Managed Care
Disease
Management
News & Commentary
Too many antibiotic prescriptions are being written for pediatric pharyngitis, according to a recent study in JAMA Pediatrics. Researchers looked at 12 million visits for the condition made from 1997 to 2010 and found that 60% led to antibiotics being prescribed. And 18% of those were for second- and third-generation cephalosporins and amoxicillin-clavulanate, which are not recommended for pharyngitis…
Contributing Voices
Steven Peskin, MD
Steven Peskin, MD

“At first they thought it was anxiety,” Melissa Thomason began her deeply moving and inspirational story.  Melissa’s first pregnancy was complicated by preeclampsia, requiring delivery 5 weeks early by C-section. Her elation was short-lived when she experienced “a bulldozer sitting on her chest and shortness of breath” two hours after her Cesarean delivery. She was told that anxiety is frequent after child birth.

“Thankfully, my OB listened to me and ordered a CT scan of my chest.” A nightmare: The severe pressure, pain and shortness of breath were caused by ...

Managed Care Outlook
Thanks to new therapies, it could be classified a rare disease by 2036 and, in a best-case-scenario, it might earn that distinction by 2026. A study in the Annals of Internal Medicine estimates how HCV will advance under four models.
Feature
Nan Myers
The ACA encourages inmates to sign up for Medicaid because good, consistent care cuts down on recidivism. This is all new, though, and Medicaid managed care plans will need to coordinate their efforts with state officials to help this problematic population. Still, it’s an example where the right thing to do aligns with financial benefits.
News & Commentary
Since the 1980s, there’s been a steep increase in the number of people who suffer from problems associated with depression, such as difficulty remembering or trouble sleeping. Teenagers seem especially vulnerable, with 38% more likely to have memory problems and 74% more likely to have trouble sleeping.
Tomorrow’s Medicine
Thomas Morrow, MD
By measuring the inflammatory marker CD154, Pleximmune promises to predict the risk of organ rejection in liver and small-bowel transplant procedures. The price of the test is $825, making it a rather inexpensive alternative given the cost of rejection.
Feature
Peter Wehrwein
Detailed information about the accountable care organization (ACO) contracts that organizations have negotiated with commercial payers is hard to come by. The word accountable is very much in vogue and being used to describe any payment system that’s not strictly fee for service.
Legislation & Regulation
Richard Mark Kirkner
Insurers argue that what patients pay above reference price for expensive services such as hip replacement or colposcopy should be included in the formula that decides out-of-pocket costs. The argument stems from the wide variation in fees in markets; a colonoscopy in northern California can range anywhere from $800 to $8,000.
Cover Story
Richard Mark Kirkner
Hospitals discover that having a cheaper place to send those sore throats and fevers and ankle sprains that would otherwise end up in the ER makes economic sense. They also want them because they fit in with new risk-sharing arrangements, notably accountable care organizations. Insurers and investors like what they’re seeing, as well.
Managing Editor’s Memo
Frank Diamond

Baseball is life, T-shirts inform us. Not because the game is something to be cherished and celebrated — though true fans are enthralled — but because every time you think you have it figured out, you learn that you don’t. (Maybe the shirts should say, “Baseball is love.”)

News & Commentary
A recent research project sought to pinpoint conclusively the effect anesthesia has in causing death or neurodevelopmental impairment in low-birth-weight infants who are operated on. But conclusive findings on that effect remained elusive.
The Formulary Files
Krishna Rutvij Patel, PharmD
Spending is climbing steeply this year, but the rate of increase should start to slow beginning in 2015. A combination of an improving economy and previously uninsured gaining coverage helped cause the increase this year, according to the Centers for Medicare & Medicaid Services.
Contributing Voices
Edie Castello

Technology in health care is in danger of going the way of the home exercise bike: Lots of potential, not enough use — and less-than-optimal results.

Take data analytics, for example. With more health care organizations than ever before using electronic health records, we’re finally getting what we have been asking for: A plethora of really good data that could inform decision making. In 2011, data from the U.S. health care system reached 150 exabytes. As growth continues, big data for U.S. health care will soon reach the zettabyte (1021 gigabytes) scale and ...

News & Commentary
Preterm birth and low birth weight can lead to cognitive problems in later years, according to new research. Such babies are in more danger of facing cognitive decline in old age, but the study also suggests that putting the brain to good use can minimize this decline.
Snapshot
Nearly 70% of organizations searched for a family medicine physician; and nurse practitioners led the pack of the top overall searches conducted, according to a survey of 631 doctors conducted by the Association of Staff Physician Recruiters (ASPR). The report also shows a large number of searches for primary care providers going unfilled.
News & Commentary
Price transparency will strengthen the doctor/patient relationship, says 54% of 631 physicians in a survey by the American College of Physician Executives. However, 22% of respondents are concerned that pricing information may be too complex for some patients to understand and thereby puts stress on the relationship.
Contributing Voices
John Marcille

Anyone who spends much time talking with me knows that one of my concerns, and not just as an editor, is the misuse of language by people in health care. Yes, I have a list of examples, and I might share that in a future essay. Today, we'll consider just one problem.