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Latest Posts

A FICO Score For Medication Compliance?

In Keeping Score on How You Take Your Medicine, Tara Parker-Pope of the New York Times, reports on a new initiative from the Fair Isaac Corporation (FICO) known previously for its credit score ratings.  FICO has developed a Medication Adherence Score, using publicly identifiable information (like employment status, age and gender) to determine a patient’s score, which it says “can predict which patients are at highest risk for skipping or incorrectly using prescription medications.”

Parker-Pope reports, “By the end of the year, an estimated two million to three million patients will have been given a FICO medication adherence score and a total of 10 million patients are expected to be scored during the next 12 months…FICO officials say insurance companies and other health care groups will use the score to identify those patients who could benefit the most from follow-up phone calls, letters and e-mails to encourage proper use of medication.”

The FICO medication adherence score has not received a universally warm reception: e-Patient Dave and Society for Participatory Medicine member Alexandra Albin point out that the score only accounts for whether prescriptions are purchased, not whether the pills have actually been taken.

In a related effort, Geisinger Health Systems and CVS Caremark are conducting a study to assess whether enhanced doctor-pharmacist communication can help with medication adherence.  Shefali S. Kukarni reports in Tracking Down Patients Who Skip Their Drugs that, “The 18-month investigation will track a prescription from the moment it is submitted electronically to the pharmacy until it reaches the patient. If the patient does not pick up the prescription a ‘red flag’ or some form of notification will be sent to the doctor.”

But as Jessie Gruman recently blogged, there is no magic pill to cure poor medication adherence.   Read more »

*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*

Why Don’t More People Use Health Apps For iPhones And Droids?

Jessie GrumanI have been musing about why, despite our fascination with gadgets and timesaving devices, so few of us use the apps and tools that have been developed to help us take care of ourselves.

The range of options is staggering – my iPhone coughed up 52 applications for medication reminders just now – but most of us don’t make use of the (often free) high-tech help available to us.  There are hundreds of websites and portals to help us monitor our diets, physical activity and blood sugar, talk to our doctors by e-mail and understand our test results.  Apps can help us watch for drug interactions, unravel our test results, adjust our hearing aids and track our symptoms.  Devices can monitor whether our mom is moving around her house this morning or continuously monitor our vital signs.

Interesting ideas.  Modest pickup.

DSCF6172In an essay published in the May issue of the American Journal of Preventive Medicine supplement “Cyberinfrastructure for Consumer Health,” I make some observations about why this may be so, Read more »

*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*

Patients Don’t Want To Communicate With Their Doctors On Facebook

Patients may not want to discuss clinical matters via social media, but they’d gladly set pay their bills when reminded. Social media’s value in communicating with patients is limited to the administrative aspects of it.

Americans still want traditional ways of communication when they need a clinical consult. A survey finds 84% would not use social media or instant messaging channels for medical communication if their doctors offered it, according to the communications firm Capstrat.

Respondents were more favorable toward conferring with the doctor via e-mail (52%) than they were by Twitter and Facebook (11%), chat or instant messaging (20%) or a private online forum (31%).

Even among those 18 to 29 years old, 21% said they would take advantage of an online forum if their doctor offered it, while 72% would take advantage of a nurse help line if available.

Respondents said they’d take advantage of online appointment scheduling (52%), online access to medical records (50%), or online bill payment (48%).

“It appears consumers are willing to move administrative experiences such as bill payment and records access online, but when it comes to conferring with their health care providers, people still prefer more traditional communications,” said the firm’s president, Karen Albritton, in a press release. “The implications include a way for doctors to free up more time for their patients by moving the right interactions online, and an opportunity to forge stronger connections through personal interaction.”

Patients want the same convenience of online appointments and bill paying from their doctor that they get in other areas of their lives, reports a second survey.

73% of those surveyed would use a secure online option to get lab results, request appointments and pay medical bills. The first caveat is that this survey was done by Intuit. The company is best known for QuickBooks, but its health care division offers patient portals for doctor’s offices. The second caveat is that respondents were surveyed online, which would skew results to people digitally inclined anyway.

With those two caveats in mind, the survey also found that:
–Almost half would consider switching doctors for a practice that offered online access.
–81% would schedule their own appointment via a secure Web service and fill out medical/registration forms online prior to their appointment.
–78% would use a secure online method to access their medical histories and share information with their doctor.
–59% of generation Y respondents said they would switch doctors for one with better online access, compared to only 29% of baby boomers.
–45% of patients wait more than a month to pay their doctor bill, and when they pay, half still send a paper check in the mail.

*This blog post was originally published at ACP Internist*

Referral Communication: What Happens To Handoffs Between Primary Care Physicians And Specialists?

Far more primary care doctors report detailed referrals than do specialists report receiving them. The same applies in reverse. Specialists report returning quality consultations, while primary care physicians report receiving them far less often.

Researchers reported in Archives of Internal Medicine that perceptions of communication regarding referrals and consultations differed widely. While 69.3 percent of primary care physicians reported “always” or “most of the time” sending a patient’s history and the reason for the consultation to specialists, only 34.8 percent of specialists said they “always” or “most of the time” received the information. And, while 80.6 percent of specialists said they “always” or “most of the time” send consultation results to the referring physicians, only 62.2 percent of primary care physicians said they received it.

So where are the reports going? Read more »

*This blog post was originally published at ACP Internist*

Making 2011 “Meaningful”

Today, $27 billion in incentives begin for using electronic medical records, as office- and hospital-based providers begin to register for meaningful use criteria.

Providers must use a certified system according to Centers for Medicare and Medicaid meaningful-use guidelines for 90 consecutive days within the first year of the program to qualify. Eligible professionals can receive up to $44,000 over five years under the program. There’s an additional incentive for eligible professionals who provide services in a Health Professional Shortage Area. To get the most money, Medicare-eligible professionals must begin by 2012. By 2015, Medicare-eligible professionals and hospitals that do not demonstrate meaningful use get punished. Read more »

*This blog post was originally published at ACP Internist*

Latest Interviews

How To Make Inpatient Medical Practice Fun Again: Try Locum Tenens Work

It s no secret that most physicians are unhappy with the way things are going in healthcare. Surveys report high levels of job dissatisfaction burn out and even suicide. In fact some believe that up to a third of the US physician work force is planning to leave the profession…

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Caring For Winter Olympians In Sochi: An Interview With Team USA’s Chief Medical Officer Dr. Gloria Beim

I am a huge fan of the winter Olympics partly because I grew up in Canada where most kids can ski and skate before they can run and partly because I used to participate in Downhill ski racing. Now that I m a rehab physician with a reconstructed knee I…

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Latest Cartoon

Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

***

Click here for a musical take on over-testing.

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Latest Book Reviews

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

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