Walk into a hospital intensive-care unit and hear the din. The sheer number—several hundred alarms per patient per day—can cause alarm fatigue. Nurses and other workers, overwhelmed or desensitized by the constant barrage, sometimes respond by turning down the volume on the devices, shutting them off or simply ignoring them—actions that can have serious, potentially fatal, consequences. Clinicians and patient-safety advocates have warned of alarm fatigue for years, but the issue is taking on greater urgency as hospitals invest in more-complex, often-noisy devices meant to save lives. Last month,the Joint Commission, which accredits hospitals, directed facilities to make alarm safety a top priority or risk losing their accreditation. The commission is requiring hospitals, starting in January, to identify the alarms that pose the biggest safety risks by unnecessarily adding noise or being ignored. By 2016, hospitals must decide who has the authority to turn off alarms.
Since 1992, the AMA has summoned this same committee three times a year. It's called the Specialty Society Relative Value Scale Update Committee (or RUC, pronounced "ruck"), and it's probably one of the most powerful committees in America that you've never heard of. The purpose of each of these triannual RUC meetings is always the same: it's the committee members' job to decide what Medicare should pay them and their colleagues for the medical procedures they perform. While these doctors always discuss the "value" of each procedure in terms of the amount of time, work, and overhead required of them to perform it, the implication of that "value" is not lost on anyone in the room: they are, essentially, haggling over what their own salaries should be.
President Barack Obama's healthcare reform law is slated to begin offering health coverage through state marketplaces, or exchanges, beginning October 1. Until now, the administration had proposed that exchanges verify whether new applicants receive employer-sponsored insurance benefits through random checks. It also sought to require marketplaces to verify each enrollee's income status. But final regulations released quietly on Friday by the Department of Health and Human Services (HHS) give 16 states and the District of Columbia, which are setting up their own exchanges, until 2015 to begin random sampling of enrollees' employer-insurance status. The rules also allow only random—rather than comprehensive—checks on income eligibility in 2014.
Persuading young, healthy adults such as Lopez to buy insurance under the Affordable Care Act is becoming a major concern for insurance companies as they scramble to comply with the law, which prohibits them from denying coverage because of pre-existing conditions and limits what they can charge to older policy holders. Experts warn a lot of these so-called "young invincibles" could opt to pay the fine instead of spending hundreds or thousands of dollars each year on insurance premiums. If enough young adults avoid the new insurance marketplace, it could throw off the entire equilibrium of the Affordable Care Act. Insurers are betting on the business of that group to offset the higher costs they will incur for older, sicker beneficiaries.
The physician shortage in Oklahoma—one of the worst in the country—is indeed severe, and in fact was a concern long before the Affordable Care Act came to be. But eliminating the possibility for many Americans to obtain insurance isn't an appropriate response to the doctor shortage. According to a recent Associated Press report, about 20 percent of Americans already live in an area that is experiencing a shortage of primary-care physicians. There are about 250,000 primary-care doctors in practice across the country now. Industry experts expect the shortage of these providers to grow to about 30,000 in two years, and to about 66,000 in a decade or so.
California's state law ending government coverage of adult dental, podiatry, optometry, chiropractic care and other healthcare services for the poor cannot stand, a federal appeals court on Friday. The 9th U.S. Circuit Court of Appeals ruled that the federal Medicaid program for the poor prohibits the changes imposed by a California law. The decision could have budgetary implications for the nation's most populous state. California Department of Health Care Services spokesman Norman Williams said the ruling covers patients at certain federally funded health centers, not all Medicaid recipients in the state, though Williams could not estimate the specific number of people affected. Faced with a budget crisis in 2009, California state lawmakers limited a variety of healthcare services covered by Medicaid, a decision ultimately approved by the federal agency that oversees the program.