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AAFP Provides Tips to Address Patients' Vaccine Concerns

Physicians must be prepared to explain the risks and benefits of vaccinations

MONDAY, April 14, 2014 (HealthDay News) -- Physicians remain the biggest influence on whether patients get vaccinated, and must be prepared to address patients' reservations, according to an article published in the March/April issue of Family Practice Management.

Marie T. Brown, M.D., from the Rush University Medical Center in Chicago, and colleagues describe tactics to effectively communicate the risks and benefits of vaccination to patients who express uncertainty about vaccines.

The authors write that physician recommendation is the most important factor influencing a patient's decision to be immunized. Practices should make immunizations a priority and include nurses in an advocacy role. Other reasons patients decline vaccinations are the mistaken beliefs that they are healthy and can naturally fight infections; that they or their child will get the illness from the immunization; that there is little threat of the disease anymore; and that the immunization is part of a conspiracy. Physicians' practices need to take into account patients' socioeconomic and cultural backgrounds and should always be prepared to suggest some trustworthy information sources.

"Only by developing a trusting relationship with our patients will we learn of their concerns, be able to address them, and hopefully continue to help our patients avoid these devastating but preventable diseases," Brown and colleagues conclude.

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Patients Select Fewer New Docs at Bottom of Tiered Ranking

Tiered networks combined with payment-based reforms can improve performance, authors say

MONDAY, April 7, 2014 (HealthDay News) -- Patients are less likely to select a new physician ranked in the bottom of a tiered network, but often don't switch if their current physician is ranked at the bottom, according to research published online March 11 inHealth Services Research.

Anna D. Sinaiko, Ph.D., and Meredith B. Rosenthal, Ph.D., both from Harvard University in Boston, estimated the impact of tier rankings on physician market share among both a plan of new patients and on the percent of a physician's patients who switch to other physicians.

The researchers found that physicians in the bottom tier (least-preferred), particularly certain specialists, had a lower market share of new patient visits than physicians with higher tier rankings. Patients were more likely to switch health plans if their physician was in the bottom tier, but patients did not switch away from physicians whom they'd previously seen based on tier ranking.

"The effect of tiering appears to be among patients who choose new physicians and at the lower end of the distribution of tiered physicians, rather than moving patients to the 'best' performers," the authors write.

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Fewer Americans Overwhelmed by Medical Bills

Reduced use of medical care, early health care reforms may be easing financial worries

WEDNESDAY, April 9, 2014 (HealthDay News) -- While millions of Americans still feel hamstrung by medical expenses, a new government report shows that some people are getting relief.

The share of people under age 65 in families reporting problems paying medical bills in the past 12 months dropped from 21.7 percent in the first half of 2011 to 19.8 percent in the same period in 2013, according to the U.S. National Center for Health Statistics, which is part of the U.S. Centers for Disease Control and Prevention. That still leaves 52.8 million people who say they or members of their families were having problems paying medical bills, or were unable to pay those bills, in the past year.

The report draws data from the long-running National Health Interview Survey, which collects health information from family members in each surveyed household. The new analysis is based on household interviews with nearly 227,000 people.

"Almost five million fewer people than two and a half years ago are in families having problems paying medical bills," report co-author Robin Cohen, Ph.D., a statistician with the U.S. Centers for Disease Control and Prevention, toldHealthDay.

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6 Best Tips to Boost Your Documentation Process: Tip 2


documentation tipsGood documentation is important for new physicians as well as veteran caregivers. While documenting can seem like a very straightforward skill, there are often “best practices” that can be utilized. As a hospitalist for EmCare at St. Petersburg General Hospital in St. Petersburg, FL I write a “weekly documentation tip” email to help physicians improve their clinical documentation. I also share these documentation strategies with the residents I teach. In this 6-part series, each Thursday, I’ll be sharing my most recent documentation tips.


by: Timothy N. BrunDage, M.D., CCDs

2. Acute MI ICD-10 Update
Acute MI will default to STEMI. AMI documentation must be more specific to either STEMI or NSTEMI. ICD-10 Guidelines dictate that all unspecified AMI will default to STEMI.
• AMI type 2 must be further specified to NSTEMI
• Unspecified AMI default to STEMI could negatively affect quality metrics
• Always document the site of MI if known (anterior wall, interior wall, etc.)
• Always document the age of the MI
• ICD-10 uses four weeks to distinguish between acute and old MI (previously eight weeks with ICD-9)
• Subsequent myocardial infarction is an MI after four weeks

brundageTimothy N. Brundage, M.D., CCDs is a Certified Clinical Documentation Specialist and Diplomate of the American Board of Internal Medicine

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High-Fat Diet Tied to Certain Subtypes of Breast Cancer

High intake of saturated fat increases risk of HER2-negative, ER/PR-positive disease

MONDAY, April 14, 2014 (HealthDay News) -- High intake of saturated fats is associated with increased risk of certain subtypes of breast cancer, according to research published online April 9 in the Journal of the National Cancer Institute.

Sabina Sieri, Ph.D., of the Fondazione IRCCS Istituto Nazionale dei Tumori in Milan, and colleagues analyzed data from a prospective cohort of 337,327 women to assess the association between fat intake and development of breast cancer subtypes.

The researchers found that high intake of fat was associated with increased risk of estrogen receptor (ER)-positive, progesterone receptor (PR)-positive disease, but not ER-negative or PR-negative disease, for the highest versus lowest quintiles of total fat (hazard ratio [HR], 1.20; 95 percent confidence interval [CI], 1.00 to 1.45) and saturated fat (HR, 1.28; 95 percent CI, 1.09 to 1.52). High intake of saturated fat was associated with significantly greater risk of human epidermal growth factor 2 receptor (HER2)-negative disease.

"High saturated fat intake particularly increases risk of receptor-positive disease, suggesting saturated fat involvement in the etiology of this breast cancer subtype," the authors write.

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Innovation: The Heart and Soul of EmCare and Medicine


Innovation seriesThis post is part of EmCare’s 4-part Innovation series where we highlight what innovation means to members of EmCare’s leadership. Follow this series each Tuesday to discover our commitment to innovation in health care. 


By Thom Mayer, M.D. Emcare Executive Vice President

EM for Innovation

Innovation is all the rage these days. The October 2013 issue of Harvard Business Review’s cover story was “The Radical Innovation Playbook: How to Engineer Breakthrough Ideas.” Consulting companies such as Accenture have placed a major effort on innovation for their clients. And innovation had clearly made its way into healthcare, with Duke, Kaiser, UCLA, The Cleveland Clinic, and others forming innovation teams to accelerate the pace of change in their organizations. And EmCare’s 2013 strategic planning meeting was largely focused on how best to innovate and implement (a key word we will come back to it repeatedly) strategies that differentiate EmCare and transform our practices.

Innovation is not new - it is the heart and soul of medicine and the future of our clinical practices. It must focus on improving patients’ lives, improving the lives of those who care for the patient, and creating hope for the future of both. But innovation without implementation across the entire practice is a waste of time, energy, and resources. It is important to understand the mission, vision, and strategies as the context in which the innovation efforts are embedded. Without that context, innovation can seem disruptive simply for the sake of disruption and not as serving the core values we hold.

I believe healthcare innovation must be driven by three other reasons:

  1. Measurably improving both the clinical and service outcomes for our patients
  2. Making the job of doing so easier for our physicians and clinicians who provide that care
  3. Creating hope for the future of our Practices

Let’s consider each one of these.

First, the patient always comes first, and our innovation efforts must always keep that at the forefront of our efforts. Whether clinically or from a service standpoint, we must always ask, “How does this benefit the patient?” And if it doesn’t benefit the patient, why are we doing it? we should be unafraid to make the results of our performance transparent and open to analysis on how they can be improved.

scribesSecond, we must also consider how we can make implementing those best practice innovations in a way in which it makes our jobs easier, not harder. Implementing scribes is an example of an innovative solution that benefits the patient and those who care for the patient.

Third, what do I mean by “creating hope for the future of our practices?”

Most of us would agree that there are fundamental elements of our daily practice which, despite our passionate commitment to our patients and their families, are sources of major dissatisfaction. We need only think about boarders, delays, bottlenecks, and shortages in order to remind us of how frustrating our lives can be on a daily basis. That requires a combination of a somewhat maniacal commitment to implementation and audacity.

One of the earliest examples for emergency medicine is an evidence-based approach to patient safety called “Creating the Risk-Free E.D.” (CRFED) CRFED is a protected, internet-based educational protocols comprising roughly 30 of the most commonly encountered and high-risk clinical entities in emergency medicine.

Following the implementation of the CRFED concept, our loss runs, loss reserves, and malpractice insurance premiums dropped 70 percent! The CRFED program now comprises both adult and pediatric modules, as well as a “Nurse’s Guide to the Risk-Free E.D.,” since it is critical that our nurses know how we intend to approach and treat these patients.While watching David Letterman’s “Top 10” list one night, it suddenly struck me that we already know the “Top 10” clinical entities constituting our risk of having a malpractice suit filed against us. Why not risk-proof our practice by developing evidence-based approaches to these patients and assuring that all of our clinicians were exposed to them and complied with them.

Mayer for InnovationDr. Thom Mayer is founder and CEO of BestPractices®, Inc., an EmCare affiliate, and executive vice president of EmCare. Dr. Mayer is recognized as one of the nation’s foremost experts in leadership and management in emergency medicine. His work has been recognized by the American College of Emergency Physicians (ACEP) as well as the American College of Healthcare Executives (ACHE). Dr. Mayer has twice been honored by ACEP as its Outstanding Speaker of the Year and three times for its “Over the Top Award.” He has lectured on key clinical and leadership issues for ACEP for each of its past 32 Scientific Assemblies. He is the Keynote Speaker for ACEP’s Emergency Department Director’s Academy (EDDA) and is the chief editor of the landmark textbook, Emergency Department Management: Principles and Practices. He has also written Leadership for Great Customer Service, Hardwiring Flow, and Leadership for Smooth Patient Flow, the latter of which won the 2008 James Hamilton Award from ACHE for the best book on healthcare leadership. Dr. Mayer is also the Medical Director for the NFL Players Association, where his work on concussions has transformed the understanding of sports concussions.

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EmCare 2013 Genesis Cup Winner featured in Becker's Hospital Review  

Innovation Series Part 1: EmCare Increases Its Focus on Innovation

EmCare Announces its 27th Annual Leadership Conference


2014 leadership conferenceEmCare-affiliated clinicians have hit the jackpot again!

The 2014 EmCare Leadership Conference will be held in Las Vegas for the third straight year, on April 23-25.

While the city and venue will be familiar, the sessions and assemblies have all new benefits to offer this year’s invited attendees.

David Nash, MD, will be the 2014 keynote speaker. Dr. Nash is the founding dean of the Jefferson School of Population Health (JSPH).

He is also the Dr. Raymond C. and Doris N. Grandon Professor of Health Policy. JSPH provides innovative educational programming designed to develop healthcare leaders for the future.

“Dr. Nash is not only a brilliant physician,” said Dr. Dighton Packard, EmCare’s chief medical officer, “but his remarkable first-hand knowledge on population health and quality under the current healthcare system will prove very valuable to our EmCare-affiliated clinicians. Dr. Nash’s presentation – along with all of the sessions we’ve planned for this year – will arm our physicians with some very valuable information and tools to take back to their hospitals. This event is designed to explore new ways to improve overall quality of care for patients.”

EmCare’s service line leaders, including Dr. Packard, Dr. Hicks, Dr. Rose, Mark Hamm and Dr. Josephs, will focus on Integration, Collaboration and Respect.

EmCare’s annual leadership conference is also where physicians of the year and the Genesis Cup awards are announced. The Genesis Cup is EmCare’s national honor for innovation in healthcare.

Watch the video below to see highlights from last year’s leadership conference!


Do you want to attend EmCare's leadership conference next year? Become an EmCare clinician!

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EmCare Honors 2013 Physicians of the Year

EmCare Genesis Cup Honors Innovation, Creativity in Health Care

Individualized Risk Should Guide Mammography Screening

Risk models, decision aids need further optimization to avoid overdiagnosis

TUESDAY, April 1, 2014 (HealthDay News) -- Better decision aids that incorporate individualized risk could improve breast cancer screening, according to a review published in the April 2 issue of the Journal of the American Medical Association.

Lydia E. Pace, M.D., and Nancy L. Keating, M.D., both from Brigham and Women's Hospital in Boston, conducted a systematic literature review to identify studies describing the benefits and harms of mammography and individualizing screening decisions and promoting informed decision making.

The researchers found that mammography screening was associated with a 19 percent overall reduction in breast cancer mortality (approximately 15 percent for women in their 40s and 32 percent for women in their 60s). The cumulative risk of a false-positive result was about 61 percent for a 40- or 50-year-old woman undergoing 10 years of annual mammograms. Over 10 years, roughly 19 percent of the cancers diagnosed would not have become clinically apparent without screening (overdiagnosis), although there is uncertainty about this estimate. Baseline breast cancer risk was found to greatly determine the net benefit of screening; this risk should be incorporated into screening decisions.

"To maximize the benefit of mammography screening, decisions should be individualized based on patients' risk profiles and preferences," the authors write.

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ER Use Up With Health Care Reform in Massachusetts

Consistent increase in emergency department use in within-reform and post-reform periods

WEDNESDAY, April 2, 2014 (HealthDay News) -- Implementation of health care reform in Massachusetts was associated with an increase in emergency department use, according to a study published online March 24 in the Annals of Emergency Medicine.

Peter B. Smulowitz, M.D., M.P.H., from the Beth Israel Deaconess Medical Center in Boston, and colleagues examined the extent to which Massachusetts health care reform (implementation started in 2006) correlated with changes in emergency department utilization. Emergency department utilization changes were compared for individuals from areas of the state that were minimally affected by health care reform versus those from areas that were most affected. In addition, changes in emergency department utilization were compared for those younger than 65 years and for those aged 65 years or older. Analyses included 13.3 million emergency department visits during 2004 to 2009.

The researchers found that emergency department use increased with increasing insurance coverage in Massachusetts. This association was consistent across all specifications and in both age groups. Compared with the pre-reform period, the implementation of health care reform correlated with a 0.2 to 1.2 percent increase in emergency department visits per year within-reform and a 0.2 to 2.2 percent increase post-reform.

"The implementation of health care reform in Massachusetts was associated with a small but consistent increase in the use of the emergency department across the state," the authors write.

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CDC: Invasive Cancer Diagnoses Down Slightly in 2010

Majority of states still have not reached 2020 targets for reduced cancer incidence

FRIDAY, March 28, 2014 (HealthDay News) -- Cancer incidence declined from 2009 to 2010, according to a report published in the March 28 issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

S. Jane Henley, M.S.P.H., from the CDC in Atlanta, and colleagues analyzed incidence data from U.S. Cancer Statistics for 2010 in order to assess progress towards reaching Healthy People 2020 targets.

The researchers found that, in 2010, 1,456,496 invasive cancers were reported to cancer registries in the United States (excluding Arkansas and Minnesota), yielding an annual incidence rate of 446 cases per 100,000 persons, compared with 459 in 2009. Men had higher cancer incidence rates (503) compared to women (405). Incidence rates were highest among blacks (455), and were driven by higher rates of prostate cancer and female breast cancer. Cancer incidence ranged by state from 380 to 511 per 100,000 persons. Fifteen states achieved 2020 targets for reduced incidence of colorectal cancer and 24 reached targets for reduced incidence of cervical cancer.

"Many factors, including tobacco use, obesity, insufficient physical activity, and human papillomavirus infection, contribute to the risk for developing cancer, and differences in cancer incidence indicate differences in the prevalence of these risk factors," the authors write.

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