Primary care physicians could increase Americans' willingness to become organ donors by educating their patients on the process during routine office visits and discussions about end-of-life care, according to a study in the January issue of the Journal of the National Medical Association.
"With more than 100,000 Americans waiting for organ transplants, it is crucial that we find new ways to increase donation. New efforts should focus on improving communication on the subject between healthcare providers and their patients," said J. Daryl Thornton, MD, lead author of the study.
Thornton conducted the research as a scholar with the Harold Amos Medical Faculty Development Program, a national program of the Robert Wood Johnson Foundation. Thornton is medical director of the Medical ICU at MetroHealth Medical Center in Cleveland and an assistant professor at Case Western Reserve University. He is also a researcher at the Center for Reducing Health Disparities at MetroHealth and CWRU.
Most often, the decision about organ donation is made by individuals coping with the death of a family member. Obtaining consent for organ donation under these circumstances is complicated, sensitive, and often unsuccessful. Most individuals who are organ donors make the decision during a visit to their local departments of motor vehicles, where workers are often not fully trained to address questions about the topic, the study found.
Shifting the location for requesting consent to a routine patient care setting may have an important impact on the number of organ donors, according to the study. About 65% of physicians surveyed agreed that organ donation discussions were within the scope of their medical practice, but only 4% reported having discussed the subject with their patients.
This is in spite of the fact that 30% of physicians reported talking about end-of-life care with their patients. The authors believe the study is the first to report on the paucity of organ donation discussions among primary care physicians and their patients.
According to physicians, the reasons for the low number of organ donation discussions include: the lack of formal training in organ donation, with only 17% of physicians receiving such training; and the lack of staff to address organ donation issues with patients, as reported by 64% of physicians. A small percentage of doctors reported having donor information available in their medical offices (11%), with even fewer having donor cards available (5%).
Primary care physicians, who had received organ donation education or who regularly discussed end-of-life issues with their patients, were more likely to talk about organ donation issues, the study found.
For this nationally representative study, 831 family and internal medicine physicians were surveyed. Hispanic and African-American primary care physicians were oversampled to determine how frequently they discussed donation with their patients and what factors encouraged or inhibited such discussions.
Race and ethnicity of primary care physicians may play an important role in improving organ donation, particularly among minorities. African-American and Hispanic physicians are likely to care for patients of similar race and ethnicities, according to the study.
As of Jan. 6, there were 105,307 people waiting for organ transplants, according to the United Network for Organ Sharing. People of color are disproportionately in need of donated organs, making up more than 50% of those waiting for a donation. African Americans, who comprise only 15% of the population, represent more than 25% of those on organ donation lists, and are more likely to die while waiting for an organ transplant.
"Increasing organ donation among people of all ethnicities should be a national healthcare priority. By increasing the number of organ donors, we can extend both the length and quality of life for those who need transplants," Thornton said.
The healthcare sector created 267,000 new jobs in 2009, including 22,000 payroll additions in December, new Bureau of Labor Statistics preliminary data released this morning show.
The overall economy shed 85,000 jobs in December as the nation's unemployment rate remained unchanged at 10%, according to BLS preliminary data.
Of the 22,000 new jobs in the healthcare sector in December, the biggest job growth came from physicians' offices, with 9,000 payroll additions, and home health services, with 8,000 payroll additions. Physician offices added 55,000 jobs in 2009.
The healthcare sector—which includes everything from hospitals to outpatient surgery centers to podiatrists' offices—has added 631,000 jobs since the recession began in December 2007. In that same time frame, the number of jobless people in the nation has risen from 7.7 million to 15.3 million, BLS figures showed.
Other healthcare highlights include:
Ambulatory healthcare services continue to push job expansion in this sector, with 179,000 jobs added in 2009, and 23,000 in December alone.
Outpatient care centers increased jobs by 13,000 in 2009.
Home healthcare services increased 74,000 jobs in 2009, with 8,000 added in December.
The BLS information is considered preliminary and may be revised.
The National Association of Insurance Commissioners told Congress this week it supports health insurance exchanges but wants them to be established and administered at the state level.
In a letter this week to House Speaker Nancy Pelosi, D-CA, and Senate Majority Leader Harry Reid, D-NV, NAIC said it backs the goals of healthcare reform to curb rising costs and improve quality of care. The association offered a qualified endorsement of provisions in the House and Senate bills that would:
Extend guaranteed issue protections to the non-group health insurance market
Eliminate pre-existing condition exclusions and annual and lifetime limits
End the practice of rating policies based upon gender and health
"The NAIC supports these measures, if they are paired with an effective individual mandate to mitigate the risk of adverse selection," said NAIC President and West Virginia Insurance Commissioner Jane L. Cline in the letter. "We also support the creation of state-based health insurance exchanges to streamline the process of purchasing coverage and make meaningful comparisons of health insurance plans much easier."
However, NAIC said consumers will benefit most from reform that ensures continued consumer protection and oversight of health insurance policies at the state level. NAIC wants Congress to:
Oppose the creation of a new federal Health Choices Commissioner and Health Choices Administration. Instead, regulators recommend health insurance exchanges be established and administered at the state level.
Ensure that all group policies be subject to the bill's reforms at the end of a five-year grace period and ensure that any risk adjustment be applied to both grandfathered and newly-issued policies.
Impose stronger penalties under the individual mandate provisions.
Avoid provisions that could separate the regulation of premiums from the regulation of solvency.
Allow the federal government to quickly shut down fraudulent multiple employer welfare arrangements that falsely claim to be exempt from state regulation.
Ensure that the effective dates of provisions in the new law are coordinated with implementation of the individual mandate and subsidies in order to mitigate the risk of adverse selection.
Insist that nationally-sold plans be subject to all statutes and regulations that apply to other plans being sold to the same population and that they remain subject to the oversight of state insurance regulators.
The NAIC also urged Congress to address healthcare costs, warning that unless spending is brought under control, all of these reforms will shift the financial burden from one group to another without reducing overall cost.
HHS today released its first National Health Security Strategy to protect public health during large-scale emergencies, such as natural disasters, bioterrorism strikes, and pandemics. The strategy sets priorities for government and non-government activities over the next four years.
"As we've learned in the response to the 2009 H1N1 pandemic, responsibility for improving our nation's ability to address existing and emerging health threats must be broadly shared by everyone—governments, communities, families, and individuals," HHS Secretary Kathleen Sebelius said in a media release. "The National Health Security Strategy is a call to action for each of us so that every community becomes fully prepared and ready to recover quickly after an emergency."
The strategy provides a framework for actions that will build community resilience, strengthen, and sustain health emergency response systems, as well as fill current gaps, she said.
"Events which threaten the health of the people of this nation could very easily compromise our national security. Whether it's a pandemic or a premeditated chemical attack, our public health system must be prepared to respond to protect the interests of the American people," Sebelius said. "In order to be prepared to both respond to an incident and to recover, we need a strong national health system with individuals and families ready to handle the health effects of a disaster."
The National Health Security Strategy and an interim implementation guide outline 10 objectives:
Foster informed, empowered individuals and communities
Develop and maintain the workforce needed for national health security
Ensure that situational awareness so responders are aware of changes in an emergency situation
Foster integrated, healthcare delivery systems that can respond to a disaster of any size
Ensure timely and effective communications
Promote an effective countermeasures enterprise, which is a process to develop, buy, and distribute medical countermeasures
Ensure prevention or mitigation of environmental and other emerging threats to health
Incorporate post-incident health recovery into planning and response
Work with cross-border and global partners to enhance national, continental, and global health security
Ensure that all systems that support national health security are based upon the best available science, evaluation, and quality improvement methods
The National Health Security Strategy also highlights specific actions that the nation—including individuals, communities, non-government organizations, and government agencies—should take to address public health threats.
Priorities for the federal government include improving the system for developing and delivering countermeasures—medications, vaccines, supplies, and equipment for health emergencies; coordinating across government and with communities to identify and prioritize the capabilities, research, and investments needed to achieve national health security; and evaluating the impact of these investments.
Federal, state, local, tribal, and territorial government agencies, as well as medical, public health, and community-based organizations collaborated to develop the strategy and interim implementation guide. HHS also solicited direct input from non-federal participants during six regional workshops, and worked with the Institute of Medicine to engage the medical community.
The Pandemic and All Hazards Preparedness Act directed HHS to develop the National Health Security Strategy with an accompanying implementation plan by 2009 and to revise the documents every four years. HHS said it will update the implementation plan every two years to reflect advances in public health and medicine.
Many of the Washington, DC, interest groups that are seeking to shape final healthcare legislation in the coming weeks operate with opaque financing, often receiving hidden support from insurers, drugmakers, or unions, the Washington Post reports. The groups, some newly formed and others reappearing with different sponsors, have spent months staging protests, organizing letter-writing campaigns and contributing to a record $200 million advertising blitz on healthcare reform, the Post reports.
The American College of Radiology today downplayed concerns that full body scanners at security checkpoints in U.S. airports would pose a health risk.
In the wake of a thwarted Christmas Day bombing attempt on Northwest Airlines Flight 253 in the skies over Detroit, the Transportation Security Administration has announced that it is ramping up the deployment and use of the scanners, which produce anatomically accurate images of the body and can detect objects and substances concealed by clothing.
TSA has deployed two types of scanning systems: Millimeter wave technology uses low-level radio waves in the millimeter wave spectrum. Two rotating antennae cover the passenger from head to toe with low-level RF energy. Backscatter technology uses extremely weak X-rays delivering less than 10 microRem of radiation per scan—the radiation equivalent one receives inside an aircraft flying for two minutes at 30,000 feet.
"The ACR is not aware of any evidence that either of the scanning technologies that the TSA is considering would present significant biological effects for passengers screened," ACR said in a media release.
"An airline passenger flying cross-country is exposed to more radiation from the flight than from screening by one of these devices," ACR said. "The National Council on Radiation Protection and Measurement has reported that a traveler would need to experience 2,500 backscatter scans per year to reach what they classify as a negligible individual dose. The American College of Radiology agrees with this conclusion."
AdvancedMD Software, Inc., a software-as-a-service medical practice and revenue cycle management provider, announced today that it has acquired PracticeOne, a private, CCHIT-certified, electronic health records software provider for physician practices. Financial terms of the deal were not disclosed.
AdvancedMD, based in Salt Lake City, said the acquisition of PracticeOne will allow it to expand its product line to include a SaaS-based electronic health records, integrating the clinical and financial functions of a practice to boost profitability, productivity, and improved claims processing, and patient safety and satisfaction.
The new product line also includes a patient portal, and mobile access to provide secure access to patient information and medical decisions via smartphones.
PracticeOne has headquartered in Richland, WA and Canoga Park, CA.
A new report released today shows that the growth of overall online job listings in most employment sectors ended 2009 on a positive note in December, with demand for healthcare practitioners, technicians, and support personnel leading the rally.
The Conference Board's Help Wanted Online Data Series, which tracks more than 1,000 online job boards across the United States, found that advertised vacancies for healthcare practitioners and technical occupations, the largest category by volume, also posted the largest December gain, with 45,100 new online listings, for a total of 541,400 online listings.
The sector had 497,400 online job vacancy listings in November, and 533,300 in October. Job demand was up in a wide variety of these healthcare occupations, including registered nurses and physical and occupational therapists. Demand for lower-paying healthcare support occupations rose by 9,200 listings in December—to 111,900, the report showed.
Because healthcare is such a broad field, the report noted that the demand for labor varies substantially from the highly specialized, highly skilled, and higher-paying practitioner and technical jobs to the lower-paying support occupations.
"In November, the last month for which unemployment data are available, advertised vacancies for healthcare practitioners or technical occupations outnumbered the unemployed looking for work in this field by almost three to one, and the average wage in these occupations is $32.64/hour. In sharp contrast, the average wage for healthcare support occupations is $12.66/hour and there were almost three unemployed looking for work in the field for every advertised vacancy," the report noted.
For all industries, online job demand grew by 255,000 advertised vacancies in December, the report added.
"Employers' modest increase in demand for labor in the second half of 2009 is a nice way to end what has been a very challenging year," said Gad Levanon, senior economist at The Conference Board. "The gap between the number of unemployed and the number of advertised vacancies is still very high, but the recent six months indicate that things are slowly moving in the right direction. The gap between the number of unemployed and the number of advertised vacancies is about 12 million, with 4.5 unemployed for every online advertised vacancy."
The U.S. Bureau of Labor Statistics, which will release its employment statistics for December and all of 2009 on Friday, has shown that the healthcare sector is one of the few areas in the economy that has seen monthly job growth throughout the recession, although that growth has slowed considerably in 2009.
University HealthSystem Consortium has formed a strategic partnership with Executive Health Resources, Inc., that will make the medical management company's Physician Advisor compliance, consulting, and auditing programs available to all UHC members.
"This strategic partnership with EHR will offer UHC members not only specialized pricing, but also services that include customized improvement insights," said Tom Robertson, vice president, business strategies and tactics, UHC. "In essence, members will receive the added benefit of a specific plan for concurrent medical necessity compliance and denials management."
Under the agreement announced today, Oak Brook, IL-based UHC's 107 academic medical centers and 220 affiliate hospitals can use EHR's programs, which include Concurrent Medicare Medical Necessity Compliance, Medicaid Medical Necessity Compliance, Retrospective Governmental Payor Appeals Solutions (including Comprehensive RAC, MAC, MIC, and QIO denial management), Managed Care/Commercial Payor Appeals, and Expert Advisory Services.
UHC and EHR will also analyze hospitals' member-level data to identify areas for improvement and customize plans for medical necessity compliance and denials management services. EHR will provide on-site implementation programs to educate case management staff on using EHR services.
Newtown Square, PA-based EHR, which works with more than 900 hospitals and health systems across the nation, said its Physician Advisors have successfully performed more than 1.2 million medical necessity reviews, conducted hundreds of audits at hospitals, and identified and reversed thousands of RAC medical necessity denials at all levels of appeal.
Healthcare spending in the United States grew 4.4% in 2008, to $2.3 trillion or $7,681 per person, the slowest rate of growth since the federal government started officially tracking expenditures in 1960, CMS reported this week.
Even with the slower growth, however, healthcare spending continued to outpace overall economic growth, which grew by 2.6% in 2008 as measured by the Gross Domestic Product. The findings are included in a report by CMS' Office of the Actuary.
"This report contains some welcome news and yet another warning sign," said Jonathan Blum, director of CMS' Center for Medicare Management. "Healthcare spending as a percentage of GDP is rising at an unsustainable rate. It is clear that we need health insurance reform now."
The 4.4% growth in 2008 was down from 6% in 2007 as spending slowed for nearly all healthcare goods and services, particularly for hospitals, CMS said.
Healthcare spending as a share of the nation's GDP continued to climb, reaching 16.2% in 2008, up 0.3% from 2007. Larger increases in the health spending share of GDP generally occur during or just after recessions, CMS said.
The recession significantly impacted health spending as more broke or jobless Americans went without care. This led to slower growth in personal healthcare paid by private sources, which increased only 2.8% in 2008. The recession also made it difficult for many Americans to afford private health insurance, so the growth in private health insurance benefit spending slowed to 3.9% in 2008, CMS said.
Health spending was also impacted by the $787 billion American Recovery and Reinvestment Act of 2009, which provided a temporary 27-month increase in Federal Medical Assistance Percentages used to determine the federal Medicaid payments to states. The legislation shifted about $7 billion of Medicaid spending from states to the federal government for the last quarter of 2008, CMS said.
Other statistics on the growth of healthcare spending in the new report include:
Hospital spending in 2008 grew 4.5% to $718.4 billion, compared to 5.9% in 2007, the slowest rate of increase since 1998.
Physician and clinical services' spending increased 5% in 2008, a deceleration from 5.8% in 2007.
Retail prescription drug spending growth also decelerated to 3.2% in 2008 as per capita use of prescription medications declined slightly, mainly due to impacts of the recession, a low number of new product introductions, and safety and efficacy concerns.
Spending growth for both nursing home and home health services decelerated in 2008. For nursing homes, spending grew 4.6% in 2008 compared to 5.8% in 2007.
Total healthcare spending by public programs, such as Medicare/Medicaid, grew 6.5% in 2008, the same rate as in 2007.
Healthcare spending by private sources of funds grew only 2.6% in 2008 compared to 5.6% in 2007.
Private health insurance premiums grew 3.1% in 2008, a deceleration from 4.4% in 2007.
