Tuesday, June 28, 2016

Insurers Attempt to Prevent Obesity

Although five drugs are currently approved by the FDA for the long-term treatment of obesity, as of 2015, most insurers don't completely cover these drugs. It has been estimated that "about a third of [the insurance] companies don't cover obesity drugs at all, a third cover all FDA-approved weight-loss drugs, and a third cover approved drugs, but with restrictions to limit their use." And Medicare does not cover the drugs at all. However, some insurers have taken steps to try to prevent the onset of obesity.

The obesity drugs, currently available, that have gained FDA approval for long-term use are Orlistat, approved in 1999, Qsymia, approved in 2012, Lorcaserin, approved in 2012, Contrave, approved in 2014, and Saxenda, approved in 2014. In general, each of these drugs can lead to a 5% weight loss. A 5% weight loss can lead to improvements in blood pressure, cholesterol and HbA1c. Still, most insurers don't cover the weight loss drugs because the insurers don't feel that the drugs have been shown to be safe and effective.

The insurers' reluctance to cover the drugs is understandable, given the health problems obesity drugs caused in the past. But while most insurers don't cover these drugs, some of the largest insurers have established programs that may help prevent obesity later in a person's life. For example, Aetna has created programs to fight obesity during childhood, while Blue Cross and Blue Shield and United healthcare have created programs to combat both childhood obesity and childhood diabetes. Further, the Blue Cross Blue Shield program includes an online obesity-preventative resource to help providers manage pediatric patients during office visits.

So while most insurers are reluctant to cover obesity drugs, some insurance companies are taking action, now, that might curb obesity in the future. This is a positive move. Prevention is a key element in the long-term fight to stop the obesity epidemic.

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Monday, June 20, 2016

Medical Scribes

It has often been said that to run an efficient meeting, the leader of the meeting should not take notes during the meeting. Instead, the leader should focus on running the meeting, because running the meeting requires the leader's full attention. By the same token, some believe that a physician should not be taking notes while treating a patient. Because treating a patient requires the full attention of the physician. But in today's environment, with the EHR documentation requirements, often the physician is typing on his or her tablet or laptop, while counseling the patient. This is inefficient. So it makes sense to have a note taker enter patient-related information into the electronic system while the physician concentrates on the patient.

Indeed, there is now a new kind of medical worker called a medical scribe that some physicians are employing. According to one definition, a medical scribe is "a personal assistant to the physician; performing documentation in the EHR, gathering information for the patient's visit, and partnering with the physician to deliver the pinnacle of efficient patient care."

These scribes can be helpful. In fact, a recent study concluded that "physicians, clinical scribes, and patients perceived more detailed notes because of real-time documentation by scribes." The researchers went on to say that "most patients were comfortable with the scribe's presence and perceived increased attention from their physicians."

However, there are no standards or regulations in place for medical scribes. And some individuals are critical of medical scribes because some do have little medical training. As one physician concluded '“Medical Scribes are unlicensed, unregulated and little-trained individuals who are a third party being inserted between the physicians and the medical record...'

While nurses and other trained healthcare professionals, who act as medical scribes, do have medical training, consistent standards for medical scribes should be put in place to insure that a patient's health is not jeopardized by a lack of training. Still, the use of medical scribes -- especially, trained medical scribes -- will likely enhance the efficiency of a healthcare organization.
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