Wednesday, October 7, 2015

New Parent or Grandparent? Get Your Flu Shot First

By Rakhi Dimino, MD
Medical Director of Operations, OB Hospitalist Group
Member, TMA Council on Science and Public Health

If you are about to welcome a new baby into your family or have had the pleasure of doing so in the last six months, now is the time to get your flu shot! Each year thousands of new parents land themselves in the emergency department ― or worse, in the hospital — with their newborn because of the flu.

The flu is an uncomfortable inconvenience for most healthy adults but a deadly infection for many newborns. Newborns below the age of 6 months cannot receive the flu vaccine, so the best method to prevent the virus is to make sure no one around them is contagious. Unfortunately, most of us who contract the flu are actually infectious prior to feeling any obvious symptoms. Therefore, the best way to prevent a baby from becoming sick from the flu is to vaccinate everyone around them.

People must get a flu vaccine each year to prevent the type of flu virus anticipated during the current flu season, which runs from about October to the beginning of April. It takes a couple of weeks after receiving the vaccine for it to become effective. So if you will be visiting a new baby in the family soon or over the upcoming holidays, make sure to protect your new family member by getting your flu vaccine at least two to four weeks prior to your visit. This vaccine is safe for most and is recommended for most who are not allergic to eggs. Children over the age of 6 months who are about to become an older sibling should be vaccinated as well. See your doctor or your pharmacist to obtain the vaccine now. And don’t forget to wash your hands!

Dr. Dimino is a Houston OB-Gyn and Medical Director of Operations for OB Hospitalist Group.

Tuesday, October 6, 2015

Flu Vaccine Saved 40,000 Lives From 2005 to 2014

For years physicians have said vaccinations like the flu shot prevent illness and have the potential to save lives. New numbers back that assertion.

In the past 10 years, the seasonal flu vaccine saved an estimated 40,000 American lives, according to a study published in Vaccine.  Without the vaccine, researchers estimate influenza’s death toll would have climbed 22 percent higher.

Seniors benefited the most from the vaccine: Nearly 89 percent of people whose life was saved by getting a flu shot were 65 years of age and older. Young children between 6 months and 4 years old (who, like seniors, are at high risk of serious flu complications) were the next highest group to benefit by getting the flu shot, based on the percentage of deaths avoided.

The researchers say 40,000 saved lives is actually a conservative estimate, as the study does not take into account indirect vaccination effects like “herd immunity.” Herd immunity occurs when a high percentage of a population is vaccinated, creating a sort of “immunity shield” around individuals who cannot be vaccinated for medical reasons.

The data show just how important it is to get a flu vaccine every year. The next life it saves could be your own!

Read the report.

Thursday, October 1, 2015

This Season’s Flu Vaccine Promises Better Protection

October marks the beginning of the dreaded “flu season,” which can last as late as May but usually peaks between December and February. Oct. 1 is Texas Influenza Awareness Day, and physicians hope the extra attention flu gets on this day prods Texans to get their flu shot before the season begins in earnest. Most doctors’ offices, clinics, and pharmacies already offer the vaccine to patients.

Each year, scientists predict which types of flu virus will circulate, and vaccine manufacturers formulate vaccines that target those strains. But sometimes their predictions don’t match up with reality. Last year’s flu season walloped Texas, in part due to a new strain of the virus that did not match the vaccine. Still, people who did get their shot were protected to some degree, so many who still contracted the flu experienced a milder case because of the vaccine.

The good news is this year, health officials say the vaccine will be much more effective because one of the flu bugs it protects against is the virus that sickened so many last season.

Everyone 6 months and older should get vaccinated, especially the elderly, young children, people with chronic medical conditions, and pregnant women. It can take up to two weeks for your immune system to develop antibodies to protect against flu infections, and Texas already has reported flu cases. Don’t delay ― vaccinate today!

Monday, September 28, 2015

Uninsured Rate Drops in All 50 States, Texas Still Last

The number of Americans without health insurance fell in all 50 states and Washington D.C. from 2013 to 2014, according to the United States Census Bureau. The biggest changes occurred in states that chose to expand Medicaid ― including Kentucky, Nevada, and West Virginia ― whose uninsured rates each fell by more than 5 percent.

Texas, however, remains in last place. The Lone Star State saw a modest decrease of 3 percent in its uninsured rate, putting the state at 19.1 percent uninsured ― a far cry from the U.S. average of 11.7 percent.

Click to enlarge.

Read the full report.

Thursday, September 17, 2015

Accountable Care Organizations, Explained

By Jenny Gold
Kaiser Health News

Content provided by Kaiser Health News

One of the main ways the Affordable Care Act seeks to reduce health care costs is by encouraging doctors, hospitals and other health care providers to form networks that coordinate patient care and become eligible for bonuses when they deliver that care more efficiently. 

The law takes a carrot-and-stick approach by encouraging the formation of accountable care organizations (ACOs) in the Medicare program. Providers make more if they keep their patients healthy. About 6 million Medicare beneficiaries are now in an ACO, and, combined with the private sector, at least 744 organizations have become ACOs since 2011. An estimated 23.5 million Americans are now being served by an ACO. You may even be in one and not know it.

 While ACOs are touted as a way to help fix an inefficient payment system that rewards more, not better, care, some economists warn they could lead to greater consolidation in the health care industry, which could allow some providers to charge more if they’re the only game in town.

 ACOs have become one of the most talked about new ideas in Obamacare. Here are answers to some common questions about how they work:

What is an accountable care organization?

An ACO is a network of doctors and hospitals that shares financial and medical responsibility for providing coordinated care to patients in hopes of limiting unnecessary spending. At the heart of each patient’s care is a primary care physician.

In Obamacare, each ACO has to manage the health care needs of a minimum of 5,000 Medicare beneficiaries for at least three years.

Think of it as buying a television, says Harold Miller, president and CEO of the Center for Healthcare Quality & Payment Reform in Pittsburgh, Pa. A TV manufacturer like Sony may contract with many suppliers to build sets. Like Sony does for TVs, Miller says, an ACO brings together the different component parts of care for the patient – primary care, specialists, hospitals, home health care, etc. – and ensures that all of the “parts work well together.”

The problem with most health systems today, Miller says, is that patients are getting each part of their health care separately. “People want to buy individual circuit boards, not a whole TV,” he says. “If we can show them that the TV works better, maybe they’ll buy it,” rather than assembling a patchwork of services themselves.

Why did Congress include ACOs in the law?

As lawmakers searched for ways to reduce the national deficit, Medicare became a prime target. With baby boomers entering retirement age, the costs of caring for elderly and disabled Americans are expected to soar.

The health law created the Medicare Shared Savings Program. In it, ACOs make providers jointly accountable for the health of their patients, giving them financial incentives to cooperate and save money by avoiding unnecessary tests and procedures. For ACOs to work, they have to seamlessly share information. Those that save money while also meeting quality targets keep a portion of the savings. Providers can choose to be at risk of losing money if they want to aim for a bigger reward, or they can enter the program with no risk at all.

In addition, the Centers for Medicare & Medicaid Services (CMS) created a second strategy, called the Pioneer Program, for high-performing health systems to pocket more of the expected savings in exchange for taking on greater financial risk.

In 2014, the 20 ACOs in the Medicare Pioneer Program and 333 in the Medicare Shared Savings generated $411 million in total savings but after paying bonuses, the program resulted in a net loss of $2.6 million to the Medicare trust fund. That’s far less than 1 percent of Medicare spending during that period.

Still the program is expected to be expanded and Health and Human Services Secretary Sylvia Burwell has set a goal of tying 50 percent of all traditional Medicare payments to quality or value by 2018 through new payment models, including ACOs.

How are ACOs paid?

In Medicare’s traditional fee-for-service payment system, doctors and hospitals generally are paid for each test and procedure. That drives up costs, experts say, by rewarding providers for doing more, even when it’s not needed. ACOs don’t do away with fee for service, but they create an incentive to be more efficient by offering bonuses when providers keep costs down. Doctors and hospitals have to meet specific quality benchmarks, focusing on prevention and carefully managing patients with chronic diseases. In other words, providers get paid more for keeping their patients healthy and out of the hospital.

If an ACO is unable to save money, it could be stuck with the costs of investments made to improve care, such as adding new nurse care managers. An ACO also may have to pay a penalty if it doesn’t meet performance and savings benchmarks, although few have opted into that program yet. ACOs sponsored by physicians or rural providers, however, can apply to receive payments in advance to help them build the infrastructure necessary for coordinated care – a concession the Obama administration made after complaints from rural hospitals.

In 2014, the third year of the Medicare ACO program, 97 ACOs qualified for shared savings payments of more than $422 million.

How do ACOs work for patients?

Doctors and hospitals will likely refer patients to hospitals and specialists within the ACO network. But patients are usually still free to see doctors of their choice outside the network without paying more. Providers who are part of an ACO are required to alert their patients, who can choose to go to another doctor if they are uncomfortable participating. The patient can decline to have his data shared within the ACO.

Who’s in charge — hospitals, doctors or insurers? 

ACOs can include hospitals, specialists, post-acute providers and even private companies like Walgreens. The only must-have element is primary care physicians, who serve as the linchpin of the program.

In private ACOs, insurers can also play a role, though they aren’t in charge of medical care. Some regions of the country, including parts of California, already had large multi-specialty physician groups that became ACOs on their own by networking with neighboring hospitals.

In other regions, large hospital systems are scrambling to buy up physician practices with the goal of becoming ACOs that directly employ the majority of their providers. Because hospitals usually have access to capital, they may have an easier time than doctors in financing the initial investment, for instance to create the electronic record system necessary to track patients.

Some of the largest health insurers in the country, including Humana, UnitedHealth and Aetna, have formed their own ACOs for the private market. Insurers say they are essential to the success of an ACO because they track and collect the data on patients that allow systems to evaluate patient care and report on the results.

If I don’t like HMOs, why should I consider an ACO?

ACOs may sound a lot like health maintenance organizations. “Some people say ACOs are HMOs in drag,” says Kelly Devers, a senior fellow at the Urban Institute. But there are some critical differences – notably, an ACO patient is not required to stay in the network.

Steve Lieberman, a consultant and senior adviser to the Health Policy Project at the Bipartisan Policy Center in Washington, D.C., explains that ACOs aim to replicate “the performance of an HMO” in holding down the cost of care while avoiding “the structural features that give the HMO control over [patient] referral patterns,” which limited patient options and created a consumer backlash in the 1990s.

In addition, unlike HMOs, the ACOs must meet a long list of quality measures to ensure they are not saving money by stinting on necessary care.

What could go wrong?

Many health care economists fear that the race to form ACOs could have a significant downside: hospital mergers and provider consolidation. As hospitals position themselves to become integrated systems, many are joining forces and purchasing physician practices, leaving fewer independent hospitals and doctors. Greater market share gives these health systems more leverage in negotiations with insurers, which can drive up health costs and limit patient choice.

But Lieberman says while ACOs could accelerate the merger trend, consolidations are already “such a powerful and pervasive trend that it’s a little like worrying about the calories I get when I eat the maraschino cherry on top of my hot fudge sundae. It’s a serious public policy issue with or without ACOs.”

Are ACOs the future of health care?

ACOs are already becoming pervasive, but they may be just an interim step on the way to a more efficient American health care system. “ACOs aren’t the end game,” says Chas Roades, chief research officer at The Advisory Board Company in Washington.

One of the key challenges for hospitals and physicians is that the incentives in ACOs are to reduce hospital stays, emergency room visits and expensive specialist and testing services — all the ways that hospitals and physicians make money in the fee-for-service system, explains Roades.

He says the ultimate goal would be for providers to take on full financial responsibility for caring for a population of patients for a fixed payment, but that will require a transition beyond ACOs.

This article was produced by Kaiser Health News with support from The SCAN Foundation.

Sunday, September 13, 2015

Celebrate Grandparenting: Stay Healthy With Vaccinations

Grandparents are an important part of children’s lives. Even before grandbabies are born, grandparents can help protect them from disease by getting themselves vaccinated. For Grandparents Day on Sept. 13, Texas Medical Association (TMA) physicians urge grandparents to make sure their shots are up to date.

“Grandparents want what’s best for their grandchildren,” said Katharina Hathaway, MD, a family physician in Austin and a member of TMA’s Be Wise — Immunize Physician Advisory Panel. “Vaccinations can help in two very important ways: preventing grandparents from passing on a potentially deadly illness to a baby and keeping grandparents healthy to keep up with their grandkids.”

Adults may need as many as 10 vaccinations, but two in particular are recommended for seniors: pneumococcal, which prevents infections in the lungs and bloodstream, and meningitis; and zoster, which protects against shingles, a painful rash. Two others are recommended for all adults: a yearly flu shot and a vaccination for pertussis (whooping cough).

Babies under 1 year old are at high risk for catching whooping cough. It is so severe in infants that more than half of babies who get it end up in the hospital with complications like pneumonia. And many of whooping cough’s tiny victims die.

Babies require a series of pertussis vaccinations, so they’re not fully protected until close to 18 months of age. Dr. Hathaway said grandparents can avoid passing on the highly contagious yet preventable whooping cough to newborns by getting vaccinated.

A Tdap vaccination (a combination vaccination that protects against tetanus, diphtheria, and pertussis) is recommended for anyone who will be around a baby, including grandparents. Adolescents and adults should get the shot at least two weeks before visiting the baby to have full protection. Physicians call it “cocooning,” vaccinating those who will be near a vulnerable newborn to surround the infant in a vaccination “cocoon.”

“As we get older, our immune systems tend to weaken,” said Dr. Hathaway. “That means adults need a vaccine boost because they are more prone to catching certain diseases, several of which you can prevent through vaccination.”

Pneumococcal pneumonia, an infection of the lungs, affects about 1 million Americans each year, and sends about half of them to the hospital, according to the Centers for Disease Control and Prevention (CDC). Experts recommend a pneumococcal shot for adults over 65 years and for younger adults with certain health conditions.

A yearly influenza vaccination is recommended for anyone over six months of age. Influenza, or seasonal flu, is especially serious for adults over 65. The CDC says nearly three-quarters of people hospitalized with flu-related illness are 65 or older, and most flu deaths are among elderly people. Two flu vaccines are available for that age group: the regular flu shot or a high-dose version with four times the protection. Ask your doctor which is right for you.

People who have had chickenpox are at risk for getting shingles because the same virus causes both illnesses. Anyone can get shingles after having chickenpox, but the risk increases with age. About half of the 1 million cases each year are in adults age 60 or older, reports the CDC. The zoster vaccine is recommended for adults in this age group to help prevent shingles.

Physicians suggest you check with your doctor to see if your vaccinations are up to date. TMA has published a fact sheet about vaccinations for adults, in English and Spanish.

Wednesday, September 9, 2015

Infographic: Flu Facts

Flu season is just around the corner, and Texas physicians want to remind everyone that your best defense is getting vaccinated. The following TMA infographic illustrates top “flu facts” everyone should know, including the dangers of influenza (it hospitalizes 200,000 people each year), who should get vaccinated (nearly everyone), and what types of vaccines are available (not all include needles!). The graphic also dispels the belief that a flu shot can give you the flu.

Check it out:

See a Spanish language version of this infographic.

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