On 'Sound Medicine': Medicare reimbursement changes, educating physicians about health care costs, and children’s resiliency to stress
How will recently enacted Affordable Care Act policies affect Medicare for hospitals? Two new policy changes enacted by the Affordable Care Act took effect in October. The first penalizes hospitals if Medicare patients are re-admitted within one month of a visit if the re-admission is for a condition that should have been treated during the first admission. The second reallocates Medicare payments to hospitals that are providing higher quality care, rather than basing reimbursements on quantity. “Sound Medicine” health care policy analyst Aaron Carroll, M.D., M.S., discusses the impact these changes will have on hospitals.
How can physician education help lower the cost of health care? The American College of Physicians and the Alliance for Academic Internal Medicine have aligned resources to create a free curriculum designed to educate internal medicine residents about how they can avoid contributing to rising health care expenditures with unnecessary care. This new curriculum consists of 10 one-hour sessions that allow residents and faculty to interact and discuss real patient cases, while considering the factors of cost and evidence-based care. Cynthia Smith, M.D., senior medical associate for content development in the American College of Physicians' medical education division, shares the response the curriculum has received so far and its potential to lower health care costs if adopted on a wide scale.
How should doctors respond to “incidental” findings? With the rise in the use of technology such as CT and MRI scans, incidental findings -- abnormalities such as masses and lesions that were not originally suspected -- has also increased. The question remains: How should doctors handle sharing such sensitive results with patients? Further examining these abnormalities often results in more expensive tests, further radiation exposure from scans, and anxiety for the patient. Lincoln Berland, M.D., professor emeritus and vice chairman for quality improvement and patient safety at the department of radiology at the University of Alabama, Birmingham, has written extensively on the topic of “incidentalomas,” a term coined to describe such accidental discoveries. Berland discusses the unwillingness of doctors to not further explore these anomalies.
How can we help kids be resilient when encountering stress and trauma? Steven M. Southwick, M.D., is a professor of psychiatry at Yale University and the author of “Resilience: The Science of Mastering Life’s Greatest Challenges.” Southwick says we can teach our children to be resilient by borrowing strengths from the adults in their lives. Adults play a vital role is soothing the child and guiding some of their emotions, which allows the child to internalize positive coping strategies as higher brain functioning is developing. Southwick also discusses children's ability to adapt to inescapable stress.
When should I call the pediatrician? New parents are frequently faced with anxiety over calling the doctor about their child’s seemingly minor symptoms. But a child’s activity level or disinterest in normal activities may indicate an illness that warrants a doctor’s office visit. Denise Somsak, M.D., pediatrician with the Pediatric Associates of Cincinnati, encourages parents to at least call the pediatrician’s office when any worry arises and talk to a practitioner. Somsak frequently writes about this topic and more on her blog, “The Pensive Pediatrician.”
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