Attention all states opting to go without medical malpractice caps: Don't be surprised if doctors don't want to practice within your borders. That's essentially the message being sent by graduating medical students in Illinois, if the results from the state's new physician workforce study are any indication. 

The study, conducted by Northwestern University's Feinberg School of Medicine, surveyed 561 new medical students on where they will practice following graduation, and their reasons for those decisions. Roughly half indicated that they were leaving Illinois to practice elsewhere, with medical malpractice liability playing a big part in that decision. 

Russell Robertson, MD, the study's lead author and a professor and chair of family and community medicine at the Feinberg School and family medicine at Northwestern Memorial Hospital, called the state's malpractice environment "toxic." Said Robertson in a press release: "The Illinois Supreme Court's decision to lift the liability caps seems to send the message that the potential for litigation supersedes the need for residents of Illinois to get needed healthcare." 

That decision--made last February by the state's Supreme Court--drew the ire of the American Medical Association, and continues to leave many doctors trained in The Prairie State feeling like they have no choice but to pull up stakes to begin their careers. 

"It is no shock that Illinois is losing our new doctors," Steven Malkin, MD, president of the Illinois State Medical Society, said in the press release. "If a graduating resident sets up shop in any of our neighboring states, the liability premiums will be about a third to half of what he or she would pay in Illinois....Graduates feel it often doesn't make sense to stick around, unless they have a strong Illinois family connection." 

Furthermore, the study ascertains that as more and more doctors opt to leave the state, rural communities throughout Illinois will remain undersupplied, increasing the likelihood of a prolonged physician shortage. 

To learn more:
- read through the study
- here's the accompanying press release
- check out this Chicago Sun-Times article

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Budget woes are spurring states to consider dropping Medicaid, according to Kaiser Health News and the Texas Tribune.

Conservative lawmakers in about a dozen states--including Texas, Alabama, Mississippi and Washington--see opting out of the federal Medicaid program as a way to deal with budget pressures and the costs associated with meeting the requirements of the federal healthcare overhaul. Many state governments complain that the expansion of Medicaid, which is expected to add 16 million new enrollees, will put their already cash-strapped budgets into even more dire straits, the Washington Post reports.

"States feel like their backs are against the wall, so this is the nuclear option for them," said Christie Herrera, a director with the American Legislative Exchange Council, an association for conservative state lawmakers. She said she's hearing chatter from legislators around the country who are considering opting out.

In the Texas State House, a larger majority of Republicans contend that states could provide more efficient care by giving up federal matching money entirely, or having federal officials grant states waivers to provide healthcare in a different way. Options that have been floated in several states include remaking Medicaid into a state-financed plan only to give states more flexibility in benefit and cost design. Texas currently is facing a budget gap estimated at $25 billion.

Opponents to dropping Medicaid say the idea is anti-Washington grandstanding that could hurt the health of 3.6 million Texans who are current enrollees. Without the 60 percent of Texas' $45 billion biennial Medicaid budget coming from the feds, there could be unintended consequences. "This will raise local property taxes because hospital emergency rooms can't turn away patients," said Regina Rogoff, executive director of the safety-net People's Community Clinic in Austin. "And it has the implication of us paying, through federal taxes, to subsidize care in other states, leaving people who live in our state without care."

Proponents of opting out aren't necessarily that worried about the latter. "If people are in superbad poverty, that's one thing," said State Rep. Warren Chisum, a Republican who is the state's biggest supporter of opting out of Medicaid and a candidate for Speaker of the House. "It breaks my heart when there's someone who smokes, and who stays drunk half the time, and we're supposed to provide their healthcare."

To learn more:
- read the Kaiser Health News/Texas Tribune article
- check out this Washington Post piece

A bipartisan White House panel is calling for belt-tightening measures to cut the deficit by $4 trillion through 2020. Proposed mandatory cuts to healthcare spending would include paying doctors and other providers less, according to the 50-page proposal developed by the National Commission on Fiscal Responsibility and Reform.

To defray the cost of the doc fix, in the medium term, the panel asks doctors and other providers to take responsibility for the growth in healthcare costs. Offsets would include:

• Paying doctors and other providers less, improving efficiency and rewarding quality by speeding up payment reforms.
• Paying lawyers less and cutting the cost of defensive medicine by adopting comprehensive tort reform that would cap non-economic and punitive damages.
• Expanding cost-sharing in Medicare.
• Fortifying the Independent Payment Advisory Board.

"America cannot be great if we go broke," the commission's proposal says. "If the U.S. fails to stabilize and cut the national debt, we could spend $1 trillion a year in interest alone by 2020."

Providers already are gearing up for a fight against belt-tightening measures that they see as draconian. A press release issued by the American Hospital Association noted that the draft proposal "could jeopardize hospital services for vulnerable patients and communities, particularly given that hospitals already face $155 billion in cuts as part of hearth reform." AHA also objects to the proposal that hospitals be subject to an independent payment advisory board that sets Medicare payment rates.

The Alliance of Specialty Medicine, an organization of national medical societies, also expressed concerns about the proposal to strengthen the Independent Payment Advisory Board--which aims to cut Medicare spending--because such cuts would endanger seniors' access to doctors and lead to care rationing.

To learn more:
- read the National Commission on Fiscal Responsibility and Reform proposal
- here's the Alliance for Specialty Medicine's press release
- here's the AHA press release
- read The Hill's article
- here's the Wall Street Journal article

Hospitals are turning to technology to better inform patients about what they are consenting for the doctor to perform, reports the Associated Press. The interactive computer programs explain procedures step-by-step, the associated risks and benefits as well as answer patient questions.

Many in the healthcare industry say using computers to acquire informed consent makes patients partners in the decision-making, according to the AP. "[It] sends a message that the decisions are truly owned by the patients," Dr. Harlan Krumholz, a Yale University heart specialist and advocate of changing informed consent procedures, told the news agency.

Cancer patient John Noble watched the program prior to a tumor removal surgery at University of Pittsburgh Medical Center. "It changed my perspective. It removed my fear," he told the AP.

The traditional informed consent process often involves convoluted medical forms, leaving patients confused about what they just signed and why a certain procedure is being performed or how it might help or hurt them.

"In order to make informed choices about healthcare, patients need complete and accurate information," Department of Veterans Affairs' Chief Healthcare Ethics Officer Dr. Ellen Fox told the AP. "It is ultimately the patient's choice whether to have a procedure. The program helps make that clear."

The VA requires its doctors to use iMedConsent computer programs for all treatments requiring informed consent. The programs, developed by Dialog Medical in Atlanta, are used by more than 190 hospitals. Chicago-based Emmi Solutions also has developed computer-based informed consent programs used in more than 100 hospitals.

The interactive programs also guard hospitals from lawsuits if something goes wrong, notes the AP. The programs act as an electronic record that hospitals can use to fight malpractice lawsuits. According to the AP, some hospitals already have used such electronic data in court to argue that patients were informed about specific risks because they watched portions of the program that explained those risks.

For more:
- read the Associated Press article

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African-Americans and Hispanics were about twice as likely as whites to be hospitalized for H1N1 during the 2009-10 flu season, according to a new report, Fighting Flu Fatigue, from the non-profit Trust for America's Health. Both H1N1 and seasonal flu vaccination rates were lower for African-Americans and Hispanics than for whites.

Here are some of the report's findings:

• 30 African-Americans were hospitalized per 100,000 people compared with 16 per 100,000 for whites.
• H1N1 vaccination rates were 12 percent lower for Hispanics and 10 percent lower for African-American adults than whites.
• Seasonable flu vaccination rates were 22 percent lower for Hispanic adults and 17 percent lower for African-American adults than their white counterparts.

To fight the flu and boost vaccination rates, the report suggests a launching campaign to educate about the need for flu shots and making a concerted effort to reach minority groups with targeted, culturally appropriate messages to encourage vaccinations, as well as countering negative beliefs and misinformation.

The report notes that while the response to the H1N1 outbreak showed that the country was better prepared to respond to a pandemic than it had been a few years earlier, the outbreak revealed continuing challenges to public health preparedness.

One key variable that dampened the response to H1N1 was that in the midst of the outbreak, budget cuts shrank local health departments by 23,000 jobs. Shortened work weeks for 13,000 local health departments also slowed the response.

To learn more:
- read the report
- here's the press release from the Trust for America's Health

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