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Thursday, July 21, 2016

TMA Recognizes Health Reporting Excellence

Deborah Fuller, MD, presents to Lauren Silverman, KERA FM,
Dallas, Texas Health Journalist of the Year and In-Depth Radio winner.
The Texas Medical Association (TMA) announces the 2016 TMA Anson Jones, MD, Award winners for outstanding health and medical news reporting during 2015 (see winner list below). TMA member physicians presented TMA Anson Jones, MD, Awards to journalists at local ceremonies throughout the spring.

“Each year, we’re impressed by the quality of work from journalists across the state, and this year was no exception,” said TMA’s Council on Health Promotion Chair Benjamin Lee, MD, of Dallas. “Whether they’re reporting for a small weekly newspaper or a TV station in a major city, the journalists relay important health information to the public.”

The annual TMA awards recognize print, television, radio, and online media journalists in 10 award categories. One award honors the Texas Health Journalist of the Year to recognize a body of work produced in a single year by a print, broadcast, or online journalist.

Award winners receive $500. The journalist of the year receives $1,000.

Since 1957, TMA has honored award-winning Texas journalists with the Anson Jones, MD, Awards, named for the pioneer physician and prolific writer who served as the last president of the Texas Republic. Members of TMA’s Council on Health Promotion judge the competition, along with respected former journalists from both news publishing and broadcast fields.

Are you a Texas health reporter or do you know one? 
TMA now is accepting entries for the 2017 awards competition. A new award category, Online Single Article/Blog, will recognize a single news article or blog that appears online only on a web-based news outlet.

“Already this year, we’ve had contributions on Zika, prescription drug abuse, and the heroin epidemic,” said Dr. Lee. “We know journalists are reporting on important topics, and we encourage them to enter the Anson Jones awards, whether for the first time or the 10th time. It’s a great way to showcase their work, and maybe come away a winner.”

Journalists have until Jan. 10, 2017, to submit an entry for any news story that is published or airs in 2016. Journalists can direct questions to ansonjones@texmed.org.

TMA 2016 Anson Jones, MD, Award Winners:


Large-Market Television
Name of Entry
Honoree(s)
Media Outlet
Winner
Sally Hernandez and Dani Guerrero
KXAN-TV, Austin
Honorable Mention
Austin Girl, 6, Needs Bone Marrow Match
Terri Gruca and Matt Olsen
KVUE-TV, Austin




Small-Market Television
Name of Entry
Honoree(s)
Media Outlet
No winner selected







In-Depth Television
Name of Entry
Honoree(s)
Media Outlet
Winner
Breast Cancer Lifers Inspire
Terri Gruca and Matt Olsen
KVUE-TV, Austin




Large-Circulation Print
Name of Entry
Honoree(s)
Media Outlet
No winner selected







Small-Circulation Print
Name of Entry
Honoree(s)
Media Outlet
Winner
Kevin King
Vital Signs, Beaumont




In-Depth Print
Name of Entry
Honoree(s)
Media Outlet
Winner
Alexa Garcia-Ditta
The Texas Observer
Honorable Mention
Saul Elbein
The Texas Observer
Honorable Mention
Brooks Egerton
The Dallas Morning News




Radio
Name of Entry
Honoree(s)
Media Outlet
No winner selected







In-Depth Radio
Name of Entry
Honoree(s)
Media Outlet
Winner (Tie)
Lauren Silverman
KERA, Dallas
Winner (Tie)
David Martin Davies
Texas Public Radio
Honorable Mention
Krys Boyd, Jeff Whittington, Stephen Becker, and Lyndsay Knecht
KERA, Dallas
Honorable Mention
Paul Flahive
Texas Public Radio




Online/Mixed Media
Name of Entry
Honoree(s)
Media Outlet
Winner
Seema Yasmin, John Hancock, Eva Parks, and Scott Friedman
The Dallas Morning News, NBC 5-TV
Honorable Mention
Alexa Ura, Neena Satija, and Becca Aaronson
The Texas Tribune
Honorable Mention
Emily Trube
KRLD, Dallas





Texas Health Journalist of the Year
Name of Entry
Honoree(s)
Media Outlet
Winner

Lauren Silverman
KERA, Dallas
Honorable Mention

David Martin Davies
Texas Public Radio

Wednesday, July 20, 2016

Dallas Surgeon Talks Candidly About Police

Photo by Leslie Boorhem-Stephenson, The Texas Tribune


By Madeline Conway,
 
Brian Williams, an assistant professor of surgery at UT Southwestern, drew national headlines when he spoke about the experiences he’s had with police, both as a black man driving a car and as a trauma surgeon in a time of crisis. (The Associated Press)
 


This article originally appeared in The Texas Tribune at http://www.texastribune.org/2016/07/18/dallas-surgeon-talks-candidly-about-police/. The Texas Tribune is a nonpartisan, nonprofit media organization that informs Texans — and engages with them — about public policy, politics, government and statewide issues.

Wednesday, July 13, 2016

Inaccurate Provider Lists A Major Barrier To Care, Study Finds

By Emily Bazar
Kaiser Health News

Provider directories for some health plans sold through Covered California and in the private market are so inaccurate that they create an “awful” situation for consumers trying to find doctors, according to the lead author of a new study published in the journal Health Affairs.

In the study, “secret shoppers” posing as patients were able to schedule an appointment with a primary care physician less than 30 percent of the time.

The callers contacted 743 doctors in five different regions of California who were listed as primary care physicians in their health plans’ online directories. They focused on Blue Shield of California and Anthem Blue Cross plans sold to individuals and families through the state health insurance exchange and in the open market.

“We were a little bit surprised at how bad the numbers were,” said the study’s lead author, Simon Haeder, an assistant professor of political science at West Virginia University.

Haeder said the pseudo-patients, who made the calls in June and July of last year, encountered a variety of obstacles to making an appointment.

About 10 percent of the time, the providers either were no longer with the medical group listed in the directory or never had been.

In about 30 percent of cases, the callers were told that the doctor had a different specialty than the one listed in the directory. Roughly 20 percent of the time, the callers were unable to reach the doctors at the numbers listed in the directories — despite repeated attempts — because the lines were disconnected, messages weren’t returned, or for other reasons. In about 10 percent of the cases, the doctors did not accept new patients.


Blue Shield and Anthem were chosen because they’re large insurers that sell policies across the state. And Anthem sells health plans in many places outside of California, “which should make our findings translatable to other states,” Haeder said.

Blue Shield and Anthem both sell plans in the private market that are identical to the ones they sell through Covered California.

“Obtaining access to primary care providers was generally equally challenging both inside and outside” Covered California, the study concluded.

Haeder said the problems were “slightly worse” for plans sold via the exchange, but that the differences were minor. “Both of them are doing relatively terribly,” he said.

Blue Shield and Anthem have a history of problems with their provider directories. In November, the state Department of Managed Health Care fined Blue Shield $350,000 and Anthem $250,000 for “unacceptable inaccuracies.”

The insurers were instructed to improve their directories and reimburse enrollees who may have been harmed by the errors, including patients who were charged for going out-of-network even though the directory showed the doctor they chose was in-network.

The managed care agency is conducting a follow-up survey to determine whether Anthem and Blue Shield have corrected the problems identified in the initial survey, and it expects to release the results later this year, said spokeswoman Rachel Arrezola.

Both insurers said they are working to fix their directories.

“Anthem has spent millions of dollars over the last three years to make our provider directory more user-friendly and to improve the accuracy of the data,” said the company’s spokesman, Darrel Ng.

Since the study was conducted a year ago, he said, Anthem has made tens of thousands of updates to its database, with nearly 19,000 revisions in the third quarter of 2015. He added that Anthem has two dozen employees dedicated to maintaining and updating the directory.

Blue Shield also makes thousands of changes and updates to its provider data each month, said spokeswoman Molly Weedn.

“Blue Shield has continued to make investments in people, processes and technology resources to improve our provider directories,” Weedn said.

Keeping the directories updated is a challenge, she said, in part because of “constantly changing information — such as whether or not a physician is accepting new patients — that needs to be promptly reported to health plans.”

Anthem and Blue Shield are participating in a pilot project run by America’s Health Insurance Plans, a national trade association, to improve the accuracy of provider directories.

Covered California spokeswoman Lizelda Lopez said the problem of inaccurate provider directories is “disheartening.” But, as the study shows, it isn’t unique to health insurance exchanges, and it predates the Affordable Care Act, she added.

Lopez pointed to a new California law that took effect July 1 requiring insurers to update their online directories once a week and their printed ones every quarter.

Starting next year, each Covered California enrollee will choose or be assigned a primary care doctor within 60 days, “so that they will have an entry point for health care as soon as possible after they enroll in coverage,” Lopez said.

The exchange also plans to add an online provider directory in time for the next open enrollment period, which begins November 1. It will allow consumers to search physicians by name, she said.

“Every Covered California enrollee should know that if they have difficulty scheduling an appointment, they should contact their health plan for assistance, especially if they have an acute health care need,” Lopez said. “All health insurers will assist consumers in finding a provider who can serve them.”

The study’s findings are “not a surprise,” said Betsy Imholz, special projects director of the advocacy group Consumers Union. “It’s a longstanding issue. In this new environment, we have to get better. That’s what our own work told us and this confirms it.”

Consumers Union conducted its own informal secret shopper survey in 2014 and 2015, in the San Francisco area, and got similar results, Imholz noted.

The group co-sponsored a new law that calls for weekly online directory updates.
In addition to the problems with provider directories, the Health Affairs study also found that shoppers with “urgent” health problems such as high fevers or heavy bleeding during menstruation faced wait times of eight to 12 days to get an appointment.

“You need to be able to use your insurance outside of an emergency room,” Haeder said. “For someone who is not financially well-off and doesn’t speak English and is trying to schedule an appointment but can’t, they either give up … or they go to the emergency room, which creates bigger issues for the health care system.”

The study suggests that updating provider directories frequently with real-time information, coupled with incentives or penalties for providers and insurers, “might be the only path to truly improved access for patients.”

“As our analysis has shown,” the study concludes, “access to health insurance is not necessarily synonymous with access to health care services.”

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

Tuesday, July 12, 2016

Tour de France or Neighborhood Ride: Wear Your Helmet

Charlie Hastings, DO, fits a helmet
on a child. He routinely talks to his
patients about helmet safety.
  Whether or not you’re following only the second Texan to compete in the prestigious Tour de France bicycle race (Lawson Craddock of Houston, after Lance Armstrong), the event is a good reminder of the importance of safe cycling. Tour competitors wear a helmet while riding. The physicians of the Texas Medical Association (TMA) encourage physical activity, such as cycling, and urge the use of a properly fitted helmet when doing so.

“I love cycling and love seeing kids, including my own, riding bikes (with helmets on),” said William (Charlie) Hastings, DO, a pediatrician in Spearman, a town on the northern edge of the Texas panhandle. “Bicycles are a great tool for exercise, transportation, relieving stress, and for just having fun. But as with all sports and activities, risks are involved.”

Each year in the United States, bicycle-related injuries send nearly 500,000 people to the emergency department, according to the Centers for Disease Control and Prevention. Injuries range from minor scrapes and bruises to severe head injuries and death. Head injury is the most common cause of death and serious disability from bike crashes.

"I have treated a lot of minor bicycle-related injuries, and a few more serious ones,” said Dr. Hastings, “and have experienced my share of injuries in 20 years of riding and racing bikes. If it weren’t for my helmet, a few could have been more severe.”

National statistics support this notion. Helmets have been shown to prevent nearly 85 percent of brain injuries, and can even help reduce injuries to the forehead and midface in crashes. To do their job, however, helmets must fit well and be worn low on the forehead just above the brow.

Dr. Hastings promotes helmet use and safety to young patients in his practice. “I commonly tell my patients we can fix an injured arm or leg a lot easier than an injured brain,” he said. Dr. Hastings also reminds his patients a head injury can occur even at slow speeds because the ground (especially paved surfaces) can be unforgiving. And with hands on the bike, breaking a fall can be difficult.

In addition to urging bike safety in his practice, Dr. Hastings recently fit helmets at a local TMA Hard Hats for Little Heads event and supports the program’s motto, “Get Moving. Stay Safe. Wear a Helmet.” The bike helmet giveaway program encourages helmet use when participating in sports on wheels: biking, inline skating, skateboarding, and riding a scooter.

TMA urges children and adults to wear the appropriate helmet for the appropriate sport, and ensure it is properly fitted and structurally sound. This TMA video describes how a helmet should fit for maximum protection.



Wearing a helmet that is too big, too small, old, or unbuckled will not fully protect a head. Also, helmets wear out and should be replaced every few years, or when a child outgrows a helmet.

In addition to wearing a properly fitted helmet and other safety gear, Dr. Hastings says cyclists can decrease the risk of injury by keeping their bike well-maintained, wearing high-visibility clothing, and learning and practicing road safety.

While your rides might not take you the nearly 2,200 miles (3,535 kilometers) of the Tour de France, doctors say it’s always the smart decision to wear your helmet whether you’re riding to a friend’s house in your neighborhood or taking to the streets and byways.

Since the Hard hats for Little Heads program began in 1994, TMA has given away more than 240,000 helmets to Texas children.

Monday, July 11, 2016

“Right-to-Try” Law Aims to Aid Terminally Ill Texans

One year after becoming law, a “right-to-try” measure to make experimental drugs more accessible to terminally ill patients has some physicians optimistic about the potential for more patients to try experimental therapies but others concerned it may give patients false hope and delay important conversations about advanced care planning. Meanwhile, it’s unknown how many patients have taken advantage of this new law the Texas Legislature passed last session, according to the July issue of Texas Medicine magazine, the Texas Medical Association’s (TMA’s) official publication.

Reps. Kyle Kacal (R-College Station) and Ken King (R-Canadian) sponsored the legislation, House Bill 21, which Gov. Greg Abbott signed into law on June 16, 2015. Both sponsors’ mothers died of ovarian cancer within 40 days of each other in 2013. That same year, a beloved lobbyist at the Texas Capitol, Andrea Sloan, publicized her own fight to obtain an experimental drug for her ovarian cancer. Bureaucracy prevented Ms. Sloan from beginning an experimental treatment right away. She died on Jan. 1, 2014, two months after finally getting access to the investigational drug. The death of these three women were the collective impetus behind the legislation, said Representative Kacal.

“Terminal patients, they don’t have weeks, months,” he said. “They’ve got a short window of opportunity, and if the drug is out there that has good science and passed that first part of U.S. Food and Drug Administration [FDA] approval, let’s go [try it].”

HB 21 provides expedited access to investigational drugs to cut through the bureaucracy patients like Ms. Sloan have faced when pursuing them through the FDA’s compassionate-use exemption. The bill allows a patient with a terminal illness to access an investigational drug or treatment if the patient’s physician has considered all other options and determined they are “unavailable or unlikely to prolong the patient’s life.” The patient must sign an informed consent form before receiving an investigational drug. HB 21 defines an investigational drug as one that successfully completed Phase I of a clinical trial (a first stage of FDA approval), meaning it has been evaluated for safety and proper dosing but is still under investigation in the trial and isn’t yet fully FDA-approved.

Many physicians see promise in the bill but caution experimental treatments are not for every patient and novel therapies need to be carefully considered by patients and their doctors.

Austin oncologist Debra Patt, MD, past chair of TMA’s Committee on Cancer, says HB 21 effectively gives cancer patients options when standard treatments are no longer available, and the patients can’t participate in a clinical trial. But Dr. Patt says patients should use that option infrequently because a clinical trial, if available, is the best setting in which to try experimental drugs.

“For most patients who receive treatment, it really should be under evidence-based care that we believe is more likely to be effective and less likely to have substantial harm,” Dr. Patt said. “I do think that this is important legislation, and it’s really important to allow doctors and patients to make the right decisions with regard to their care. But I think it is in the best interest of patients if it’s used extremely infrequently.”

Echoing Dr. Patt’s apprehension was Sen. Charles Schwertner, MD (R-Georgetown), who raised “concerns that vulnerable individuals could be hurt by the law.” Senator Schwertner said at the bill’s hearing that he worried physicians and drug companies might “sell hope” using unproven medications.

History is replete with snake oil salesmen in the medical field,” he said.

Houston gynecologic oncologist Lois Ramondetta, MD, chair of TMA’s Committee on Cancer, says she’s concerned that it’s “always easier to give another drug than really sit and talk with someone about advance care planning, for both the patients and the physicians, to avoid the elephant in the room and the fact that the end of life is coming.”

“I would say it’s very important to recognize that more drugs [are] not always better and can in fact sometimes even shorten life,” she said. “Really, with the speed at which new drugs are discovered, they need to be evaluated carefully before being used.”

Charles Levenback, MD, a Houston gynecologic oncologist who treated Ms. Sloan at MD Anderson Cancer Center for seven years, was more optimistic about the law, citing its ability to draw attention to experimental therapies and the difficulties patients can face while pursuing them.

Anything that shines a light on the complexity of the health care system is a good thing, Dr. Levenback said. Thus far none of the physician’s other patients have applied for compassionate-use access under HB 21.

But he asked why it’s so difficult for a patient like Ms. Sloan to gain access to potentially life-extending therapy when good science provided evidence the drug could help.

“Andrea paid her taxes, she was insured, she was a good servant of society, she was responsible, and now she'’ asking back for a drug [that’s] not going to cure her but maybe prolong her survival,” he said. “And it felt like everything was conspiring to keep her away from it.”

Friday, July 8, 2016

HPV-Related Cancers Increasing in Men, Women

The Centers for Disease Control and Prevention (CDC) reports a rise in cancers caused by the human papillomavirus (HPV), including cervical and oropharyngeal (head and neck) cancers, as well as vaginal, vulvar, penile, rectal, and anal cancers.

According to the CDC, an average of 38,793 new HPV-associated cancers were diagnosed annually between 2008-2012, including 23,000 in women and 15,793 in men. The CDC estimated more than 79 percent of these cancers were caused by HPV infection. The new numbers are significantly higher than in years past: The 38,793 yearly cases is a 16 percent increase from the previous four-year annual average of 33,369 cases.

The most common types of cancer were cervical cancer in women (11,771 females diagnosed on average each year) and oropharyngeal in men (12,638 males diagnosed, as well as 3,100 females). The CDC published their findings in this week’s Morbidity and Mortality Weekly Report.

But HPV — and the cancers it causes — is largely preventable. Physicians say these findings stress the importance that both females and males receive the HPV vaccine.

“In the past, people always felt that the boys needed to be vaccinated to protect the girls but, truthfully, they need to be vaccinated to protect themselves,” Lois Ramondetta, MD, a gynecologic oncologist and chair of TMA’s Committee on Cancer told NBC News. “There is an epidemic of HPV related cancers in men, specifically those of the tonsil and the back of the tongue.”

Yet in the United States, just 40 percent of adolescent females and 22 percent of adolescent males have received all three doses of the HPV vaccine. Adolescence is the best time to get the series of shots.

“We know that almost 100 percent of cervix cancers are caused by HPV, 90 percent of anal cancers are caused by HPV, and about 70 to 80 percent of oropharyngeal — which mostly occur in men — are related to HPV,” Dr. Ramondetta said in a TMA news release. “If more people received the HPV vaccine, we could prevent these cancers by stopping this infection.”

Texas physicians say all adolescents should get the HPV vaccine when they are 11 or 12 years old, as the vaccine is most effective in the body when given before the age of 14. However, older teens and young adults can still receive the vaccine up until age 26.

TMA created an infographic to help educate patients and families about HPV and the HPV vaccine. Download it here in English or Spanish.

Tuesday, June 28, 2016

Heads-Up, Students: No Shot, No College

As college-bound students pack their bags to move into the dorm, the physicians of the Texas Medical Association (TMA) want to remind them about an important and required vaccination. Texas law requires almost all new and transfer college students under age 22 to be vaccinated against meningococcal disease at least 10 days before classes begin, or to show proof of vaccination within the previous five years.

“Meningococcal infection spreads among people who live in close quarters, like a college dorm or a military barracks, so college students need this vaccine,” said Carol J. Baker, MD, of Houston, a pediatric infectious disease specialist and a member of TMA’s Be Wise — ImmunizeSM Physician Advisory Panel.

Meningococcal disease includes infections of the brain’s lining and spinal cord (meningitis) and the bloodstream (bacteremia or septicemia) caused by the bacteria Neisseria meningitidis, or meningococcus. A healthy, nonsusceptible person can spread the bacteria to a healthy, susceptible person through coughing, sneezing, sharing drinks or eating utensils, or kissing.

Meningococcal disease strikes quickly with fever, headache, severe muscle aches — and later, stiff neck. The illness can seem like flu, but progresses with vomiting, weakness, mental confusion, shock, and sometimes a purple rash on the extremities. Emergency medical attention is important.

“These infections can become deadly in just a few hours,” said Dr. Baker. “With antibiotic treatment, some sufferers can survive, but up to 15 percent have lasting consequences.”

About one in 10 people who get meningococcal disease will die ― often within hours of the onset of symptoms and the start of treatment. Survivors can suffer severe, lifelong complications, such as hearing loss; amputations of fingers, toes or even arms or legs; and skin scarring.

The good news is that vaccination can prevent meningococcal disease. As many as four out of five adolescents and young adults who contract the infection could have avoided it had they been vaccinated. The meningococcal vaccine protects against the most common strains seen in the United States, namely groups A, C, W, and Y.

If an incoming college student’s vaccinations are up to date, he or she likely had a meningococcal vaccination at age 11 and 12. Protection from the vaccine lasts for only several years, so a second vaccination is needed at age 16-18 to protect young adults during the years when they are at highest risk for meningococcal disease.

“This ‘shot of prevention’ is an easy way to keep students healthy as they head off to their first phase of adulthood,” said Dr. Baker.

Students should check with their doctor to see if they are up to date with all recommended vaccines. Free or low-cost vaccinations may be available for teens and young adults who don’t have health insurance.

TMA has published a fact sheet about the importance of meningococcal vaccination, in English and Spanish.

It’s best to check and get vaccinated now, doctors say, well before packing those first items for college.

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