To Treat or Not to Treat? The Debate on Incidental Medical Findings

In an article dated August 29, 2016, doctors and researchers debate whether they should disclose to patients minor abnormalities that are incidentally found during an imaging procedure (such as an MRI or CT scan). On the one hand, researchers say that doctors are going “overboard” on disclosing low-risk findings that lead to overtreatment and unnecessary worry by the patient.   However, on the other hand, a decision not to follow up on an incidental finding can have serious consequences. For one patient, kidney cancer was incidentally found and led to early treatment that arguably saved his life. Although the professionals disagree on whether to treat or not to treat, most agree that guidelines are needed to help doctors make the difficult decision.

Excerpt from article:

Often there is “little benefit” to patients knowing about minor, low-risk findings, and it can have significant financial, psychological and clinical consequences, they say.  Failure to follow up incidental findings can come back to haunt some patients, other experts say. . .

To read full article: When a Medical Test Leads to Another, and Another


Integrated Health Care Delivery Systems: “The Wave of the Future?”

Health care delivery is undergoing a major change in the United States, and it is happening with little fanfare, due to the fervent debate over the viability of the Affordable Care Act (ACA). Hospital systems, such as Mt. Sinai in New York, are cutting out the middle man when it comes to insurance coverage, in order to retain more profits from services provided. Mt. Sinai, located in New York, is an example of a hospital system that is providing its own insurance options to patients who receive treatment within the system.

Both non-profit and for-profit hospitals can benefit from implementing such programs, as there are certain services that are not economically sustainable, but must be accessible to the public. For example, psychiatric care does not generate a lot of revenue, but is a necessary and important service. Ezekiel Emanuel was one of the creators of the ACA, and is chairman of the Department of Medical Ethics and Health Policy at the University of Pennsylvania. He states that “the wave of the future is integrated delivery systems—integrating insurance with the delivery function.”

Read more here.

Medicare Part D in Good Health per CMS

The Center for Medicaid and Medicare Services (CMS) administrator, Marilyn Tavenner, stated in a letter to Congress that Medicare Part D is working well, and a proposed rule change, which would have “substantially reduced patient choice,” is unnecessary. The Senate Finance Committee stated that, at present, the cost of the program is 45% below the projections of the Congressional Budget Office. In addition, Part D enjoys a 90% satisfaction rate by its beneficiaries. Under the Affordable Care Act the cost of Medicare Part D premiums has remained low, but the quality of care has improved. However, Ms. Tavenner wrote also that opportunities exist to improve the program, and CMS will continue to review Part D policies periodically.

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Approximately 50% of Americans Believe Health Conspiracy Theories

JAMA Internal Medicine published a research letter by authors J. Eric Oliver, PhD and Thomas Wood, MA, which indicates that almost half of the nation believes in at least one health conspiracy. For example, thirty-seven percent of Americans believe that the Food and Drug Administration is concealing natural cures for cancer in response to industry pressure from pharmaceutical companies. The authors conducted an online survey of 1,351 adults; the survey posited four health conspiracy theories. Forty-nine percent of those polled indicated that they believe at least one of the proposed theories, and eighteen percent believe in at least three. According to Oliver, the takeaway from the survey “is that people who embrace these conspiracies are very suspicious of traditional evidence-based medicine.

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D.C. Instructs Insurance Companies to Cover Gender Reassignment Surgery

Mayor Vincent Gray of Washington D.C. announced that D.C. will now require insurance companies to provide full coverage to transgender residents, which includes gender reassignment surgery. The D.C. Department of Insurance, Securities and Banking stated its official position that treatment and gender reassignment surgery for gender dysphoria are covered benefits. The Mayor stated that transgender people should not be required to pay extensive out-of-pocket fees for treatment.

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California Law “Designates Pharmacists as Health Care Providers”

A pharmacist must undergo eight years of education in order to obtain a doctorate in pharmacy. Until recently, pharmacists could only fill prescriptions. However, pharmacists across the nation have been taking on a more direct role in patient care. States such as North Carolina, California and New Mexico have implemented laws that allow a pharmacist to perform additional duties, and not just “fill a bottle with pills.” Some claim that allowing pharmacists more responsibility will alleviate the strain on resources experienced by both primary care physicians and hospitals. Others are concerned that pharmacists are being given too much responsibility.

Read more here.

UPDATE: Man Forced to Undergo 3 Enemas and Colonoscopy by Police

David Eckert, from Hidalgo County, New Mexico, was subjected to numerous, highly invasive procedures, because police suspected him of hiding drugs in his rectum. Mr. Eckert had been convicted of methamphetamine possession in 2008, and the police suspected his continued involvement with drugs. However, the officers who searched both Mr. Eckert’s person and his vehicle, after pulling him over for a traffic violation, found neither drugs, nor weapons. One officer indicated that Mr. Eckert held himself in an “erect” position, and “kept his legs together,” which led the officers to assume that Mr. Eckert held drugs within him.

 After a local hospital refused forcibly to search Mr. Eckert, he was transported to the Gila Regional Medical Center (GRMC), 50 miles away. At GRMC, Mr. Eckert was subjected to two rectal exams, three enemas, forced bowel movements in front of officers and nurses, x-rays, and a colonoscopy performed under anesthesia. However, each search was fruitless. Mr. Eckert received a bill from the hospital for $6,000. Mr. Eckert filed suit against the hospital, and the parties settled for $1.6 million.

Read more here.

Federal Government Overpays for Penis Pumps

The inspector general for the Department of Health and Human Services and Medicare compiled a report recently, which shows that Medicare pays “more than twice as much” for vacuum erection systems (VES) than either internet consumers or the Department for Veteran Affairs. According to the Mayo Clinic, VES is one of a few viable treatments for erectile dysfunction. However, at present legislators struggle to reach agreement on a $1 trillion spending bill, and government waste is a pressing concern. The report indicates that if Medicare had lowered its payments to match the cost paid by non-Medicare consumers it could have saved “an average of about 14.4 million for each of the last 6 years.”

Read more here.

No Medical Monitoring Cause of Action in New York Without Physical Injury

On December 17, the New York Court of Appeals ruled that New York would not recognize a medical monitoring claim in the tort context without a physical injury, merely because an individual has an increased risk for future injury. The Court recognized that it has authority to create this cause of action, but determined that such a measure is better left to the legislature. Courts across the nation are split on the issue of whether to allow such claims to proceed in the absence of physical harm. However, New York’s highest court may persuade other jurisdictions to follow its lead on this issue.

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Cease-And-Desist Orders Filed Against Health Net, Blue Shield and Anthem Blue Cross

The California Department of Mental Health Care (CDMH) filed cease-and-desist orders against Health Net, Blue Shield and Anthem Blue Cross for the “unlawful denial of necessary medical therapies.” CDMH claims that the language in their speech therapy policies violates state law, which mandates access to speech therapy. Children with conditions such as autism, cerebral palsy, expressive language disorders and speech delays were denied coverage under the policies.

Read more here.