course continue to monitor the season in the coming months to see how much H1N1 activity there ultimately is.”

As a physician do you prefer using a shot or the nasal spray for your patients?

Physicians Strongly Support Childhood Vaccinations

Doctors know the threat of low vaccination rates. We have seen diseases cropping back up that had been under control such as whooping cough in California and measles in the New York area. Another vaccination poll, conducted in August, showed 79 percent of physicians think unvaccinated children should not be allowed to attend school.

As a physician, do you get an annual flu shot? Do you think medical personnel should be required to vaccinate or risk losing their jobs? Do you think wearing a mask is enough encouragement for medical personnel to receive a shot? We will be discussing this more inside Sermo, if you’re an M.D. or D.O. please join us.

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What the Republican Win Means for Medicine in the U.S.

marketingsermowpuser — Wed, 05 Nov 2014 15:49:33 +0000

Last night’s “red wave” brought Republicans back in power in the Senate and pushed the House to the biggest Republican majority since 1932. Their big win and a few state ballot questions will have a direct impact on medicine in the US. We’ve rounded up a few results.

Recreational Marijuana now legal in five states and Washington, D.C.

Recreational marijuana bills passed in Alaska, Oregon and Washington, D.C. last night but failed in Florida. They join Colorado and Washington state. Healthcare pundits are watching what impact this will have on the population and if it will change opinions about medical marijuana.

Medical marijuana is currently legal in 23 states and the District of Columbia. Despite the growing number of states passing laws for its use, several bills were defeated. In 2014, medical marijuana passed in 14 states but failed in seven.

Physicians aren’t a big fan of marijuana; a SermoSays poll showed that 61 percent would not prescribe marijuana to a patient, even if legal. They cited Federal laws still in place and other medications that work equally well.

Drug Testing of Doctors Fails in California

Proposition 46 failed in California last night. The bill called for an increase in malpractice settlements from $250,000 to over a million and also called for standardized drug testing of physicians.

Only 35 percent of doctors think drug testing should be mandatory for physicians. A SermoSays poll from April breaks it down by profession among hospital administrators, HCPs, and pharmacists.

Physicians cite the dire consequences for their peers if they test positive. Often a positive test means the immediate suspension of license. A family practitioner wrote, “this seems to be a completely misguided ‘solution’ to a problem that may be real, but has a lot of other, and more effective, potential solutions.”

Dismantling Obamacare?

Obamacare will likely take a few hits after this election cycle. Expected Senate Majority Leader, Mitch McConnell, said it will be a top issue for his party. While no one thinks the entire Affordable Care Act will be repealed, Republicans will focus on the following three areas:

Repealing the medical device tax
Restoring the minimum hours for workers to qualify for health insurance from 30 back to 40 hours per week
Eliminating the mandatory compliance for health insurance

What do you think about last night’s election results? As a physician, do you think medical marijuana has a place in the U.S. healthcare system? Would you eliminate mandatory health insurance? If you’re an M.D. or D.O. we will be discussing this in detail inside the Sermo community. Please join us.

The post What the Republican Win Means for Medicine in the U.S. appeared first on Sermo.

Why Ebola Preparedness Is So Haphazard

wpsitecare — Tue, 28 Oct 2014 19:23:20 +0000

Click to enlarge

Ebola news scrolls by on our screens fast and furious. A suspect case here, a hospital failing there, airborne rumors, social chatter with scary and conflicting information. There seems to be precious little information coming out of official government channels

Twenty-six Ebola outbreaks have occurred since 1976. Researchers and medical teams documenting information about containment, contact lists, and patient care. This outbreak, the first to touch an urban area, has screamed out of control debilitating nations as the death count relentlessly mounts. The World Health Organization predicts up to 10,000 cases a week and in a best case scenario two months before the virus is back under control.

Extensive information about containment exists. Ebola protocols have been around for decades and have improved as we learn from each outbreak. Why then are so many mistakes happening now that Ebola has reached the United States?

Ebola Mistakes

Many within the community spoke about the Keystone Cops calamity that seems to be out there. A list of mishaps include:

Releasing the first patient for two days into the community before transporting him by ambulance for hospitalization.
Hospital staff wearing light protection in the early days of Duncan’s treatment; now two nurses have contracted Ebola, and the contact list reaches 76 people.
A nurse with a fever and Ebola patient contact calls the CDC about her low-grade fever and is cleared to fly; now 132 passengers and airline staff are on another watch list.
Dr. Nancy Snyderman, after being potentially exposed to Ebola when her cameraman contracted the disease, “elopes” on voluntary quarantine for Chinese food. Her “sorry, not sorry” response was she was asymptomatic and therefore not a threat.

Our most recent Ebola posts here.

We are also hearing from the physicians on the front-lines that they have received little, if any training.

One ER physician wrote, “As an ED physician, I have received no Ebola preparedness training. Neither has any other ED doctor or any of our ED nursing staff. We have NO IDEA if we have any personal protective gear or any protocol in place. But I did read in our local paper that our hospital is telling the media we are prepared for Ebola. In fact, they are holding a press conference today to explain it to the public! What a farce.”

A second physician wrote, “As an ED physician at a county hospital, I have still had ZERO training from my hospital on how to screen or isolate a potential Ebola patient. We have had no drills. No meetings. We have no isolation protocols, no plan. We are not prepared. No one believes it will come here, or infect enough people to be a real threat to the U.S. The CDC has told them not to worry and that it is hard to get sick from Ebola. So they don’t worry.”

Medical Personnel Search Online for Answers

Our infographic looks at the disconnect between medical teams and the flow of information. Physicians, are searching for best practices and are often turning to online sources. As of today, approximately 60 percent of all conversations in the Sermo community are focused on Ebola. Physicians are sharing stories about preparedness, patient treatment options, the possible Ebola vaccine and travel bans.

Doctors look to multiple channels for Ebola information. Fifty-four percent of doctors say they are checking with the CDC regularly, and 52 percent they are getting clinical information from their peers in Sermo. If you’re an M.D. or D.O. you can join the community to learn more about Ebola.

What do you think about Ebola preparedness in the United States? Do you support strict measures such as a travel ban from hot zones? Where do you get clinical information about Ebola?

The post Why Ebola Preparedness Is So Haphazard appeared first on Sermo.