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In a random survey of 5,000 American College of Physicians members, 27 percent say antibiotics are often administered in situations where they have no benefit. In most cases, they are prescribed to treat infections most often caused by viruses. Pressure to fulfill patients' expectations might be driving some doctors to prescribe antibiotics. Physicians also might be practicing defensive medicine to ward off potential malpractice suits, or trying to meet clinical performance measures that call for blanket treatments that must be applied to all patients. (HealthDay)

The Health Care Transformation Task Force has a message for President-elect Trump and congressional leaders: Regardless of what happens to the ACA, keep moving away from fee-for-service health care and toward payment models that encourage value. "[B]ipartisan support is critical to help consumers and businesses fully realize the goal of a sustainable, person-centered health care system that promotes choice, quality, and affordability," according to a task force letter. The task force is a coalition of 43 groups including Aetna, the American Academy of Family Physicians, Catholic Health Care Initiatives and the Pacific Business Group on Health. (Morning Consult ; letter )

Nearly 59 million Americans would lack health insurance--more than double the current number--by 2019 if the Affordable Care Act is partially repealed, according to an Urban Institute report. The report also predicts the individual health insurance market will drop from more than 19 million customers now to just 1.6 million by the beginning of 2019. "This scenario does not just move the country back to the situation before the ACA," the report says. "It moves the country to a situation with higher uninsurance rates than was the case before the ACA's reforms." (CNBC ; the report )

AHIP says it's willing to give up ACA's individual mandate and replace it with different incentives. In return, it wants a commitment that a replacement would continue to help low-income people purchase insurance, and provide incentives for young and healthy people to buy coverage. AHIP CEO Marilyn Tavenner says, "If insurance companies believe cost-sharing subsidies will not continue, they are going to pull out of the market during the next logical opportunity." Continuous health coverage for all consumers is critical to maintaining a solvent individual health insurance market and should be a priority for the incoming administration, she adds. (The New York Times )
Innovation & Transformation    
Wyandot Inc., a community mental health center in Kansas City, saved $6 million last year by stabilizing people in crisis who otherwise would have ended up in state hospitals, local emergency rooms or jails and prisons. Randy Callstrom, president and CEO of Wyandot, told the story to Kansas lawmakers last month, explaining crisis-stabilization centers like his also need robust community mental health services that patients can access at discharge. Housing is also a major issue, Callstrom said, because it's more challenging for community providers to track homeless people with mental illness. (Kansas Health Institute)

Minnesota is using a computerized screening tool that flags beneficiaries of public programs who frequently use emergency departments and hospital clinics. The Minnesota Restricted Recipient Program , controversial among patients, is gaining traction with family physicians, the Star Tribune reports. By limiting these "high use" patients to a single primary care provider, along with a hospital and one pharmacy, the program is saving taxpayers at least $7 million a year in unnecessary medical costs, state data show. In most cases, however, patients are simply suffering from "fragmented care"; the program forces them to deal with a regular team of clinicians. ( Star Tribune )
Consumers & Providers
Patients with complex medical needs have far more unmet behavioral health and social service challenges than other adults, according to a new Commonwealth Fund study. Although 95 percent have consistent access to health care, they struggle to get the coordinated medical, behavioral and social services they need to stay well and avoid costly hospital visits: Sixty-two percent experienced stress about their ability to afford housing, utilities or nutritious meals (vs. 32 percent of people without high needs). For health systems to improve outcomes and lower costs, they must assess patients' comprehensive needs, increase access to care and improve how they communicate with patients, researchers conclude. (Commonwealth Fund )
In conjunction with the study, five national health care foundations--The John A. Hartford Foundation, the Peterson Center on Healthcare, the Robert Wood Johnson Foundation, The SCAN Foundation and The Commonwealth Fund--launched a new online resource to help health system leaders and insurers improve care for patients with complex medical and social needs. Developed by experts at the Institute for Healthcare Improvement, The Playbook: Better Care for People with Complex Needs is an effort to compile and share promising approaches, offering insights into patients with complex needs, examples of successful approaches to care and more. (announcementPlaybook )
If you want to live longer, be optimistic. That's the implication of research published last week in the American Journal of Epidemiology. The subjects who were most optimistic were 29 percent less likely to die during the six-year study follow-up than the least optimistic. The mechanism isn't clear, and the association remains even when controlling for health behaviors, depression and physical health. One possibility: Optimists cope better. It's also possible that optimism directly influences biological functioning, says coauthor Dr. Eric Kim, of the Harvard T.H. Chan School of Public Health. (TodayAmerican Journal of Epidemiology)
The medical establishment is, for the most part, praising the appointment of Rep. Tom Price, MD, to lead the Department of Health and Human Services, HealthLeaders Media reports. Among his proponents: the AMA, the American Academy of Family Physicians, the Association of American Medical Colleges and AHIP. However, more than 4,800 physicians signed an open letter railing against the American Medical Association's support for him. The physician group wrote that the AMA's backing of the nominee contradicts any support for patient well-being. (HealthLeaders Media ; Becker's Hospital Review )
New & Noted   
Live fast, die younger? For the first time since 1993, life expectancy for Americans declined in 2015, according to data from National Center for Health Statistics. Death rates rose for eight of the top 10 leading causes of death. Cancer deaths, however, declined. ( The Washington Post )

Get the medications right: A free ePALS webinar at 3 p.m. Thursday, Dec. 15, will provide an overview of Get the medications right: a nationwide snapshot of expert practices--Comprehensive medication management in ambulatory/community pharmacy, a report that explores comprehensive medication management in the community setting. The webinar, part of the PALS (Patient Advocacy Leaders Summit) program, features Terry McInnis, MD, MPH, CPE, FACOEM, the report's principal investigator. (Registration; about the report).

Retail clinics not reducing ED use:  Retail clinics have not been associated with a meaningful reduction in low-acuity visits to the emergency department. (Annals of Emergency Medicine)
Dr. Don Berwick provided a relatively optimistic vision of the future regarding the effort to improve quality and patient safety. The former CMS administrator--and president emeritus and senior fellow of the Institute for Healthcare Improvement--makes the case that the basics of quality and safety won't change under the Trump administration. (Hospitals and Health Networks)
MarketVoices...quotes worth reading
"Conceptually, I think there's high agreement that there's a commitment to protecting the value-based purchasing initiatives. How it's made operational, we haven't had those discussions." -- David Lansky, president and CEO of the Pacific Business Group on Health, on conversations with GOP lawmakers, quoted in  Morning Consult
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Roxanna Guilford-Blake
Sandy Mau




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Wednesday, December 14, 2016