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.

You'll be hearing and using the terms EMR (electronic medical record) and EHR (electronic health record) more and more. But will you use them correctly? Are they interchangeable? I myself have confused the two. In fact, I used EMR wrongly in an interview the other day and the subject didn't bat an eye, even though his reply assumed a meaning for EMR that is not the real meaning. So it's easy to do.

Norman S. Ryan, MD
Norman S. Ryan, MD

As if the worsening diabetes epidemic were not enough to worry about, this chronic condition also increases risk for complications like heart disease, stroke, and kidney failure. This is a major challenge for health plans managing the care of a growing population of Medicaid members, who tend to overutilize emergency rooms for routine or non-urgent care.

While preventive and disease management programs are helping improve outcomes for people with diabetes and other chronic conditions, more must be done beyond just phone outreach to adequately engage Medicaid members. For instance, the single mother with young children and no car doesn’t need a call to remind her of an A1C test; she needs help resolving socioeconomic barriers like lack of transportation or child care.

Paul E. Terry, PhD

Though hospitals were the slow adopters of EHRs, most are now fully engaged in trying to satisfy the federal requirement for “meaningful use” of an EHR thanks to CMS financial incentives. Still, as much as acceptance of the complex requirements needed to earn incentives is now a given with three fourths of health systems achieving stage 1 requirements, my discussions with providers from around the country leaves me observing that the intense focus on the details behind satisfying requirements has obscured the greater health policy picture.

Edie Castello

The United States spends considerable money on health care. Unfortunately, the clinical return on investment has been coming up short for years, according to Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally, an oft-cited Commonwealth Fund study.

Krishna R. Patel, PharmD, RPh

If you haven’t already heard about the negative impact of formulary restrictions on adherence, well here it is. With mixed messages regarding formulary restrictions’ impact on patients, a recently published systematic literature review, published by Happe, et al., sought to get to the bottom this.

Norman S. Ryan, MD

Next year is a big year for Medicare Advantage plans. In 2015, they will not receive bonuses unless they have a 4-star rating or above. Many health plans are feeling under pressure right now, and may even feel a little disgruntled, as their businesses could really take a hit next year if they fall even slightly below 4.

One way to view this challenge that may take the edge off the pain is that the CMS Five Star Quality Rating System for Medicare Advantage Plans is not just about being able to stay or earn a spot in the Medicare Advantage program. Taking steps to improve ratings can help Medicare Advantage plans and other health plans hoping to enter the program achieve the Triple Aim and move them even closer to getting the business results they really want.

Steven R. Peskin, MD, MBA, FACP

This is my third installment on the Choosing Wisely Campaign from the American Board of Internal Medicine Foundation and Consumer Reports that brings into sharp focus, and in plain English, the things patients and we physicians should question. The Choosing Wisely campaign now includes submissions by more than 60 medical professional societies and organizations. Examples include:


  • Why scheduling early delivery of your baby is not a good idea
  • Treating sinusitis: Don't rush to antibiotics
  • Don't perform annual stress cardiac imaging or advanced non-invasive imaging as part of routine follow-up in asymptomatic patients
  • Bone density tests: When you need them and when you don't
  • Treating migraine headaches: Some drugs should rarely be used

What prompted this update is a new video in the zeitgeist of today, with light music, happily dancing people from seniors to millennials, and scrolling text.


I am hoping to prompt readers of Managed Care to help to take viral this video for the important campaign to reduce unneeded and in some cases harmful medical testing, treatments, and services. A wise choice!


https://www.youtube.com/watch?v=FqQ-JuRDkl8


Steven R. Peskin, MD, MBA, FACP, is associate clinical professor of medicine at the University of Medicine and Dentistry of New Jersey – Robert Wood Johnson Medical School, and is governor of the American College of Physicians, New Jersey South.

Michael Flanagan
Michael Flanagan

Uncertainty regarding health insurance exchanges is not going away. Changing enrollment deadlines and newly insured populations have brought challenges to payers and providers. Success will require staying competitive on price, network quality, and access.

Paul E. Terry, PhD

One of the more audacious promises of the accountable care organization (ACO) movement is the idea that providers of medical services can play a larger role in improving a population’s health. It stems from a notion that health care financing reforms will move the focus of providers from “the tyranny of the office visit” to activities where success will be judged according to improvement in clinical metrics whether a patient visits the office or not. It’s the right vision from a health promotion advocate’s vantage point because it may serve as a preamble to an era where medical and public health practices and public policies truly intersect. Dartmouth’s Jack Wennberg famously observed predictable provider-centric small-area variation in the use of clinical procedures while the Centers for Disease Control and many other public health observers have long shown that ZIP codes have more to do with health than do medical codes. Can the next generation of health reforms reconcile the tension between these loosely related truths?

Steven R. Peskin, MD, MBA, FACP

The title of this post might also read "Don't Mess with Mother Nature"

We have seen remarkable improvements in human health as a direct result of the science that has brought us our antibiotic age with significant reductions in infant mortality, deaths due to bacterial pneumonia, and other serious infections that sometimes led to systemic infection and death.

Fast forward to today, when we may obtain with a prescription many of these powerful germ killers for $4 at WalMart and Target and drug and grocery store chains. Some retailers even give away a prescribed course of antibiotics as a loss leader to entice the customer to enter that store.

The liberal (excessive, really) use of antibiotics in the United States and much of the rest of the world is having profound unintended negative consequences.

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