When should an aging doctor call it quits?

From the Post (hat tip: Deb):

The median age for retirement from clinical activity for primary care physicians is 65, according to a report from the American Academy of Family Physicians. The number of physicians over 65 who are actively practicing medicine quadrupled from 1975 to 2013. In 2016, the Federation of State Medical Boards’ census reported that the number of actively licensed physicians 70 and older numbered 94,969. I’m part of that club.

The reality is: As your longtime doctor ages, there may come a point when you start to wonder whether your doctor is still competent and up to date on the best practices or whether it’s time to end what is likely a trusted relationship and go find someone new.

It’s a valid concern.

Factors associated with patients’ and companions’ satisfaction with a hospital emergency department: A descriptive, cross‐sectional study

From Nursing Open:


The aim was to study the level of satisfaction with an emergency department and to identify the factors associated with satisfaction.


This research consisted of a descriptive, cross‐sectional study.


The study population was composed of patients and companions who visited the emergency department during a three‐month period. The patients were selected randomly from the register of visits to the emergency department during the period of study. Sociodemographic variables and variables related to the attention received were studied through questionnaires (response rate 33%).


Older age was associated with greater satisfaction (p = 0.002), as was female sex (p = 0.013) and greater optimism (p < 0.001). Greater control of pain was a factor associated with satisfaction (p = 0.033), as was the perception of a shorter waiting time before the medical visit (p < 0.001).

UnitedHealthcare to Depart from the IA Health Link Program

Press Release (hat tip: Jeff):

On March 29th, the Department of Human Services (DHS) received notice from UnitedHealthcare that they would be leaving the IA Health Link program in the next several months. For the time being, members may continue to see their providers as usual.

DHS issued a statement that, “We wanted to notify the public as soon as possible; however, that means we are still working out the details, including the timeline of the transition for UnitedHealthcare members.” UnitedHealthcare members will be sent notices providing a choice in managed care organizations (MCOs). They can choose Amerigroup of Iowa or Iowa Total Care for their coverage.

“Ensuring that our members receive the best care, and that our program is sustainable for the long-term, is our highest priority. The Governor and I have both been firm that our MCOs need to be held accountable and I applaud her for her support in that effort. This is the right thing to do for our members and for taxpayers,” said Director Foxhoven.

“Today I ended negotiations between the State of Iowa and UnitedHealthcare because of terms that I believed to be unreasonable and unsustainable, said Governor Reynolds.

“From the day I was sworn in as Governor I have been committed to ensuring a sustainable managed care program that protects patients, supports providers, and holds the insurance companies accountable.

“We have continued to work in good faith, along with the legislature to make improvements to the managed care system, including a substantial increase to funding this past year.

“Unfortunately, UnitedHealthcare continued to make additional demands that I found to be unacceptable, including a provision that would remove pay for performance measures that would hold them accountable.

“I want to assure Iowans that the state will work closely with UnitedHealthcare over the next several months to minimize disruption and ensure a smooth transition to the two other managed care companies.”

More details with specifics will be provided in the coming weeks.

For more information on visit: www.IAHealthLink.gov.

Keys to Honoring Physician Orders for Life-Sustaining Treatment Directives in the ED

From HealthLeaders:

Engaging patients and family members is crucial when there are documents specifying physician directives for life-threatening conditions.


  • Adherence to POLST form directives is higher than for living wills and durable power of attorney documents.
  • POLST forms have broader scope than CPR directives.
  • Emergency department clinicians can use POLST forms to help patients and family members craft action plans for hospital-based care.

Rates of stethoscope cleaning, hand hygiene practices ‘lower than expected’ in ED, study says

From Becker’s:

The study shows:

• In 13 percent of the encounters involving a stethoscope, the provider placed a glove over the stethoscope before patient contact.
• Providers cleaned the stethoscope with water and a hand towel before patient interaction in 4.3 percent of the encounters.
• Providers cleaned the stethoscope with an alcohol swab after patient interaction in 11.3 percent of the encounters.
• Providers used hand sanitizers or washed hands before patient interaction in 50 percent of the encounters. After patient interaction, hand sanitizer use or handwashing increased to 77.9 percent.
• In 48.4 percent of encounters, gloves were used before patient interaction.

Purdue Pharma agrees to $270M opioid settlement with Oklahoma

From Politico:

Purdue Pharma, the OxyContin maker accused of helping spark and fuel the nation’s opioid epidemic, has reportedly agreed to pay $270 million to settle a lawsuit with Oklahoma.

The settlement is the first resolution of hundreds of lawsuits filed by state and local governments across the country, and it could provide a measuring stick for others seeking redress for the damages inflicted by opioids.

The settlement comes two months before Purdue, Johnson & Johnson and Teva Pharmaceutical were scheduled to go to trial for promoting OxyContin to physicians.

Demand for uncompensated care would jump 82% if ACA repealed

From Becker’s:

A full repeal of the ACA in 2019 would result in an increase in uncompensated care and a decrease in federal healthcare spending, according to a report from the nonprofit think tank Urban Institute.

For its analysis, the Urban Institute estimates state-by-state implications if the U.S. Court of Appeals for the 5th Circuit upholds a Texas judge’s ruling repealing the federal health law. Plaintiffs in the case argue that the tax law signed by President Donald Trump in December 2017, which eliminated the law’s individual mandate penalties, made the mandate unconstitutional and the rest of the ACA invalid.

A new age of epidemics

From Axios:

In the 1950s, 400–500 Americans died every year from measles and another 100 from chicken pox. In the last major outbreak of rubella — in 1964–’65 — some 11,000 pregnant American women lost their babies and 2,100 newborns died.

  • The 1960s vaccine revolution all but wiped out these diseases by 2000. But now they are back — in the U.S. and around the world.
  • Much onus for this regression so far has been laid on the global anti-vaccination movement. But experts blame much more sweeping reasons, primarily a tectonic change in how humans live now as opposed to three, four and five decades ago.

Friends & Family: The unofficial health care system

From Axios:

When we talk about the cost and complexity of the U.S. health care system, we usually don’t account for the time, money and labor donated by friends and family members — sometimes even strangers. But those unofficial supports are a large and growing part of American health care.

Rural providers see hope as Medicaid expansion advances in Kansas

From Modern Healthcare:

“Medicaid expansion would give us a $1 million boost,” said John Broberg, Hiawatha’s interim CEO, who has lobbied his area’s Republican senator to support expansion—without success so far.

Expansion in a solidly red state like Kansas would be a big victory for expansion advocates, following voter approval in November of expansion in Idaho, Nebraska and Utah. It likely would be a financial boost for these states’ many rural hospitals, though experts say other factors, such as the Medicare cuts and declining rural populations, also are squeezing these facilities.

Health Affairs study last year found that ACA Medicaid expansion was associated with improved hospital financial performance and substantially lower likelihood of closure, particularly in rural markets and counties with large numbers of uninsured adults prior to expansion.

But so far only Nebraska has moved ahead with implementing a straight Affordable Care Act expansion to all adults with incomes up to 138% of the federal poverty level, as mandated by the voters in all three states.