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Popular TV Medical Advice Shows Not as Accurate as Your Patients Think

EDMUNTON, ALBERTA – Just once, would you like a good way to respond to patients who question your diagnoses or make their own, citing popular medical television shows?

Here’s your opportunity: A new Canadian study published recently in the British Medical Journal finds that the medical information offered by The Dr. Oz Show and The Doctors isn’t all that accurate.

“Recommendations made on medical talk shows often lack adequate information on specific benefits or the magnitude of the effects of these benefits,” according to the study led by researchers from the University of Alberta. “Approximately half of the recommendations have either no evidence or are contradicted by the best available evidence. Potential conflicts of interest are rarely addressed.”

In fact, the authors caution: “The public should be skeptical about recommendations made on medical talk shows.”

For the study, the researchers randomly selected 40 early 2013 episodes of each of The Dr. Oz Show and The Doctors – both of which run Monday through Friday. All recommendations made on each program were identified, and a group of experienced evidence reviewers independently searched for and evaluated evidence to support 80 randomly selected recommendations from each show.

The authors report that the evidence reviewers “could find at least a case study or better evidence to support 54% (95% confidence interval 47% to 62%) of the 160 recommendations, 80 from each show.

In terms of The Dr. Oz Show, evidence supported 46%, contradicted 15%, and was not found for 39% of the recommendations. The television show The Doctors fared a little better: evidence supported recommendations 63% of the time, contradicted them 14% of the time, and was not found for 24%.

“Believable or somewhat believable evidence supported 33% of the recommendations on The Dr. Oz Show and 53% on The Doctors,” study authors point out. On average, The Dr. Oz Show had 12 recommendations per episode with 11 recommendations on The Doctors.

Study results indicate that the most common recommendation category, made 39% of the time on The Dr. Oz Show, was dietary advice. Viewers were advised to consult a healthcare provider 18% of the time on The Doctors.

The study also finds:

A specific benefit was described for 43% and 41% of the recommendations made on The Dr. Oz and The Doctors shows respectively.
The magnitude of benefit was described for 17% of the recommendations on The Dr. Oz Show and 11% on The Doctors.
Disclosure of potential conflicts of interest accompanied 0.4% of recommendations.

Chances are better than you may think that your patients watch one of the shows. According to a Nielsen’s report cited by the study, The Dr. Oz Show was consistently ranked in the top five talk shows in America with an average of 2.9 million viewers per day, while The Doctors had a high of 2.3 million viewers in its 2012-13 season.

AMA “Appalled” By How Many Physicians Are Penalized Over EHR Performance

WASHINGTON, DC – If you receive a letter from the Medicare program in the next few weeks saying that your practice is being penalized for failing to achieve meaningful use of electronic health record (EHR) technology, you are certainly not alone.

Hundreds of thousands of physicians and other healthcare providers will face losing 1% of their pay next year, according to the Centers for Medicare and Medicaid Services.

If you find that egregious, you are still in good company.

“The American Medical Association (AMA) is appalled by news from the Centers for Medicare and Medicaid Services (CMS) today that more than 50% of eligible professionals will face penalties under the Meaningful Use program in 2015, a number that is even worse than we anticipated,” Steven J. Stack, MD, president-elect of the American Medical Association said in December.

The AMA conceded it had supported the original HITECH legislation but said the program has not turned out as expected.

"The Meaningful Use program was intended to increase physician use of technology to help improve care and efficiency,” Stack noted. “Unfortunately, the strict set of one-size-fits-all requirements is failing physicians and their patients. They are hindering participation in the program, forcing physicians to purchase expensive electronic health records with poor usability that disrupts workflow, creates significant frustrations and interferes with patient care, and imposes an administrative burden.”

He pointed out that the AMA has “provided extensive and constructive feedback to the [Obama] Administration to help fix the Meaningful Use program, but few changes have been made. In light of the dismal number of eligible professionals meeting Meaningful Use, we hope that the administration will now move forward with the solutions we put forth in our Blueprint to make the program more successful and better enable physicians to provide quality care for their patients."

Recommendations included in the AMA's Meaningful Use blueprint include:

Adopting a more flexible approach for meeting Meaningful Use to allow more physicians to successfully participate;
Better aligning quality measure requirements including reducing the reporting burden on physicians and helping relieve them from overlapping penalties;
Ensuring quality measures and clinical decision support within the program are current to improve care for patients and ensure physicians are following the latest evidence; and
Restructuring EHR certification to focus on key areas like interoperability.

As part of its recommendations to improve the program, the AMA has asked CMS to make optional the objectives physicians are finding most challenging.

"The penalties physicians are facing under the Meaningful Use program are part of a regulatory tsunami facing physicians, apart from the flawed Sustainable Growth Rate formula, that could include cuts from the Physician Quality Reporting System (PQRS), the Value-based Modifier Program (VBM) and the sequester, further destabilizing physician practices and creating a disincentive to see Medicare patients,” said Stack, who cited statistics that only half of eligible physicians participated in PQRS in 2013, meaning many will incur penalties from both the Meaningful Use and PQRS programs.

At its interim annual meeting in Dallas in November, the AMA House of Delegates adopted a resolution urging CMS to suspend all meaningful use penalties.

Patient Portals: Build It and Patients Will Come, New Industry Survey Says

NORWALK, CT – Most Americans don’t use online patient portals, but that’s not because they aren’t interested, according to a survey finding low awareness of online medical records.

The missing link is information and instruction from medical providers on how to obtain access, according to an annual survey on the usage of electronic health records commissioned by Xerox.

The Harris Poll survey was conducted online in September among 2,017 U.S. adults. A majority, 64%, reported that they do not currently use online patient portals. Yet, more than half of those who don’t use portals, 57%, said they would be much more interested and proactive in their personal healthcare if they had online access to their medical records.

Among those who do not use patient portals, 35% did not know a portal was available and 31% said their physician had never spoken to them about portals. Among those who reported the access, 59% said use of patient portals increased their interest and proactivity in their personal healthcare.

“With providers facing regulatory changes, mounting costs, and patients who increasingly seek access to more information, our survey points to an opportunity to address issues by simply opening dialogue with patients about patient portals,” said Tamara St. Claire, chief innovation officer, commercial healthcare for Xerox. “Educating patients will empower them to participate more fully in their own care while helping providers demonstrate that electronic health records are being used in a meaningful way.”

The Centers for Medicare & Medicaid Services allows providers to earn Meaningful Use (MU) Stage 2 federal incentives if they demonstrate that 5% of patients are using secure portals to view, download and transmit their health information.

The survey reported separate results from two groups, Millennials, born from the early 1980s to the early 2000s, and Baby Boomers, defined as being born from the mid-1940s to the mid-1960s, to determine whether their interest would differ in using patient portals.

The survey found that:

Millennials are more likely to report the highest preference in accessing patient portals on the go, with 43% saying they prefer to use their smartphones.
Millennials expressed the highest interest, 57%, in accessing medical records as compared to any other content on online patient portals.
The younger group also said they want to be able to view personalized recommendations to improve their health, 44%, information about additional services from their physician, 44%, and industry news about health topics of interest to them, 23%.

As for Baby Boomers, the survey found that:

Two of every three older Americans have multiple chronic conditions, and treatment for this population accounts for 66% percent of the country’s healthcare budget.
Many Boomers who do not use portals say they would be much more engaged in their care if they received access to medical information online (56% of those ages 55 to 64, and 46% of those 65 or older.
Boomers ages 55 to 64 accounted for the highest percentage, 83%, of respondents who say they already do or would communicate with healthcare providers via a patient portal.
Among Baby Boomers, 70% say they do or would schedule appointments; 64% access/review medical records/test results; 60% ask their physicians questions; 58% order prescription refills, and 40% request a referral.

Most Patients Unaware They Are Using Epinephrine Shots, Inhalers Incorrectly

GALVESTON, TX – Most of the patients walking out of physician offices with prescriptions for epinephrine auto-injectors and metered-dose inhalers (MDI) don’t know how to use the devices properly, even if they tell you they do.

In fact, only 16% of patients prescribed epinephrine for severe allergic reactions used their auto-injectors properly, and only 7% of those with MDIs for asthma used them correctly, according to a new study published in the Annals of Allergy, Asthma and Immunology.

Repercussions can be significant: Misuse of epinephrine auto-injectors has been documented in cases of fatal anaphylaxis, according to the study led by researchers from the University of Texas Medical Branch in Galveston.

"Our study suggests that either people weren't properly trained in how to use these devices, didn't completely understand the instructions even after training, or forgot the instructions over time," explained lead author Rana Bonds, MD. "Younger patients and those with prior medical education were more likely to use the auto-injector correctly."

Patient education to assure that patients are able to correctly self-administer medications is the solution, according to the report. “Repeated verbal instruction and, perhaps even more effective, repeated visual education, including demonstration using trainer devices, are highly recommended,” the authors emphasize. “Novel methods of providing this repetitive training for patients are needed.”

For epinephrine users, the most common mistake was not holding the unit in place for at least 10 seconds after triggering. Failing to place the needle end of the device on the thigh and not pushing down forcefully enough to activate the injection were other common errors, according to the article.

Patients using inhalers often don’t exhale in order to empty out the lungs as much as possible before delivering the puff of medication, according to the study, and then don’t shake the inhaler before administering the second medication puff.

"Clearly there is room for improvement in how we teach patients to use these devices," explained co-author Aasia Ghazi, MD. "We need to consider repeated verbal instructions as well as more effective visual presentations. Improper use of the devices means people's lives are at stake, especially with epinephrine, and there is reduced value in the medicine they're trying to use. Most patients made multiple mistakes and steps were missed. They wouldn't benefit from these potentially life-saving tools if they were in trouble."

NEW WEBINAR – Live on January 21, 2015 @ 1 - 2:30 PM ET

Revenue Cycle Management and EHRs
Credits: 1.5 Nursing Contact Hours | Speaker: Ron Sterling, CPA, MBA | Location: Online

This webinar presents strategies to capitalize on electronic health records by improving your revenue cycle and operations under various service and compensation relationships. Key topics include alternative payment models, matching services to revenue, transition issues, new revenue sources and more.

The Vitals - January 2015