South Dakota’s Avera Will Acquire Physician-Owned Clinic in Iowa

From Becker’s Hospital Review:

Family Medicine Clinic of Sibley, Iowa, will join Avera Medical Group network and be owned by Avera McKennan Hospital & University Health Center, both in Sioux Falls, S.D., according to an Avera news release.

The transaction is effective Jan. 1. The new name of the clinic will be Avera Medical Group, Sibley. The clinic, which is owned by two physicians and employs another physician, provides primary care, family practice and obstetrical services.

Read the release on Avera’s acquisition of Family Medicine Clinic of Sibley.

Rural teens more likely to abuse prescription drugs than their urban, suburban counterparts

From Modern Medicine:

Adolescents living in rural areas are significantly more likely to abuse prescription drugs than their counterparts in urban areas, according to a study published online in the Archives of Pediatrics & Adolescent Medicine, HealthDay News reported.

Jennifer R. Havens, PhD, of the University of Kentucky College of Medicine, and colleagues analyzed data on 17,872 adolescents from the 2008 National Survey on Drug Use and Health. Researchers compared the prevalence of nonmedical prescription drug use, including pain relievers, sedatives, stimulants, and tranquilizers, among adolescents (aged 12 to 17) living in urban, suburban, and rural settings.

Researchers found that adolescents living in rural areas were 26% more likely than those in urban areas to have used prescription drugs nonmedically. In comparison, suburban adolescents were 4% more likely to have used prescription drugs nonmedically than those in urban areas.

However, it was also found that among rural adolescents, school enrollment and living in a 2-parent household were factors that protected them against nonmedical use of prescription drugs.

Study: Electronic Medical Records Don’t Boost Hospital Quality Measures

From the WSJ Health Blog:

Standard measures of hospital quality aren’t improved much by the use of electronic medical records, according to a recently published study by Rand Corp. researchers.

The study compared data on hospital EMR capability from 2003 and 2006 and publicly reported hospital quality data for 2004 and 2007, looking specifically at care for pneumonia, heart failure and heart attack.

During the period studied, the quality of care for those three conditions was “broadly improving,” the authors wrote, and quality scores for heart failure improved significantly more among hospitals that used a basic EMR system throughout the study period.

But the same relationship wasn’t seen between basic EMRs and pneumonia or heart-attack quality scores. And quality improvements at hospitals with advanced EMR systems were actually smaller than those seen at hospitals with no EMR system at all.

Quality improvements at hospitals that started using an EMR system for the first time during the study period or upgraded to a more advanced system also mostly lagged those at hospitals that made no change to their EMR capability. The study was published online by the American Journal of Managed Care.

Spencer Jones, first author of the study and an associate information scientist at Rand, tells the Health Blog that trying to introduce an EMR system to an already complex health-care workplace can cause “a myriad of unintended consequences” in terms of workflow and communication. That’s especially true with the full-bells-and-whistles systems, which include things such as computerized physician order entry system.  “The complex systems are more difficult to implement and use,” he says.

It’s also “tough to do two things at once” by simultaneously introducing EMRs and also trying to improve standard quality measures, says Jones.

Fake “Nurse of the Year” Headed to Prison

From NBC Connecticut:

A woman who staged a dinner honoring herself as “Nurse of the Year” will spend nine months in prison for practicing nursing without a license.

Betty Lichtenstein, 57, of Danbury was working for Dr. Gerald Weiss in 2009, when Weiss complained to the Connecticut Department of Health that Lichtenstein had acted unprofessionally. An investigation found that Lichtenstein was never licensed to practice nursing.

During her employment, Lichtenstein injected patients with medicine, wrote prescriptions and gave medical advice to Weiss’ patients, according to prosecutors.

Weiss and his staff believed Lichtenstein was a registered nurse partly thanks to a “Nurse of the Year” award given to her at a November 2008 dinner hosted by the “Connecticut Nursing Association.”

It turns out the association doesn’t exist and Lichtenstein paid more than $2,000 of her own money to stage the dinner, prosecutors said.

She also forged several narcotics prescriptions for herself on blank forms from the doctor’s office, according to the Chief State’s Attorney’s office.

She was sentenced to nine months in prison on Tuesday.

Sex bias in cardiovascular testing, intervention due to patient preference

From Cardiology Today:

Despite presenting in ED’s with similar symptoms of acute coronary syndrome, women are less likely than men to receive the appropriate diagnostic tests and interventions because they are less apt to follow their physician’s recommendations, according to a cohort study published in Annals of Emergency Medicine.

Researchers enrolled 1,080 patients, 54% of them women, who presented in the ED with symptoms of acute coronary syndrome; 60% were admitted to the hospital. After receiving an explanation of the potential risks and benefits of each test and intervention, patients were surveyed on their preference for noninvasive procedures versus PCI or coronary artery bypass grafting. Patients were also asked about their predilection for compliance with physician recommendations. After 30 days, 96% of study participants were contacted for follow-up on outcomes.

After their initial hospital admission, women were less likely to receive diagnostic testing of any type (38% vs. 45%; 95% CI for the difference –13% to –1.5%). Cardiac catheterization for women was 7% less than for men (10% vs. 17%; 95% CI –11% to –2%). Revascularization was less frequent in either group (4% vs. 6%; 95% CI –5% to 0.6%).

Women and men both preferred stress tests to catheterization (58% vs. 52%; 95% CI –0.06% to 12%), and the proportion of both groups stating they would accept medical advisement for stress testing was similar (85% for both). However, women were less likely than men to state their acceptance for cardiac catheterization (65% vs. 75%; 95 CI –15% to –4%). Women also were less inclined to choose PCI over medical therapy (67% vs. 73%; 95% CI for difference 12% to 0.5%) and less likely to choose coronary artery bypass grafting over medical therapy (61% vs. 68%; 95% CI for difference –13% to 1%).

The researchers posited the disparity in testing and treatment was due in part to women being more risk-averse than men, and to women’s perception that their disease was not severe. “Future studies should focus on delineating why women appear less likely than men to accept physician-recommended evaluation of potential acute coronary syndromes,” the researchers wrote.

DHS: Iowa Medicaid providers first to receive incentives to upgrade records


Doctors and other Iowa Medicaid providers will be among the first in the nation next month to receive direct incentives for installing electronic health record systems in their offices, according to Medicaid Director Jennifer Vermeer.

Doctors, dentists, and other providers whose practice includes a high percentage of Medicaid patients can receive up to $63,750 in federal funds over a six-year period to defray the cost of installing or updating electronic systems to replace traditional paper files. Hospitals are eligible for higher amounts.

“The benefits for the providers are obvious, but the most important reason for making this improvement is to provide more accurate and more efficient care for Medicaid members,” Vermeer said.

In addition to improved accuracy, the advanced systems also can be used to contact patients at home regarding medical or healthy lifestyle regimens. Other features could prevent the ordering of duplicate testing or the prescription of a drug that might cause an allergic reaction for a specific patient.

Iowa joins three other states – Oklahoma, Louisiana, and Kentucky – in being the first to take advantage of the program, which was part of the American Recovery and Reinvestment Act of 2009. About a year ago, Iowa was the first state to have its planning documents approved by federal officials.

Woman Waits 30 Hours for Ambulance in Blizzard

From FoxNY:

As a battering snowstorm stranded ambulances and hundreds of 911 calls piled up unresolved, Annie O’Daly knew she might have to wait for help after slipping and breaking her ankle on Sunday night.

She didn’t think she’d be waiting for 30 hours.

Help finally arrived at the 58-year-old woman’s Brooklyn home Tuesday morning at 2:30 a.m., said her husband, Jim Leonhardt, who described her ordeal. Three emergency medical technicians — themselves recovering from being stranded earlier in an ambulance for eight hours — and Leonhardt carried her out on a gurney onto the unplowed street, wheeled her down the block and lifted her over a snowbank, he said.

O’Daly was among hundreds of New Yorkers left waiting for help during the blizzard and its aftermath, as emergency responders grappled with snow-clogged streets, many blocked by cars that had been abandoned mid-storm. At one point, 911 operators had a backlog of 1,300 calls.

Dozens of ambulances got stuck in the storm, and on Tuesday, Mayor Michael Bloomberg said ambulance drivers probably erred in driving on unplowed roads. Instead, they should have stayed on cleared roads and walked down snowy streets to respond to calls, he said.

Medicare regulation revives end-of-life planning

From the Associated Press:

 new health regulation issued this month offers Medicare recipients voluntary end-of-life planning, which Democrats dropped from the monumental health care overhaul last year.

The provision allows Medicare to pay for voluntary counseling to help beneficiaries deal with the complex and painful decisions families face when a loved one is approaching death.

But the practice was heavily criticized by former Alaska Gov. Sarah Palin and some other Republicans who have likened the counseling to “death panels.”

The “voluntary advance care planning” is included in a Medicare regulation issued Dec. 3 that covers annual checkups, known as wellness visits. It goes into effect Jan. 1.

The new regulation was first reported by The New York Times.

For years, federal laws and policies have encouraged Americans to think ahead about end-of-life decisions and make their wishes known in advance through living wills and similar legal documents. But when House Democrats proposed last year to pay doctors for end-of-life counseling, it touched off a wave of suspicion and anger.

Opponents said end-of-life planning should be left to families, while proponents said doctors’ advice was a basic element of health care.

Prominent Republicans singled it out as a glaring example of government overreach. Palin’s use of the phrase “death panels” solidified GOP opposition to the health care bill.

The Joint Commission Appoints New CMO


The Joint Commission said Wednesday it appointed Dr. Ana Pujols-McKee as its new executive vice president and chief medical officer.

McKee will work on developing policies and strategies that promote patient safety and improve quality in health care. Her responsibilities will include supporting The Joint Commission’s Patient Safety Advisory Group and offer clinical guidance for the organization’s Center for Transforming Healthcare.

“Ana has a well-deserved reputation as a dynamic leader who forms strong, effective partnerships that promote health care quality and patient safety,” Dr. Mark Chassin, the organization’s president, said in prepared remarks. “Her talents will serve The Joint Commission well as it continues to focus on helping health care organizations excel in providing the highest quality and safest care that Americans expect and deserve.”

McKee currently serves as the CMO and associate executive director for Penn Presbyterian Medical Center, University of Pennsylvania Health System. She is also an associate professor of medicine at the University of Pennsylvania School of Medicine in Philadelphia.

Obese Drivers at Higher Risk of Death in Car Crashes: Study

From US News and World Report:

Here’s another reason not to pile on too many excess pounds: A new study finds that the obese and very obese are at raised risk of death in severe car crashes.

According to the research, published in the American Journal of Emergency Medicine, a moderately obese driver is 21 percent more likely to die in a severe motor vehicle crash compared to non-obese drivers, while being severely obese hikes the risk of death by 56 percent.

However, being just slightly overweight seemed to lower the odds for death in a severe crash: these drivers were actually less likely to die than either underweight or normal-weight drivers, according to researchers at the University at Buffalo School of Medicine and Biomedical Sciences.

In the study, the researchers analyzed data from the national Fatality Analysis Reporting System involving almost 156,000 drivers in severe motor vehicle crashes occurring between 2000-2005. The researchers included all fatalities occurring within 30 days of a crash.