Ethical concerns come into play when physicians become part of health conversations on Facebook and other sites.

By Pamela Lewis Dolan, amednews staff. Posted March 28, 2011.

Patients using social media to check in on what their friends and family are doing are starting to use the sites as sources of information for something else — health care.

National Research Corp., a health care research company based in Lincoln, Neb., recently surveyed more than 22,000 Americans and found that nearly 16% use social media sites as a source of health care information. Of those, 94% said Facebook was their preferred source, followed by YouTube with 32% and Twitter with 18%.

The company did not ask patients why they used social media as a health information source. However, analysts say that because people are spending more time on social media sites, they have begun to include questions and research about health care as a part of that experience. They say many like having an instant conversation online, rather than merely reading what someone has posted on a website.

“For many people, social media — or Facebook in particular — is the Internet,” said Jennifer Dyer, MD, MPH, a pediatric endocrinologist and an assistant professor of pediatrics at the Research Institute at Nationwide Children’s Hospital in Columbus, Ohio.

On a scale of 1 to 5, with 5 being the highest, 82.3% of those surveyed who used social media trusted the information on a level of 3 or higher, and 78.8% gave a level of 3 or higher to the likelihood of social media influencing their health care decisions.

Physicians can ask patients about what health websites they consult and give their patients a list of recommended sites. However, the dynamic is different with social media — and so are the moral and ethical expectations and obligations.

For example, American Medical Association policy discourages physicians from socially interacting with patients on social media, though professional sites are encouraged. The Association has had policy, even before social media was an issue, that physicians should not practice medicine online with patients when there has been no previous face-to-face relationship.

But experts say physicians concerned about what patients might find on social media can come up with ways to become involved in their health conversations.

For example, a physician can have a Facebook page that is actively updated and maintained so that when patients have general health or wellness questions, they can ask the doctor instead of throwing it out to everyone they know on Facebook. It also can be a place where physicians share what they consider quality research and educational material. Patients would be amenable to what a physician has to say on social media, given that the National Research survey found that hospitals and physicians are patients’ most trusted sources of health information.

“I do think, as a physician and a communicator, it’s an ethical duty … for everyone to contribute something to this massive pool of information — where everyone is looking — that is accurate information,” Dr. Dyer said. She and her hospital have presences on multiple social media sites, and she said often patients say it’s more convenient to get in touch with her through those means rather than by email.

The National Research survey did not ask specifically what social media presences the respondents checked out, what advice they were seeking or from whom. But there is plenty of evidence that social media users are following health-related feeds.

The American Cancer Society has more than 228,000 “likes” on its Facebook presence, meaning the number of Facebook users who follow its updates. The Centers for Disease Control and Prevention has about 82,000 likes on Facebook, and the American Diabetes Assn. has more than 72,000.

The amount of health information varies by the site. The American Diabetes Assn.’s Facebook page includes a 10-question test to see if a person is at risk for type 2 diabetes. Hospital and physician social media sites might mix general health observations with news about their organizations.

Setting up a presence on a social media site doesn’t mean soliciting patients to come to the site with the promise of a diagnosis. But it can help steer patients to helpful information. For example, at Tufts Medical Center in Boston, the Facebook page also serves as a referral outlet to its other online educational resources, said Tim Brennan, public affairs and marketing manager for Tufts.

Though physicians are not expected to be the “rulers of the Internet” and monitor their patients’ every move or be available for every question they have, they can offer assistance when needed, Dr. Dyer said.

Take a recently reported case from the United Kingdom. Rahul Velineni, a physician from the Princess of Wales Hospital in Bridgend, Wales, saw a Facebook status update of an old school friend saying he was having severe stomach pains and trouble walking. The doctor suspected appendicitis and shared his concerns with his friend. The friend did have appendicitis and that by the time doctors operated, the appendix had perforated.

Howard Brody, MD, PhD, director of the Institute for the Medical Humanities at the University of Texas Medical Branch in Galveston, said the scenario represents an ethical question that goes beyond social media, or even the fact that the person who offered the advice was a doctor.

“There’s a general sort of ethical obligation to help other people out,” Dr. Brody said. A physician may have knowledge relevant to a certain situation, he said.

“If you stumble upon information that they could really use to protect themselves, not to share it would be ethically questionable,” he said.

On the other hand, offering specific medical advice can cross ethical boundaries, Dr. Dyer said.

“If someone says, ‘How much Tylenol do I take?’ and they are not your patient, you can’t say, because you don’t know if they have a liver condition or anything about them,” she said. “It’s not too different from someone at the airport that you happen to be sitting next to asking, ‘Should I do this or that?’ Most doctors are not going to practice medicine on someone they do not know.”

What Tufts Medical Center and other hospitals and physicians have found is that they don’t have to provide answers to every question to keep patients coming back to their Facebook page, Brennan said. The community shares its expertise and experiences. The hospital or physician practice simply acts as a host that brings the community together.

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The U.S. Food and Drug Administration has approved the first  melanoma  drug in 13 years. The new drug, ipilimumab, which will be sold under the brand name Yervoy and manufactured by Bristol-Myers Squibb, is designed to stop the cancer cells from growing by stimulating the immune system to recognize the cancer cells as something to attack.

“Late-stage melanoma is devastating, with very few treatment options for patients, none of which previously prolonged a patient’s life,” Richard Pazdur, M.D., director of the FDA’s Office of Oncology Drug Products said in a press statement.”Yervoy is the first therapy approved by the FDA to clearly demonstrate that patients with metastatic melanoma live longer by taking this treatment.”

“It’s good solid base hit, but it’s not a home run,” says Tim Turnham, executive director of the Melanoma Research Foundation. “The response rates are in the low 20% rate, so three-fourths of the people who take it won’t benefit from it,” Turnham says. “It’s pretty clear we still have a long way to go.”

The drug extended survival for advanced (stage 4) metastatic melanoma patients beyond standard of care by about 4 months in patients who had already failed another form of therapy. While it’s currently being used only in stage 4 melanoma patients, Turnham says there is interest in using it in some stage 3 patients as well.

Turnham adds that another drug is expected out this year and that if you could combine them with the first killing the tumor cells and the other stimulating the immune system, “That’s exciting to think about.

“most people believe the answers will only be found in combinations of drugs, two or more together,” he says.

Melanoma is the most serious type of skin cancer. If the cancer is found early, it can be easily removed and treated.  But if the cancer cells grow and spread, it can be very difficult to control, according to the National Institutes of Health. An estimated 114,900 new cases of melanoma were diagnosed in the U.S. in 2010, according to the Skin Cancer Foundation, with nearly 8,700 resulting in death.

While  the real cause of melanoma is still unknown, experts says about 65% of cases can be attributed to ultraviolet  radiation from the sun.  It’s the most common form of cancer for 25-29 years old and the second most common for 15-29 years old.

The side effects of ipilimumab seem to be fairly rare and can be easily managed, says Dr. Douglas W. Blayney from the American Society of Clinical Oncology. But he cautions that as the treatment is more widely used, there could be rare, unusual infections.

According to a study published in the New England Journal of Medicine in 2010, patients who received ipilimumab lived on average 32% longer and had a 20% greater chance of surviving one year, compared with patients who received a melanoma vaccine instead.  Another positive Blayney adds, is, “Most people who have found success with it can tolerate long-term treament with it.”

But the big hiccup according to Blayney may be the price. “It’s likely to be expensive,” he says.

Turnham makes a broader point. “Not only does this drug offer new hope for patients, but the approval of this drug highlights the importance for patients to be aware of their treatment options, because the landscape for melanoma is changing quickly. Patients who are aware of the new treatments coming out in their field have the best chance of surviving. It’s just another example of how cancer patients need to take better control of their cancer care.”

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The AMA and groups representing clinical laboratories had urged CMS to rescind a new requirement that doctors sign off on lab tests.

By Charles Fiegl, amednews staff. Posted Feb. 28, 2011.

Washington — Responding to pressure from the American Medical Association and others, the Centers for Medicare & Medicaid Services has indicated that it will rescind a new Medicare rule requiring physicians to provide their signatures on requisitions for laboratory tests. Doctors had warned that the rule would have created paperwork headaches for medical professionals ordering and fulfilling lab test requests, ultimately having an adverse impact on patient care.

The signature policy has been on the books since Jan. 1, but it was never enforced by the Medicare agency. CMS finalized the rule in its 2011 physician fee schedule in November 2010. However, citing concerns about lack of awareness of the change in the health care industry, the agency delayed enforcement of the policy until April 1.

Lawmakers soon became involved, requesting an additional nine-month enforcement delay. Reps. Michael Burgess, MD (R, Texas) and Bill Pascrell Jr. (D, N.J.) wrote a Feb. 10 letter to the agency stating, “We worry about how the rule could affect Medicare beneficiaries where such lab services are necessary for a physician to make critical decisions that affect patients’ health and well-being, often under significant time constraints, and urge CMS to consider these situations as they examine this policy.” The letter was signed by 87 other lawmakers. A group of 34 senators sent a similar letter to CMS on Feb. 11.

But the AMA, along with several other members of organized medicine, called for the agency to abolish the signature rule permanently.

“We clearly communicated to CMS that the added administrative hassles this rule would impose on physicians were burdensome and unnecessary,” said AMA President Cecil B. Wilson, MD. “CMS’ decision to reverse this policy will allow physicians to spend less time on paperwork and more time on patient care. This decision is an important step as the administration works to ease regulatory burdens for businesses, including physician practices.”

CMS spokeswoman Ellen Griffith would not comment on how the agency would go about rescinding the rule. “All I can confirm is that the agency is taking another look at the policy and considering next steps,” she said.

Not a new concept

The lab signature policy had been in development for several years. CMS proposed the rule in 2009, but it chose not to finalize it because of concerns raised during a public comment period. In 2010, agency officials had enough confidence that they had ironed out those details that they decided to include a signature requirement in the 2011 fee schedule.

The rule would not create an extra burden for physicians, CMS had said, because in most instances a physician already is annotating the patient’s medical record with either a signature or an order, as well as with any paperwork needed to identify the lab test. The agency also noted that a signature in ink would not be required for similar requisitions made over the phone or through an electronic medical record system.

In the final fee schedule rule, CMS further defended its decision by stating that the policy would make it easier for lab technicians to know whether a test was appropriately requested. Also, “potential compliance problems would be minimized for laboratories during the course of a subsequent Medicare audit because a signature would be consistently required.”

But physicians argued that the signature requirement would create an additional barrier between them and their patients. The policy could interfere with a physician’s ability to practice medicine professionally and efficiently, said Jeff Terry, MD, a urologist in Mobile, Ala. He said physicians can’t be in front of patients to sign requisitions all of the time.

For instance, Dr. Terry said, a scenario might exist where a physician performing surgery in the operating room receives an urgent call for another patient. The doctor already is aware of the second patient’s problem, so he wants the patient to get an x-ray immediately, then follow up with the physician in the office later. The physician’s nurse could provide the patient with the requisition needed to obtain the x-ray, expediting the process in a way that benefits both patient and physician, he said. This handoff would not be possible if a physician signature requirement were in place.

“Patients with kidney stones don’t want to wait another day for me to sign the paper before they can do a test,” he said.

Before the most recent rule change, CMS had been very clear that doctor sign-offs weren’t required, said JoAnne Glisson, senior vice president of the American Clinical Laboratory Assn. in Washington, D.C. Consequently, almost all requisitions arrive at labs without signatures.

The new policy had left labs facing a choice between two unpleasant options if they wanted to be paid by Medicare for all the services they provide, said Richard Daly, CEO of Laboratory Partners, a large full-service lab company based in Cincinnati that runs about 5.5 million tests a year. “One would be to not provide the test — or provide the test and chase the physician or facility for a signature,” he said. “Neither was a great solution.”

Glisson said senior CMS officials informed the lab association that they were going to rescind the policy. She said the agency would need to issue an interim final rule to undo the requirement before April 1, but the new document had not been released at this article’s deadline.

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The AMA obtains delayed enforcement of a regulation requiring proof of face-to-face encounters with patients referred for such services.

By Chris Silva, amednews staff. Posted Jan. 17, 2011. American Medical Association

Washington — Advocacy efforts by the American Medical Association helped persuade the Centers for Medicare & Medicaid Services to delay enforcement of a new regulation that requires physicians to document face-to-face encounters with patients for the beneficiaries to receive covered home health services.

The regulation, required under the health system reform law, went into effect Jan. 1. However, CMS decided to delay enforcement of the regulation for the first three months of 2011.

Patients always have needed physician authorization to receive home health services. The new documentation requirement is intended to ensure that a doctor’s order is based on up-to-date knowledge of the patient’s condition, CMS said.

Under the rules, a doctor or authorized nonphysician practitioner whose patient needs home health services must document a face-to-face visit with the patient within 90 days before the start of services and provide a separate certification that the patient is homebound and needs the care. For patients who start home health care based on a new condition without having seen a doctor in the past 90 days, the doctor must document a face-to-face visit and certification within 30 days of the onset of care for the services to be covered by Medicare.

The AMA had argued for a six-month delay of enforcement for the rule, saying that CMS had not done enough to make physicians aware of the new documentation requirements.

“We are deeply concerned that CMS has done little outreach to physicians affected by this requirement, and unless CMS postpones enforcement of this requirement, patients and physicians could be negatively impacted,” AMA Executive Vice President and CEO Michael D. Maves, MD, MBA, wrote in a Dec. 23, 2010, letter to CMS Administrator Donald M. Berwick, MD. The Association worried that home health agencies would start rejecting patients who did not have the appropriate documentation, forcing them into hospitals or nursing homes.

Dr. Maves said the AMA is pleased that the agency already made changes to the final rule based on physician recommendations, such as extending the window of time in which the face-to-face encounters can occur. But, he added, “We know from considerable experience that at least six months is needed to conduct outreach to physicians on new policies.”

Concerns about fraud, abuse

According to physicians familiar with the regulation, Congress authorized it and CMS developed it to improve access to home health services and prevent fraud and abuse.

“CMS was concerned about home care agencies serving patients who might not actually be eligible for coverage for the services,” said Edward Ratner, MD, associate professor of medicine at the University of Minnesota Medical School.

He said once physicians who see patients requiring home health care know about it, the documentation requirements shouldn’t prove too difficult for doctors.

“It requires some level of appropriate physician oversight, and it might be messy at first, but hopefully it won’t be too onerous,” Dr. Ratner said. “It’s important for physicians to make sure they don’t stop referring. We don’t want to underserve our patients because there’s a new paperwork requirement.”

C. Gresham Bayne, MD, an emergency physician in the San Diego area, said physicians who already make house calls should not have a problem with the new regulation. He said such doctors already have had to document the “medical reasonableness and necessity” of home visits for years. However, he said office-based physicians may have more trouble with the new documentation requirements.

These doctors “simply have fewer options to the quandary of seeing patients who cannot be seen in the office,” said Dr. Bayne, who is also the chair and founder of Call Doctor Medical Group, a San Diego-based organization that provides board-certified physicians and physician assistants to provide house calls to patients. He started the organization after seeing firsthand how costly unnecessary emergency department care can be.

Dr. Bayne added that patients of office-based physicians who may need home care services could encounter access problems if they’re not made aware of the new face-to-face visit requirements. The vast majority of homebound patients do not have any contact with doctors or nonphysician practitioners who make house calls, he said.

Still pushing for more time, outreach

Some physicians who refer patients for home health services said the 90-day delay in the regulation will be advantageous.

“Pushing back the deadline is helpful, because I don’t think a lot of doctors knew about this regulation,” said Peter Boling, MD, professor of medicine and interim chair of the division of internal medicine at Virginia Commonwealth University School of Medicine in Richmond. “Home health agencies worry that patients will not have a timely certifying visit post-hospital that will support agency billing.”

Dr. Boling said typical problems with documentation and continuity under the new rules could arise when a patient initially is treated for an illness in a hospital and is then placed on home care after discharge without a solid hand-off.

That’s one of the reasons the AMA continues pushing for a full six-month delay of enforcement from CMS. In the meantime, the Association is calling on CMS to continue educating physicians about the new requirements, as well as the contractors who will need to process the related claims.

In accordance with the Patient Protection Affordable Care Act, CMS issued a Final Regulation that goes into effect January 1, 2011 whereby Medicare will pay for home health services only when a patient has had a face-to-face encounter with the physician …that certifies the home health plan of care. The patient for whom you’ve ordered home health services must have a documented face-to-face encounter with you within 90 days prior to, or take place by 30 days of, the start of home health services. The primary reason for which your patient needs home health services must be addressed during the encounter.

For more information Contact Options Home Health.

Article By hcafadmin

Sadly it is official, in the state of Florida a physician must place a date on all Medicare home health orders that he/she signs. This includes the 485 (initial certifications and recertifications) along with all interim orders!

No longer can the agency apply a date or stamp the date on the order if the physician inadvertently leaves off the date. On or after January 1, 2011 all orders and subsequent services/claims based upon those orders would have to have the physician signature dated by the physician or those claims could be denied.

Change your processes immediately so that physicians and referral sources can start to realize that a order not dated will simply have to be sent back to them! It would also be beneficial to make sure that the physician and his/her office staff clearly understand that the date has to be provided by the physician, not written in by the physician’s staff or stamped on the document by the physician’s staff.

Home care providers will need to protect themselves from unsubstantiated claim denials or from having to prove to a surveyor that the stamped date on the document , or the different colored ink was placed there by the physician not the homecare agency.

Finally, make sure the aggravated physician understands that this frustrating, ridiculous requirement is being forced upon them and upon the home care industry by CMS!

Categories : Home Health Care
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Senior’s Need to Stay Warm

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Hypothermia and Seniors Staying Warm during Cold Winter Months

By: Wendy D’Uva – Options Home Health

In most parts of the country, a 60-degree day would hardly count as a cold snap. And yet if a senior citizen lives in a poorly insulated house and keeps the heater off to save money, such a day might be chilly enough to cause a hazardous drop in body temperature. As people get older, their bodies become a little less efficient at regulating heat. And if the body temperature dips below 94 degrees, hypothermia sets in: The person becomes confused, speech is slow and slurred, the pulse weakens, movements become clumsy, and the body often shivers uncontrollably (although some people don’t shiver at all). Mainly, this happens because their heart rates have slowed, blood vessels no longer contract as well, and muscle tone and body fat have been lost. The risk of developing hypothermia also increases among senior citizens that have under active thyroids, suffer from diabetes or heart disease, or take certain prescribed medications. Medications that can increase an older person’s risk for hypothermia include drugs that are used to treat anxiety, depression or nausea, and even some over-the-counter cold remedies. And all this can happen on a day when most people don’t even bother to wear a coat.

Hypothermia symptoms usually begin slowly. As you develop hypothermia, your ability to think and move often becomes clouded. In fact, you may even be unaware that you need help. As your thought process is impaired, you fail to realize that you are becoming colder.

As the colder months approach we all need to be aware of the warning signs of hypothermia, and of ways to prevent hypothermia from occurring. Changes in a person’s behavior may indicate that the cold is affecting how well their muscles and nerves work. It is best to watch for the “umbles”-stumbles, mumbles, fumbles, and grumbles.

Symptoms may include:

  • Confusion, forgetfulness, or drowsiness
  • Difficulty speaking
  • Shivering- although elderly adults may not have this symptom
  • Slow breathing
  • Clumsiness or stiff muscles

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Home Health Care Benefits

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Recovering from an illness or injury can be a stressful time for both the patient and the patient’s family. That stress is compounded when chronic illness or disability is involved. Research has consistently shown that, when at all possible, recovering at home is the best option for the patient’s physical and mental health. Unfortunately, when the patient is elderly or too injured or ill to care for themselves, recovering at home is sometimes not an option.

Finding friends or family members to assist with daily tasks is not always feasible. Even when family members are in a position to assist, the burden placed on them often puts a strain on their other family relationships, as well as their career and personal life. The alternative to home recovery-having their loved one leave their home to life in a medical facility or nursing home-is often a last and regretful resort.

Luckily, there is another way for patients to remain in their beloved homes while receiving quality health care assistance: Home Health Care. Recent technological advance such as the internet and home infusion have made home health care available to many more patients than in the past. According to the National Association for Home Care, there are approximately 20,000 home health care providers today. While almost two-thirds of home care recipients are seniors over 65, home health care can assist anyone who requires some assistance while recovering from an illnesses or suffering a disability.

Here are some benefits of home health care:

Seniors can continue living in their own familiar, comfortable environment
Dignity and independence is maintained
Patients receive one on one attention and care from the home health caregiver
Home health care is often less expensive than care in nursing homes / assisted living facilities
It relieves the burden placed on adult children to provide care for their aging parents

Most people prefer receiving care in a familiar setting where they are surrounded by love, patience and understanding people. Home health care providers help strengthen and increase the patient’s ability to care for themselves in their homes. They can also have a positive impact on a patient’s hopes and aspirations.

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