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Health Care Quality Special Reports |
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Issue Date: July 2010 Physician, Pharmacist Collaboration Cuts Costs Pharmacists cannot prescribe and physicians cannot dispense, but there are overlaps in training and scope of practice between the two. As provisions in the Patient Protection and Affordable Care Act of 2010 are implemented, it will be increasingly important for all members of a health care team to bring their unique skills to support each patient’s ability to manage his or her health conditions. Study Shows Value of Screening Patients With Prediabetes Recognizing that patients with diabetes are at high risk for developing chronic kidney disease (CKD), the American Diabetes Association (ADA) recommends annual screening for CKD for these patients. A recent study that estimates the prevalence of CKD in prediabetic patients and patients with undiagnosed diabetes suggests that CKD screening may be warranted in the prediabetes population as well. Shift to a Medical Home Model Requires Two Years of Sustained Effort, Report Says Transforming a medical group from a physician-centric practice to a team-based, patient-centered medical home (PCMH) is challenging for physicians, especially for those accustomed to being responsible for the entire patient encounter, according to a new analysis of the PCMH model of care. The transformation requires a great deal of effort, motivation, and support, according to a report from the American Academy of Family Physicians (AAFP), in Leawood, Kan. After Layoff From Multispecialty Group, Rheumatologist Finds Success in Solo Practice For a dozen years, rheumatologist Eileen Schwartz, MD, was a member of a large multispecialty medical group in Burbank, Calif. But then in December 2008, the practice was forced to lay her off. For many physicians, such a change might have been a devastating blow. Online Clearinghouse Reduces Claims Denials, Boosts Cash Flow Only about 20% of the 12 billion health care claims submitted annually to commercial and government health care payers are paid correctly, according to a report last month by the American Medical Association. The rest—a staggering 80%—are paid inaccurately, the AMA said. When payments are made incorrectly, particularly if payments are denied or delayed, cash flow and profits for physicians suffer. Report Says Insurers Need to Improve Claims Payment Accuracy The U.S. health care system could save $777.6 million in unnecessary administrative costs if health insurers improved their claims-payment accuracy rates by just 1%, the American Medical Association (AMA) said in a report last month. Increasing health insurers’ payment accuracy rate to 100% would save $15.5 billion annually, the AMA said. That money could be put to better use to improve patient care and reduce overall health care costs, the AMA added. Managing Patients With SIADH- Associated Hyponatremia The syndrome of inappropriate antidiuretic hormone (SIADH) is the most common cause of euvolemic hyponatremia (Am J Med. 2007;120[11A]:S1–S21). Release of the antidiuretic hormone arginine vasopressin (AVP) causes water retention. In normal physiology, AVP release is suppressed, excess water is excreted, and urine is dilute when the plasma osmolality is low. Plasma sodium is the main component of plasma osmolality; therefore, low serum sodium should lead to AVP suppression. Increased plasma osmolality or low intravascular volume appropriately stimulates AVP release. AVP release in the absence of these stimuli, when effective osmolality falls below 275 mOsm/kg of water, is one of the diagnostic features of SIADH (see “Criteria for SIADH Diagnosis,” below; Clin J Am Soc Nephrol. 2008;3:1175– 1184; N Engl J Med. 2007; 356:2064– 2072). Recognizing and Treating Drug-Induced Hyponatremia A variety of drugs can lead to hyponatremia, typically defined as a serum sodium level below 135 mmol/L (N Engl J Med. 2007;356:2064–2072.). Clinicians often are cognizant of the risk with thiazide diuretics and carbamazepine but may not suspect other medications as causes of hyponatremia, said Denise H. Rhoney, PharmD, FCCM, FCCP, associate professor at the Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University in Detroit. Medications frequently are overlooked as a possible cause of hyponatremia, she said. Potential Levels of HIT Incentive Funds Reported Financial incentives for physicians implementing electronic medical record (EMR) systems could bring as much as $4 billion to individual states, according to an analysis by Practice Fusion, an EMR provider in San Francisco.
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