Nurse practitioners would be allowed to treat patients and prescribe medications independently under a proposal by Gov. Dannel P. Malloy's administration, a potentially significant — and controversial — change in the medical landscape aimed at expanding access to primary care. The ability of nurse practitioners to work independently of doctors has long been an issue of contention between the two professions, and states vary widely in how they allow nurse practitioners to practice. But the federal health law commonly known as Obamacare puts the debate in a new context: The expansion of insurance coverage to thousands more people is expected to raise the demand for primary care, at a time when the state already faces a shortage of primary care doctors and an aging physician population.
A database could help physicians avoid writing prescriptions for people who may be selling those potentially addictive drugs under a bill approved by the Missouri House. But senators involved in the issue said there's little chance of such a measure moving forward. The bill creates an electronic system to monitor who is being prescribed drugs such as OxyContin, Vicodin and Xanax. Bill sponsor Rep. Kevin Engler, R-Farmington, said keeping people from obtaining large quantities of drugs will save lives. "People have died from getting prescriptions from people that illegally bough them," Engler said. "We're killing people."
Lawyers have something to teach doctors. But it is not how to avoid medical malpractice claims, protect patients' rights, or negotiate better contracts with hospitals and insurance companies. Instead it is a cautionary tale—a tale of woe, really—about pitfalls the medical profession needs to guard against if it wants to avoid reprising the epidemic of de-professionalization and demoralization that has beset lawyers and the legal profession. Simply put, the law is not well. US law school applications are down by nearly half from eight years ago, and 85% of graduates now carry at least $100,000 in debt.
The Treasury Department on Monday rolled out more tweaks to the health-care law's requirement that all large employers--those with 50 or more workers--provide insurance coverage to their workers. This is the part of Obamacare was supposed to take effect at the start of 2014, but was delayed by the White House this past summer as the White House was facing significant push back from employers. In today's final rule, the Obama administration is essentially relaxing the employer mandate for 2015--in a big way for medium-sized businesses, and a smaller way for the largest employers. Here's a rundown of the key changes.
The American Medical Association says it strongly supports legislation that would change the way Medicare pays doctors, to emphasize quality care and not just sheer volume of services. The endorsement Monday from AMA President Ardis Dee Hoven provided a boost for a bipartisan bill moving through Congress. The bill would repeal the centerpiece of the current payment system. That approach relies on automatic cuts to doctors to limit Medicare spending and has proven unworkable. Instead, doctors would get five years of small increases while Medicare shifts its financial incentives to reward quality, cost-effective care.
Hospital groups are pushing back on a proposal from House Republicans to extend the Medicare sequestration cuts as part of a bill to raise the debt ceiling. The idea from Speaker John Boehner (R-Ohio) would "undermine care for seniors" and add to onerous reductions already facing Medicare providers, a coalition of hospital groups wrote in a letter to lawmakers Monday. "Medicare is meant to assure seniors' access to needed medical care, not serve as a piggybank for other programs," the letter stated. "We urge you to reject this proposal, which will jeopardize health services for seniors."