Physicians not asking enough about alcohol use

January 8, 2014
alcohol screeningOne major television network, several major US newspapers, and numerous online media sources cover a Vital Signs report released by the Centers for Disease Control and Prevention on Tuesday showing that many Americans are drinking too much alcohol, even though they are not alcoholics, and that many of these individuals have never discussed their alcohol use with their physicians.

NBC Nightly News (1/7, story 8, 1:50, Williams) reported that the CDC has released a new report revealing that “many millions of Americans drink too much,” a problem rarely discussed with their physicians. NBC News chief medical Editor Nancy Snyderman, MD, explained, “At least 38 million people in the United States drink too much and most are not alcoholics.” Still, 75 percent of binge drinkers claim never to have had a discussion about their alcohol use with their physicians. CDC Director Thomas Frieden, MD, MPH, was shown saying that a brief interview with a physician “can result in a substantial reduction of problem drinking for a long period of time.”
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House, Senate Committees approve bill to overhaul how Medicare physicians are paid

December 16, 2013
capitalThe Wall Street Journal (12/13, Schatz, Subscription Publication) (12/13, Schatz, Subscription Publication) reported that the House Ways and Means Committee and the Senate Finance Committee on Thursday approved legislation to revamp how Medicare physicians are paid. The measure would scrap the current way physicians are reimbursed by Medicare and replace it with a system under which doctors would be rewarded for meeting quality standards. In a statement, the AMA lauded the move. Because lawmakers have not determined how to pay for the legislation, it is not expected to pass before the end of the year.

The Washington Times (12/13, Howell) reported that lawmakers “both parties said they were driven by the desire to provide year-over-year certainty to doctors and the seniors under their care.” The Times quotes Senate Finance Chairman Max Baucus (D-MT) as saying, “After a decade of Band-Aid solutions, it is time for this committee to act. I am proud to say that today we are taking the first step.”
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Senate and House to take up permanent SGR repeal

December 11, 2013
The AP (12/11, Alonso-Zaldivar) reports that both Democrats and Republicans now favor a permanent change to “Medicare’s broken physician payment policy,” known as the “sustainable growth rate” (SGR) and are working towards a new system that would contain “financial carrots and sticks for doctors to provide quality, cost-effective care” for Medicare patients, with “up to 10 percent of an individual physician’s pay” connected to “quality indicators.” This week, the Senate Finance Committee is expected to take up “a broad bipartisan framework” on the matter which will also be taken up by the House Ways and Means Committee. Yet, Congress will still have to adopt a “temporary patch” for early 2014, as no one expects agreement on a plan before the beginning of the year. The biggest obstacle to that is the need to find “offsets” to the cost of the temporary fix. As to the permanent fix, the AMA is said to be “reserving judgment.”

The National Journal (12/11, Ritger, Subscription Publication) reports that one reason why a permanent repeal of the Sustainable Growth Rate seems likely is that the cost over ten years has now fallen according to the CBO from over $150 billion to $116.5 billion. Still, it “won’t happen before the holiday recess.” One version of a permanent replacement, attributed to the House Ways and Means committee, would adjust physicians’ payments, starting in 2017, “based on four performance metrics: quality of care, budget-neutral resource use, meaningful use of electronic health records, and clinical-practice improvement activities.”

The Hill (12/10, Viebeck) reports in its “Healthwatch” blog that a three month patch is expected. CQ (12/11, Ethridge, Subscription Publication) reports that both Senate Finance and House Ways and Means committees are expected to take up permanent plans tomorrow, but have not “announced plans to bring a short-term patch to either chamber’s floor.”

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Americans more likely to put off healthcare due to costs

health care reformNovember 14, 2013
CBS News (11/14, Jaslow, 3.87M) reports a Commonwealth Fund survey of 20,000 adults in 11 “high-income countries” found that the US led the categories of residents who “went without recommended medical care, did not see a doctor when ill or failed to fill a prescription” due to cost at 37 percent; those having “major problems paying medical bills” at 23 percent; per capita spending at $8,500; and administrative costs at $606 per capita. Second place in those categories went to Sweden (6 percent); France (13 percent); Norway ($5,670); and France ($277). Commonwealth Fund president Dr. David Blumenthal commented that the US spends “more on health care than any other country,” but still “falls short in terms of access to care, affordability, and quality.” The countries in the survey were Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States.

The Dallas Morning News (11/14, Landers, 1.13M) reports the study found, “Americans are frustrated” by “costs, accessibility and complexity.” Indeed, 75 percent said that “fundamental changes” were needed. The News points out that “coverage gaps” in other countries also lead to delayed care so that New Zealand (41 percent) and Australia (28 percent) both have higher rates of adults putting off dental care than does the US (27 percent). Among the countries surveyed, residents of the UK were happiest with 63 percent saying that “it works well or needs only minor changes.”
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