Healthcare providers including MDs, DOs, dentists, podiatrists, psychiatrists and chiropractors that work in a Health Professional Shortage Area (and meet the requirements) can apply for the Medicare Physician Bonus Program which qualifies for a 10% reimbursement bonus if they’re providing services to Medicare beneficiaries in a medical shortage area. Medical providers can check online to see if their practice site is in a federally designated Health Professional Shortage Area and they can apply for the program online. Providers that have questions can also submit a request for analysis to our Bureau of Health Systems Development or Tracy Lenartz.
Posts Tagged ‘medical’
A new CDC report released this week gave a status update on the national Winnable Battle to reduce hospital associated infections. Not all medical procedures carry the same risk of infection, so the report uses something called a standardized infection ratio to compare infection rates among hospitals. It’s a complicated statistic, but basically, it divides the number of infections that actually occurred in a hospital with the number of infections that were expected in the same time period. The lower the score the better.
Arizona’s 2011 overall score was less than 1… meaning we did well. Our overall average (2011) score was 0.575, which was better than expected for Arizona, and better than the national average score of 0.592. The report also shows a decrease in scores since 2010, meaning that the work Arizona hospitals are doing to decrease infections and make care safer for their patients is making a difference. If you’re interested in seeing the score for your local hospital, you can check it out on Hospital Compare. Right now, this site only shows CLABSI scores, but it’ll soon display scores for catheter-associated urinary tract infections and some surgical site infections.
We’re making it a priority to prevent hospital associated infections by maintaining our HAI Program and licensing and inspecting healthcare facilities across the state. We also facilitate a multidisciplinary HAI Advisory Committee that identifies and addresses priority areas for Arizona. This dedicated group of partners has collaborated continuously since 2009 to coordinate prevention efforts across the state. The partnerships and open dialogue help us improve surveillance, report and prevent hospital associated infections, which support our Strategic Map goal of reducing healthcare associated infections and re-admissions.
We’re continuing to make significant progress in our licensing regulatory reform efforts. Our overall goal is to simplify and streamline our regulations so they align with our strategic plan and map to improve public health outcomes. The new regulations will more acutely focus on health and safety criteria- and will put more emphasis on outcomes. We’ve held numerous meetings with representatives from the medical community, the behavioral health system, advocates and other affected stakeholders to help us reform our regulations for Inpatient Behavioral Health Facilities, Residential Facilities, DUI Services, Domestic Violence Offender Treatment Programs, Outpatient Treatment Centers, Nursing Care Institutions, Assisted Living Facilities and Hospitals. Public comments are being solicited through online surveys.
In all, 18 Articles of regulations are being overhauled. Draft Articles and online surveys can be found at the Health Care Institution and Behavioral Health Service Agency webpages. By April 1st final drafts will be posted on our website for another round of comments. The completed rules will be submitted to the Secretary of State by July 1, 2013. Thanks to all who have helped to advance the licensing of integrated health in Arizona!
The effectiveness of a State’s EMS and Pre-Hospital & Trauma System makes the difference when it comes to saving lives (and quality of life) from injuries. Injuries are the leading cause of death for Arizonans from age 1 to 44- so you can see how important it is for states to have an effective EMS & trauma system. But what is it? The easiest way to picture the pre-hospital and trauma system is to look at it as a continuum.
Let’s start with a car crash. The first link in the chain is the bystander that knows to call 911 first and then starts helping any way they can. The next step is 911 dispatch. Dispatcher education and training is crucial in coaching the Good Samaritan and getting the paramedics and EMTs on the way. Paramedic & EMT training and effectiveness is the next link in the chain. Good awareness of the latest science and practice results in good interventions by paramedics and EMTs in the field. Next is the transport. We need a good well-regulated network of ambulance providers that know how to properly triage and transfer patients to the right place at the right time- taking into consideration the severity of the injury, distance to facilities, traffic, and other factors. Solid on-line medical direction is also a key at this level. Finally, it takes a solid network of trauma centers (specialized and certified hospitals) that can handle a wide variety of injuries in an effective way- along with good post-surgery rehabilitation within medical facilities.
Complicated- I know. But it really is a system. Each component plays a role in improving the outcome of a severe injury. The bottom line is that the public, 911 dispatchers, first responders, the ambulance team that transports the injured to a trauma center, the specialized care provided at that center, and the post-surgery rehabilitation within a medical facility are critical components of a state’s trauma system.
Developing an excellent statewide EMS and trauma system has been one of our top priorities and we’ve come a long way in a short time. We’ve been working with stakeholders to implement system improvements including dispatch training, performance improvement, mode of transport decisions and data quality checks and everything in-between.
For example: one of the programs we have put in place is our Premier EMS Agency Program. The EMS Agencies that meet our criteria are listed on the website above. You can check out our participation materials including our; Schematic; Application; Handbook; and Data Dictionary. By bringing in more EMS partners to the Premier EMS Agency Program- we’ll be able to continue to make Arizona’s pre-hospital system the envy of the nation.
We’ve also recruited 17 rural hospitals (up from 0) into our trauma system in the last 3 ½ years. For the first time, Arizona’s rural trauma patients have timely access to good trauma care. Our State trauma registry has been strengthened by undergoing validation checks and audits and is now one of the best registries in the country, allowing us to conduct all kinds of research to improve care across the state.
The AZ Medical Marijuana Act requires us to periodically accept petitions to add new medical conditions to the list of conditions that qualify folks for an AZ Medical Marijuana Registration Card. In January, we accepted petitions from the public and had a public hearing in May. Folks submitted numerous articles as a part their petitions for PTSD 1; PTSD 2; Depression; Migraines; and Generalized Anxiety Disorder. We also received lots of informal comments regarding adding PTSD; Depression; Migraines; Generalized Anxiety Disorder and General comments.
We also contracted with the U of A to review published scientific studies related to marijuana use and the petitioned conditions. You can see the UA analyses for Depression; Generalized Anxiety Disorder; Migraine Headaches; and Post Traumatic Stress Disorder (PTSD) on our petition website. Our ADHS medical team will be meeting within the next week or so and will be providing me with their analysis and recommendations. The ultimate decision rests with me, the Director, and I have a decision deadline in late July.
You probably think I sound like a broken record because I’m always writing about obesity… but it really is the dominant public health issue of our time. Last week, the CDC released its latest Vital Signs report called “State-Specific Obesity Prevalence Among Adults – United States, 2009,”… which finds that nine states had an obesity rate of 30 percent or higher in 2009. In comparison, no state had an obesity rate of 30% or more 10 years ago. The report also finds that people who are obese incurred $1,429 per person more in medical costs every year when compared to people of healthy weight, and that the nation’s total medical costs of obesity were $147 billion in 2008. OK that’s the problem- so what’s the solution?
The solution is a combination of public policy changes and community planning, combined with better education and personal responsibility. For example, people need to eat more fruits and vegetables and fewer foods high in fat and sugar; drink more water instead of sugary drinks; be more physically active; and watch less TV. As a society, we need to promote policies and programs at school, at work and in the community that make the healthy choice the easy choice. You can read a lot more on the CDC’s Vital Signs Adult Obesity website.
As I’ve mentioned in previous posts, an Initiative called the Arizona Medical Marijuana Act will be on the Ballot this November. We organized several teams (behavioral health, substance abuse, public health, licensure, rules, IT, and administrative council etc.) to examine the Initiative over the last few weeks. You can read a news article this week that highlights some of my concerns about the Initiative.
Here’s some background:
The active ingredient in marijuana that’s cited for its medicinal value is called Tetrahydrocannabinol (or THC). A synthetic version of THC called dronabinol is available by prescription (tradename Marinol®). Marinol (dronabinol) is approved by the FDA for the treatment of anorexia in AIDS patients and for nausea and vomiting in folks undergoing chemo. It’s a Schedule III medicine, which means that doctors can prescribe it off label (e.g. for things other than nausea, vomiting, and chemotherapy) and it can be refilled. It’s generally considered to be non-narcotic and to have a low risk of dependence.
But, the Initiative would allow people to apply for and get marijuana registration cards (from us) that allows them to buy & use marijuana itself for therapeutic purposes. The basic problem is that the FDA doesn’t recognize the smoking of marijuana as a treatment for any medical condition.
The medical conditions that qualify for a medical marijuana registration card in the Voter Initiative include “a chronic or debilitating disease or medical condition or its treatment that produces severe or chronic pain.” Smoking marijuana isn’t part of any conventional, licensed or approved medical management of pain; it hasn’t been tested by the FDA for its safety or effectiveness for pain management. However, numerous FDA-approved medications are available that have been clinically proven to be safe and effective for pain relief and management and new strategies like acupuncture and biofeedback are showing more promise all the time. And remember, if a doctor thought that THC might be helpful for a patient’s pain management, they could always prescribe dronabinol.
Many states that have implemented medical marijuana laws found most applicants cite “severe or chronic pain” as part of their qualifying medical condition. Severe or chronic pain was a factor for more than 88% of all medical marijuana cardholders in Montana. In Colorado, 91% of applicants qualified because of chronic pain (the majority of them were under 45 years old)- and only 3% of the cardholders qualified because of HIV or the symptoms from chemotherapy (areas where there’s evidence that marijuana can be helpful).
The bottom line is that the Initiative would allow people to apply for and receive registration cards so they can purchase and use marijuana even though the FDA doesn’t recognize smoking marijuana as a treatment for any medical condition. The majority of cardholders in Arizona will likely qualify because of severe or chronic pain, which has dozens of approved safe and effective treatment alternatives. It also leaves the door open for recreational users to claim they have pain issues in order to get a card to avoid getting in trouble in case they get caught with marijuana (for their recreational use). And remember, doctors can always prescribe dronabinol for their patients when they think THC may be helpful to their patient.
Dr. Nelson and I co-wrote a statement along these lines that will be in the upcoming voter guide. Our letter represents our opinions. Every voter should examine the proposal for themselves and make their own decision about how to vote.