Today’s Top Story
ACEP poll respondents say patients delay care due to deductibles and copays.
A survey of 1,433 members of the American College of Emergency Physicians (ACEP) finds support for the idea that many patients may delay care because they can’t afford insurance deductibles or copays. In addition, the poll finds that:

  • 73 percent of respondents have seen increased numbers of Medicaid patients who have delayed care due to narrow physician networks
  • 60 percent report difficulty finding specialists for their patients because of narrow network plans
  • 20 percent report contemplating or knowing other emergency physicians who have opted out of health insurance networks
  • 67 percent say that primary care physicians send patients to emergency departments for tests or procedures when health insurance companies refuse to cover office visits

Read more…
View the complete survey…

Other News

Study: Many federal marketplace plans lack access to certain specialists.
Findings from a study published in the Oct. 27 issue of The Journal of the American Medical Association (JAMA) suggest that access to some specialties may be limited or unavailable in some federal marketplace insurance plans. The researchers searched physician networks across 34 states for in-network specialist physicians in obstetrics/gynecology, dermatology, cardiology, psychiatry, oncology, neurology, endocrinology, rheumatology, and pulmonology. They found that 18 of 135 networks were specialist-deficient within 100 miles of the search area’s most populous city. The researchers state that endocrinology, rheumatology, and psychiatry were the most commonly excluded specialties, and an additional 7 to 14 plans had fewer than five in-network physicians in those specialties. Overall, nearly 15 percent of networks reviewed completely lacked in-network physicians for at least one specialty. Read more…
Read the abstract…

Study: Treatment with prostate-specific a antagonist may increase risk of falls and fracture in older men.
According to a study conducted in Canada and published online in the journal The BMJ, men who start treatment with prostate-specific a antagonists may be at increased risk of fall, fracture, and head trauma. The research team reviewed data on 147,084 men aged 66 years or older who filled their first outpatient prescription for prostate-specific a antagonists tamsulosin, alfuzosin, or silodosin and a 1:1 matched cohort of men who did not initiate a antagonist therapy. They found that exposure to a prostate-specific a antagonist as associated with a significantly increased risk of falling and of sustaining a fracture. In addition, secondary outcomes of hypotension and head trauma were also significantly increased in the exposed cohort. Read the abstract…

What does it mean when opioids are considered “abuse-deterrent?”
An article in the Oct. 27 issue of JAMA summarizes information on abuse-deterrent opioid formulations. The writers note that three available opioid formulations now include claims of abuse deterrence in their package inserts, yet no opioid formulation prevents consumption of a large number of intact dosage units, which is the most common method of abuse. Instead, they explain that abuse-deterrent formulations have one or more properties to make intentional nontherapeutic use more difficult, less attractive, or less rewarding, including but not limited to:

  • Controlled release of drug
  • Sequestered opioid antagonist
  • Tablets that resist crushing or grinding
  • Gelling agents that make injection via hypodermic needle difficult

The writers state that postmarket epidemiologic studies are required for all opioid formulations that have claims of abuse deterrence in their labeling. They note that, of the three current formulations, one has completed several postmarketing epidemiologic studies and been associated with a reduction in abuse, while the other two are undergoing studies that are scheduled for completion in 2018 and 2019. Read more…

Study: Use of professional language interpreters may improve communication with English-limited patients.
Data from a study published in the November issue of the journal Medical Care suggest that use of professional interpreters may improve communication between healthcare providers and patients who are not proficient in English. The authors conducted a cross-sectional study of transcribed audiotaped primary care visits of 32 Spanish-speaking patients and 14 clinicians. They found that accurate interpretation made up 70 percent of total coded text units (segments of continuous speech), while the other 30 percent consisted of inaccurate interpretation (errors). Overall, inaccurate interpretation was associated with 54 percent of ad hoc translations, compared to 25 percent of in-person professional translations and 23 percent of professional videoconferenced translations. In addition, the likelihood of a moderately or highly clinically significant error were increased for ad hoc interpreted visits compared to in-person professional interpretation. Read more…(registration may be required)
Read the abstract…

Report looks at decline in black male applicants to medical school.
According to a report from the Association of American Medical Colleges, despite overall increases in demographic diversity among the U.S. physician community, the number of black male applicants to medical school has fallen from 1,410 in 1978 to 1,337 in 2014. The writers interviewed 11 black premedical students, physicians, researchers, and leaders and noted the following as potential factors in the decline:

  • Personal and external factors that contribute to success in becoming a physician
  • Factors in the early grades in the public education system that may adversely affect young black boys
  • The role of community members in positive or negative influence on career exploration and decisions
  • Public perceptions and images of black men that may adversely influence educational and career progress

“With the predicted physician shortage of between 46,000 and 90,000 physicians by the year 2025, and the changing demographics of the patient population, it’s even more critical to provide greater access to care for a more diverse patient population,” the writers state. Read more…
Read the report (PDF)…

The U.S. Department of Justice (DOJ) and the U.S. Federal Trade Commission have submitted a joint statement to the Virginia Certificate of Public Need (COPN) Work Group to recommend that the state consider whether its COPN program best serves the needs of its citizens. “The evidence suggests that certificate-of-need laws have not served consumers well,” states a representative of the DOJ Antitrust Division. “They raise the cost of investment in new health care services and can shield incumbents from competition that would benefit consumers and lower costs. By reexamining the certificate-of-need process state policymakers have an opportunity to invigorate competition in this important sector, to the benefit of patients, employers and other health care consumers.” Read more…

Call for volunteers: Central Evaluation Committee.
Nov. 30 is the last day to submit your application for a position on the Central Evaluation Committee. Members of this committee write questions for the Orthopaedic In-Training Examination annually and for the Orthopaedic Self-Assessment Examination triennially. The following openings are available:

  • Oncology (one member)
  • Pediatric Orthopaedics (one member)
  • Trauma (one member)

Applicants for these openings must be active or emeritus fellows with a practice emphasis in the relevant topic. Learn more and submit your application…(member login required)