Progress Notes features doctors and medical students across the country on the frontlines of our health care system. Our views and experiences are diverse, but we share common goals and values. We speak up to move toward a future where everyone can have access to affordable, high-quality health care. Please share our posts, and follow us on Facebook and Twitter!
At this point in time, you are probably being bombarded by the media with Ebola and Enterovirus D68! However, a much greater problem in the United States has been the inappropriate use of antibiotics, the development of antimicrobial resistance and adverse events from antimicrobial therapy, including Clostridium difficile –associated diarrhea.
The week of November 17-21, 2014 is the Centers for Disease Control and Prevention's Get Smart About Antibiotics Week. This is an annual event to raise awareness of antibiotic resistance and to educate about the appropriate and safe use of antimicrobial therapy.
For this event, the CDC works closely with many partners, including the SHARPS Collaborative (Sharing Antimicrobial Reports for Pediatric Stewardship). The SHARPS Collaborative is a working group of 24 free-standing US Children’s Hospitals.
Here are some facts that you can use to educate other physician colleagues and patients:
-Institute of Medicine and the CDC have recognized that antimicrobial resistance is a key threat to the health of the citizens of the United States
-Up to 70% of United States antibiotics are provided to animals that are not sick
-Antibiotics are the 2nd most commonly used class of drugs and prescribing is highest for pediatrics
-In pediatrics, adverse reactions to antibiotics result in frequent emergency room visits, more than any other prescribed medication in children
-More than half of antibiotics prescribed in the outpatient setting are unnecessary (antibiotics being prescribed for common viral respiratory illness)
-More than half of antibiotic prescribing is inappropriate (treatment is not indicated, wrong drug is chosen to target the infection and the duration is too long)
-Thirty to Fifty percent of hospitalized patients will receive antibiotics
-C. difficile is linked to 14,000 deaths each year
-Antimicrobial resistance is on the rise and novel antimicrobial development is on the decline
David Berman works at the Division of Pediatric Infectious Diseases at All Children's Hospital, Johns Hopkins Medicine in St. Petersburg, FL.
As a passionate community of doctors, medical students, and friends, I wanted to make you aware of some opportunities and roles to continue the fight against Ebola.
This is the worst Ebola epidemic in history, and it continues to plague West Africa. You can help bring the epidemic under control abroad and protect everyone in the U.S. by getting involved. USAID and the CDC are looking for volunteers, and have also opened platforms for healthcare workers to provide assistance with innovation and education.
Four Ways You Can Help:
- SIGN UP TO VOLUNTEER. Learn how to become a medical volunteer in West Africa through USAID, Last Mile Health or Partners In Health.
- SUBMIT YOUR IDEAS for USAID’s Challenge Competition to fund and test innovations for PPE, infection treatment and control.
- SIGN UP TO BE AN INSTRUCTOR for the CDC Safety Training Courses taking place in Alabama for healthcare workers going to volunteer in West Africa.
- SHARE THIS with your networks: Ebola 101 – CDC Slides for U.S. Healthcare Workers
Raj Panjabi is a former DFA Board member and co-founder of Last Mile Health, an organization based in Boston and Liberia.
Open Enrollment for 2015 begins tomorrow and runs through February 15, 2015.
It’s hard to believe that it has been one year since Americans began enrolling in the Health Insurance Marketplace. Since that time, 7.3 million enrollees have signed up for marketplace plans and another 8 million have gained coverage through Medicaid or CHIP.
We have made tremendous progress already. And, tomorrow, with your help, we can continue making progress to ensure every American finally has access to the healthcare they need and deserve.
To kick start your efforts, I wanted to share some DFA tools that have been vital in my advocacy and will serve as the basis for DFA’s enrollment and education campaign:
- Doctors for America Enrollment 101 PowerPoint Presentation - To help aid your education and outreach, this slide show presentation offers an ACA overview about the benefits available during open enrollment. Use elements of this for your outreach presentations to best suit your audience.
- Pocket card – If you are looking for a handy ACA pocket reference card to slip into your white coat, we have the perfect thing for you. Learn how to screen patients for health insurance, answer basic questions, and point them in the right direction. Print out the pocket reference card and share it with your patients!
Last but certainly not least, don’t forget to tell your friends and family to get covered if they aren't already! They can also check out their new options if they got covered in the last enrollment period. For more info visit www.healthcare.gov.
Dr. Katherine Scheirman is the Oklahoma State Director of Doctors for America and a retired US Air Force Colonel.
By now you have heard the news. A third person has been diagnosed with Ebola here in Dallas. News of the virus has consumed the headlines recently -- not only here in Texas but across the country.
People are understandably concerned and seeking information to protect themselves and their families. Many healthcare providers also have questions about how to properly deal with Ebola in their hospitals and clinics. To calm fears and dispel misinformation, I want to share the information available to providers.
Get the facts on Ebola. Four things you can do today:
- Get up to speed on the basics:
- Symptoms consistent with Ebola
- Headache, muscle aches, abdominal pain, vomiting, diarrhea
- People are not infectious until they develop symptoms.
- The time interval from infection to onset of symptoms is 2 to 21 days.
- Two suggested questions to ask a patient for whom you suspect Ebola:
- Have you been to West or Central African countries, in particular Sierra Leone, Guinea or Liberia, within the past three weeks?
- Have you been in contact with blood or any body fluids of someone known or suspected to have Ebola within the past three weeks?
- Symptoms consistent with Ebola
- Review this CDC algorithm on triaging patients with suspected Ebola. For more in- depth information, you can use this CDC checklist.
- If you have more questions, find your local health department on this searchable map.
- Ask your local or state medical society to share this information as well.
The most important thing we can do to care for our patients and communities is to stay informed and make sure others are informed, too. Visit the CDC’s Ebola website to stay up-to-date on the latest information for healthcare workers.
Dr. Tran is a Medicine- Pediatric hospitalist in the Dallas- Fort Worth area and the State Director for Doctors for America.
One year ago today Americans began enrolling in the Health Insurance Marketplace. With the barriers to quality, affordable healthcare finally lifted, millions enrolled.
Today, despite the bumps in the road, 7.3 million enrollees have signed up for marketplace plans and another 8 million have gained coverage through Medicaid or CHIP. These accomplishments are due in large part to the tireless work of physician advocates like you who conducted community talks, knocked on doors and even organized a statewide bus tour. As we reflect on this major accomplishment we know there is still much work to be done to ensure every American finally has access to the healthcare they need and deserve.
The good news is the next opportunity to expand coverage is just around the corner. The Open enrollment period for 2015 coverage begins November 15, 2014 and runs through February 15, 2015.
Doctors across the country are going to be working hard to help more Americans #getcovered and ensure this enrollment is as successful as the last!
I have some exciting news to share.
Florida members of Doctors for America joined with other physicians to successfully lobby the Florida Medical Association to support the expansion of Medicaid for nearly one million Floridians! Florida’s physician community will no longer sit on the sidelines while Floridians are denied access to lifesaving healthcare.
This a big win for Floridians and the entire DFA movement.
We wouldn’t be here if Dr. Robert Luedecke of Texas had not paved the way for our efforts last year when he secured the Texas Medical Association’s support of expansion for about 1 million hard-working Texans.
It is clear physician advocates can be powerful voices in the fight to close the gap for 5.7 million people in the remaining 24 states. And we are making progress.
In Florida, where 2,200 Floridians will die this year because they do not have access to healthcare, we are now one step closer to ending the needless suffering and saving lives.
Together, we are going to double down on our fight to expand access to care in Florida and the remaining 24 states.
Dr. Mona Mangat is the Chair of Doctors for America and an Allergist-Immunologist based in St. Petersburg.
BY KATHERINE SCHEIRMAN
Many politicians, including Rep. Glen Mulready (“Like your health insurance? Tough,” July 16), are peddling myths about the Affordable Care Act that sound scary, but never turn out to be true. Remember being told that “no one will sign up?” More than 8 million people signed up for private health insurance coverage through the marketplace.
So let’s look at some facts instead.
Citing a new study, Forbes said that “new Hepatitis C therapies such as Sovaldi and a flood of new health-care consumers, thanks to an improved economy and the Affordable Care Act, will help push health spending up 6.8 percent in 2015. But researchers at PwC’s Health Research Institute say employer strategies to shift costs to workers through consumer-directed health plans, savvier health-care shoppers generally and the increasing shift away from fee-for-service medicine ought to keep health inflation from jumping by double-digit percentages common in the late 1990s through much of the early 2000s.”
So health-care spending is going up because more people are getting care, but costs are rising more slowly than before, which sounds like a win for everyone.
As for premiums rising in 2015, consulting firm Avalere Health has found insurers plan to submit only modest (average 8 percent) rate increases.
For consumers who sign up through the federal marketplace, nearly 90 percent receive tax credits to help them afford coverage. Nearly seven in 10 enrollees are paying $100 or less per month and nearly half are paying $50 or less per month. The average premium after tax credits is $82 per month.
In spite of the limits on insurance company profits, no insurers have dropped out of the program. In fact, many more will participate, because many new customers means a lot more profit. UnitedHealth Group, which initially limited its plans to four states due to concerns about the health status of the newly insured, will expand into as many as two dozen states next year. More competition should lead to lower rates.
Prior to “Obamacare,” small businesses paid much more than large firms for the same coverage, and their premiums could shoot up rapidly if even one employee developed an expensive illness. Now, the Small Business Health Options Program Marketplace lets small business owners leverage buying power with others, getting comprehensive information about benefits, quality, and price — leveling the playing field.
Businesses with fewer than 25 employees that offer coverage through SHOP and meet eligibility requirements may claim a small business health-care tax credit worth up to 50 percent to help offset the costs of premiums.
The number of Americans without insurance has dropped sharply. According to a new study of “Obamacare’s” newly insured, 78 percent are satisfied to very satisfied with their coverage, including 74 percent of those who identify themselves as Republicans. Sixty percent of the newly covered already have started to use their new insurance, and most enrollees said they could get an appointment within two weeks.
The Affordable Care Act is a success, giving people the freedom to change jobs or start a business, without fear of losing health insurance, delivering financial security in a time of economic uncertainty while slowing the rise in health-care costs.
It could be even more successful in Oklahoma if Gov. Mary Fallin would stop blocking low-wage Oklahomans from access to health care, which is already funded with our taxes — millions of federal dollars that our hospitals and economy need, that we already paid for, and that now go to other states.
Dr. Katherine Scheirman, MD, is the Oklahoma state director of Doctors for America. She lives in Edmond.
This column first appeared in the Tulsa World.
Patients over politics. That’s the message physicians are championing from Utah to Virginia. With patients’ needs at the forefront, physicians with Doctors for America are taking their message out of the exam room and into the public square in communities across the country to advocate for expanding and protecting access to healthcare.
Whether it’s speaking up for the 5.7 million Americans in the Medicaid coverage gap or speaking out against the Supreme Court’s ruling that allows employers to impose their religious beliefs on employee’s health care decisions, doctors are leading the way to improve the health of the nation.
CONNECTICUT MED STUDENTS STAND WITH VIVEK
Medical Student Kyle Ragins penned a joint op-ed with Neel Butala in the New Haven Register on the day Surgeon General Nominee Vivek Murthy spoke at the Yale School of Medicine’s Commencement.
“For a couple of 23-year-olds with only a few months of medical school under our belts, we had big dreams. Today, after years as roommates — coming up just short of fixing healthcare — we have the privilege of hearing a man speak at commencement who has turned the dreams he had as a 23-year-old medical student into a reality: Dr. Vivek Murthy, the current nominee for Surgeon General.”
IL’S POLLACK: REJECTING MEDICAID EXPANSION COULD KILL NEARLY 6,000 A YEAR
Harold Pollack penned a powerful piece in Politico Magazine on a recent study published in the Annals of Internal Medicine which found a decline in mortality rates after health reform in Massachusetts. According to the study, one death was prevented for every 830 people who gained coverage. What does that mean for states refusing to expand Medicaid? It means the issue is literally a matter of life and death.
“One thing is for sure. If anything close to these results apply, the ACA is saving many lives every year. The new law is projected to cover more than 20 million adults who would otherwise go uninsured… Some of the very same states bitterly resisted Medicare and Medicaid 50 years ago. It took until the early 1970s for southern states to embrace Medicaid… Delay still brings enormous human costs. Nearly 5 million low-income Americans are income-eligible for Medicaid under the ACA, yet live in states that now reject the Medicaid expansion. Within this rather small but critical low-income population, that same one-per-830 estimate implies that almost 5,800 people will die every year as a result of being left uninsured.”
MASSACHUSETTS MEMBERS SEEK TO EMPOWER PATIENTS
Dr. Umbereen Nehal attended a White House briefing on the Affordable Care Act with Faith and Community Leaders where she says she, “learned ways to continue to educate patients to be empowered consumers so the whole patient-centered care works as it is meant to work.”
NEW YORK PHYSICIANS ORGANIZE ADVOCACY CONFERENCE
Drs. Nina Agrawal and Bruce Rector held a successful physician advocacy conference in New York City, where they worked with a partnership of physicians and medical students from a number of different organizations. Dr. Manisha Sharma helped spearhead the workshop and provide participants with the tools and skills needed to make their voice heard on a community, state, and national level.
NORTH CAROLINA THANKS USPHS OFFICERS, MARCHES FOR MEDICAID EXPANSION
Drs. Alice Chen and Seanta Clark attended the U.S. Public Health Service’s Physician Day Conference in Raleigh, North Carolina. Dr. Chen spoke at the conference about DFA’s mission and work in states across the country and then joined Dr. Clark to greet USPHS officers at a booth where they thanked them for their service to improve the health of the nation.
Dr. Cheryl Viglione helped organize white coats for a Moral March on Raleigh to protest the state’s failure to expand Medicaid with tens of thousands of North Carolinians.
OHIO DOCTORS URGE LEADERS TO ACT ON CLIMATE CHANGE
Dr. Don Nguyen and Dr. Leroy spoke to a large crowd about climate change and the health effects of pollutants with Dayton Mayor Nan Whaley.
OKLAHOMA'S FEARLESS PHYSICIAN ADVOCATE FIGHTS TO IMPROVE COVERAGE
Dr. Kathy Scheirman has been working tirelessly to sway leaders in Oklahoma to support expanding access to healthcare. Outreach in Oklahoma is tough, but Dr. Scheirman knows that being uninsured is tougher. That’s why she has been pounding the pavement, talking to partners and allies and arming them with the tools they need to fight to improve coverage and care for the people of OK.
REMINDING UTAHNS ABOUT THE REAL PEOPLE IN THE COVERAGE GAP
Dr. Scott Poppen has been supporting efforts to forge a Medicaid compromise and pushing back on attempts from those who seek to block the expansion in Utah, as he did in a recent op-ed in The Utah Desert News: The whole story on Arkansas' and Utah's Medicaid expansion alternatives.
“King’s piece glaringly overlooks the fact that Utah is losing $796,789 each day in federal funds that would have been coming to our state if Utah lawmakers had expanded access to health care as 26 other states have already done. Total lost funding since the start of Jan. 1, 2014, is now in excess of $110 million. I think it would have been polite for him to offer a simple ‘thank you’ to the citizens of Utah for sending our own hard-earned tax dollars to fund the health needs of Arkansans.”
When Dr. Poppen isn’t fight back against those spreading misinformation about the ACA, he’s reminding Utahns about the real people impacted by the state’s failure to expand. People like Emily, an unemployed woman battling breast cancer that failed to qualify for Medicaid and passed away. Dr. Poppen has been helping share Emily’s story which is featured in a chilling documentary about denying Medicaid coverage.
VIRGINIA PHYSICIANS FIGHT OBSTRUCTION, PUSH FOR EXPANSION
Dr. Chris Lillis has been busy fighting day and night to expand Medicaid in Virginia. From to holding a press call to crafting a wildly successful sign-on letter demanding state leaders close the coverage gap, Dr. Lillis has been a vocal advocate against the House of Delegates obstruction. Gov. Terry McAuliffe heard the call from advocates and physicians across the state, and responded with a powerful message about the importance of putting people over politics, by declaring that he will move forward to expand access to care despite legislative opposition.
Three cheers for Dr. Lillis and physicians across Virginia for their tireless advocacy on behalf of 400,000 Virginians! They know the fight is not over yet. Speaker Bill Howell is now embarking on a legal battle to block Virginian's uninsured from getting care. That’s why Dr. Lillis is keeping the heat on the elected officials by holding a vigil followed by a march to Speaker Howell’s office to remind Virginia’s elected officials that lives are on the line and by continuing to write commentary like his piece in the Free Lance Star calling out ideological obstruction in Richmond.
“By my count, there were at least four different proposals to Speaker Howell and his Republicans in the House of Delegates…Speaker Howell and his Republicans in the House of Delegates had four different proposals, three of which were compromises offered by their fellow Republicans, and Speaker Howell’s answer was always a concise: ‘No.’”
Christopher Newport University (CNU) released a poll yesterday and boy have the headlines about it been misleading. A writer at Slate started with the headline “Polls Show Democrats Losing Medicaid Debate in Virginia” while many local news outlets exclaim “Majority Oppose Virginia Medicaid Expansion.” The Slate writer did a good job of addressing some problems with his own headline in the piece, but the headline is hard to ignore.
What gives? A poll by the same University in February showed a very different result. The April poll - 53% of those polled do not want “Medicaid expansion” while 41% support expansion. The February poll showed 56% polled SUPPORTED expansion while 38% were against expansion. To this observer’s eyes, this is quite the dramatic change in 2 months, and focusing on the topline difference it appears 15% of Virginias changed their minds in the last 2 months.
I want to focus on the poll, which can be seen in its entirety here. Many polling items are ignored by the headlines, as are differences in the wording of the questions from February to April diminishing their apples-to-apples comparison. The most glaring omission from the headlines and stories is the wording of the questions. Virginians clearly do not want to see Medicaid expansion if the federal government does not pay its share. This was true in the February poll, and now is more pronounced in the April poll. This demonstrates the power of the negative propaganda of Medicaid expansion opponents. Their claim is that the federal government cannot afford expansion, and will fail to meet its statutory obligations to supply the funding to Virginia. This false, yet common claim is poisoning the debate and it is disappointing that CNU chose this wording to its questions.
Also ignored, and I feel the most dramatic, is that 71% of respondents say that Republicans and Democrats should compromise! Why is this not getting headlines? I would think the compromise that emerged from the Virginia Senate, “Marketplace Virginia,” should have had a much more prominent place in this poll. If Republicans and Democrats in the VA Senate have already come up with a compromise proposal, how to Virginians feel about that?
Unfortunately, this is all about the political horse race and ignores the 400,000 Virginians who should be newly eligible for Medicaid under the Affordable Care Act. It ignores the majority of newspaper editorial boards, economists, health care advocates, hospitals, physicians and even health insurance plans that strongly support expansion.
I think it’s media malpractice to run these headlines when a mere 806 out of 8.2 million Virginians were polled, and the questions give credence to the false arguments of expansion opponents. I would love to see pollsters ask respondents what alternative they suggest to Medicaid expansion - should Virginians simply be left without health insurance coverage? I would also like to see a focus on patients, not politics, as we have an opportunity to improve the lives of millions left in the coverage gap due to the ideological intransigence of expansion opponents. Refusing Medicaid expansion is masochism, pure and simple. Refusing expansion hurts taxpayers, job seekers and most of all the human beings who should be given the chance to have health insurance coverage.
As we celebrate the 7 million and counting Americans with new coverage, it is important to remember the window hasn’t closed for everyone still seeking coverage.
I volunteered at an enrollment event on March 31 in Dublin, California and I can tell you personally of the many people who tried to enroll, wanted to enroll, and were unable to finish before the deadline. In addition, I have been corresponding by email and phone with patients, friends, colleagues, and community members all across the state with similar stories. Luckily for them, and for many people you may know, there is an opportunity to finish their enrollment.
The Special Enrollment Periods allow people to enroll in health coverage outside of the Open Enrollment Period, if they previously tried to enroll but couldn’t through no fault of their own. Those who tried to enroll in health coverage any time before midnight on March 31 and didn’t finish, can still get coverage for 2014 -- but they must act quickly.
Patients must finish enrollment by April 15 to get coverage for 2014. If they enroll by April 15, their coverage will begin May 1.
WHO ELSE WILL QUALIFY THE FOR
SPECIAL ENROLLMENT PERIODS?
- Exceptional circumstances
- Misinformation or misrepresentation by a non-Marketplace enrollment assister
- Enrollment error
- System errors related to immigration status
- Display errors on Healthcare.gov
- Medicaid/Marketplace transfers
- Error messages which stopped your application
- Unresolved casework
- Victims of domestic abuse who were not allowed to enroll
- Other system errors that kept you from enrolling
And don't forget Medicaid patients and those who have a qualifying life event like getting married, having a baby, moving to a new area, or losing other health coverage can enroll all year round!
Additional materials from HHS:
Patients must request a Special Enrollment Period and can do so by dialing the Marketplace Call Center at 1-800-318-2596 or visiting Healthcare.gov/marketplace/ to make the request in their state-based Marketplace. It's important to check with your state exchange as some states have different deadlines.
We will continue to share information with you as it becomes available. Please continue to share your feedback on what's working with special enrollment periods and as you see newly uninsured patients.
Carolyn is a Preventive Medicine Resident at the University of California San Diego and the State Director of California Doctors for America.