Patients in your exam room may be experiencing one of a number of forms of abuse—domestic violence, human trafficking or other violence—and identifying those being abused can sometimes be tough.
How physicians can identify, assist trafficking victims
An article published in the AMA Journal of Ethics® outlined the challenges and identified ways for physicians to better spot and help trafficking victims. The authors noted that a 2014 study found that 88 percent of victims had contact with a health professional while being trafficked, but none were identified or offered help in getting out of their situation during the medical encounter.
Family physician Anita Ravi, MD, MPH, MSHP, discovered that she has had to rethink the way she approaches patients to best help those facing abuse or violence. The founder and medical director of the PurpLE (Purpose: Listen & Engage) Clinic at the Institute for Family Health in New York City offers a health home for those who have been victims of human trafficking and other trauma.
Dr. Ravi said her experience, including a study that involved interviewing 30 sex-trafficking survivors about their interactions with the health care system, has taught her that patients experiencing violence or abuse can be of any gender, age, documentation status or background and they may be encountering a range of medical issues. It may be a patient who has never encountered the health care system before because traffickers deny their access to care or the person seeking care was never able to leave their abuser long enough to seek medical care.
Patients have told her there were times when they have left a medical setting because they felt they were being judged.
“We need to think differently about people we deem “frequent flyers”,” Dr. Ravi said. For example, a patient may be coming in for frequent sexually transmitted disease testing because they are being forced to have unprotected sex.
She said physicians need to be nonjudgmental and let people know that mental health, housing, legal and social services are available. While a patient may not open up to what is really going on during a first or even second visit, those interactions can lay the groundwork that the physician’s office or an emergency department is a safe place.
Dr. Ravi said it is also important to establish a policy—even putting it in writing in the exam and waiting rooms—that says a patient needs to be seen one-on-one for part of the visit. Often, trafficked patients will come in with a man or woman who is trafficking them; sometimes that person could even be a relative.
The AMA Code of Medical Ethics offers physicians guidance on their obligation to take appropriate action to help patients avert harms that violence and abuse cause.
What physicians can do individually
In Opinion 8.10, “Preventing, Identifying and Treating Violence and Abuse,” the Code explains that all patients may be at risk for interpersonal violence and abuse, which may adversely affect a patient’s health or ability to adhere to medical recommendations. Physicians, in light of their obligation to promote the well-being of patients, have an ethical obligation to take appropriate action to avert the harms caused by violence and abuse.
The Code says to protect patients’ well-being, physicians individually should become familiar with:
How to detect violence or abuse, including cultural variations in response to abuse.
Community and health resources available to abused or vulnerable persons.
Public health measures that are effective in preventing violence and abuse.
Legal requirements for reporting violence or abuse.
Physicians also should:
Consider abuse as a possible factor in the presentation of medical complaints.
Routinely inquire about physical, sexual, and psychological abuse as part of the medical history.
Not allow diagnosis or treatment to be influenced by misconceptions about abuse, including beliefs that abuse is rare, does not occur in “normal” families, is a private matter best resolved without outside interference, or is caused by victims’ own actions.
Treat the immediate symptoms and sequelae of violence and abuse and provide ongoing care for patients to address long-term consequences that may arise from being exposed to violence and abuse.
Discuss any suspicion of abuse sensitively with the patient, whether or not reporting is legally mandated, and direct the patient to appropriate community resources.
Report suspected violence and abuse in keeping with applicable requirements.
What to consider before reporting
Before reporting suspected violence or abuse, the Code says physicians should inform patients about requirements to report.
Obtain the patient’s informed consent when reporting is not required by law. Exceptions can be made if a physician reasonably believes that a patient’s refusal to authorize reporting is coerced and therefore does not constitute a valid informed treatment decision.
Physicians should also protect patient privacy when reporting by disclosing only the minimum necessary information.
Tanya Albert Henry
“INFLUENZA 2018-19” WEBINAR OCTOBER 17TH REGISTRATION NOW OPEN
“Medical Matters” will begin its 2019 webinar series with “Influenza 2018-19” on Wednesday, October 17, 2018 at 7:30 a.m. Registration is now open for this webinar here.
William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program.
The educational objectives are: 1) Describe key indicators to look for when diagnosing patients presenting with flu-like symptoms. 2) Describe clinical and laboratory diagnostic features and treatment specific to each flu season. 3) Identify recommended immunizations and antiviral medications for treatment and how best to effectively encourage patients to get vaccinated.
Medical Matters is a series of Continuing Medical Education (CME) webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response. A copy of the flyer can be accessed here.
The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA/PRA Category 1 credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Additional Medical Matters programs will be conducted on November 14, 2018 – June, 2019. Registration is also open for the November 14, 2018 program: Cybersecurity: A Daily Threat for Healthcare here. Additional program dates for Medical Matters will be announced shortly.
Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at email@example.com.
Four months after taking UnitedHealthcare to arbitration over $11.5 million in denied claims, NYC Health + Hospitals says it has uncovered an additional $28.6 million in wrongful denials.
The additional denials were discovered following a review of nearly 4,000 claims between July 2014 and December 2017. All told, the nation’s largest public hospital said it is owed $40.1 million.
“Our clinicians have no incentive to admit patients needlessly, while UnitedHealthcare has an obvious conflict of interest: They want the premiums from their beneficiaries and don’t want to pay for their care,” Mitchell Katz, M.D., president and CEO of NYC Health + Hospitals said in a statement. “Rather than provide appropriate reimbursement for services rendered, they prefer to give more money to their shareholders and reap big bonuses for themselves.”
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UnitedHealth reported $8.3 billion in profits during the first half of 2018. The company’s two CEOs pulled in more than $110 million in compensation last year.
“The priorities are skewed,” Katz added. “It’s our responsibility to stand up and challenge wrongful denials, as all health systems should.”
On average, UnitedHealthcare denied reimbursement for three newly hospitalized patients every day over a three-and-a-half-year period, according to the health system. The “vast majority” of the denied claims involved emergency services, NYC Health + Hospitals spokesperson Bob de Luna told FierceHealthcare.
The denied claims included a pregnant woman with a history of miscarriages admitted for medical treatment at 22 weeks because an ultrasound showed she was at high risk for losing her baby. Another denied claim involved a 62-year-old woman who showed up at the emergency department with multiple signs of a stroke or heart attack, just three days after she was discharged from a previous stroke.
Another claim involved a one-year-old girl that required a surgical consultation and IV antibiotics.
Matthew Siegler, senior vice president for managed care and patient growth at NYC Health + Hospitals said he was “appalled” by some of the denied claims and UnitedHealthcare’s decision not to provide coverage.
The health system has been reviewing all its managed care contracts as it modernizes its financial operations and indicated it may pursue arbitration against other insurers. An arbitration hearing is scheduled for this fall, although no date has been set.
“As we continue to negotiate fair rates and terms with private insurance companies, we see that some want to be good partners for the benefit of their beneficiaries, and some care more about profits,” Siegler said. “Some are especially egregious. And then, there’s UnitedHealthcare.”
“We have offered to meet with NYC Health + Hospitals to review their concerns, but they have declined our invitation," UnitedHealthcare spokesperson Maria Gordon Shydlo said in a statement to FierceHealthcare. "We remain willing to meet with them as soon as they are ready to address this issue with us directly.”
Other insurers have come under fire for emergency department policies seeking to limited unnecessary visits. Earlier this year, UnitedHealth said it would begin rejecting complex ED claims. In July, the American College of Emergency Physicians (ACEP) took Anthem to court to prevent Anthem from implementing a policy to restrict coverage for ED visits.
ACEP said the insurer has been retrospectively denying claims for what it deems “non-emergent” services since it announced the new policy last year.
Editor's Note: This story has been updated to include a statement from UnitedHealthcare.
NEW YORK — An estimated 80,000 Americans died of flu and its complications last winter — the disease’s highest death toll in at least four decades.
The director of the Centers for Disease Control and Prevention, Dr. Robert Redfield, revealed the total in an interview Tuesday night with The Associated Press.
Flu experts knew it was a very bad season, but at least one found size of the estimate surprising. “That’s huge,” said Dr. William Schaffner, a Vanderbilt University vaccine expert. The tally was nearly twice as much as what health officials previously considered a bad year, he said. In recent years, flu-related deaths have ranged from about 12,000 to — in the worst year — 56,000, according to the CDC.
Last fall and winter, the U.S. went through one of the most severe flu seasons in recent memory. It was driven by a kind of flu that tends to put more people in the hospital and cause more deaths, particularly among young children and the elderly.
The season peaked in early February. It was mostly over by the end of March, although some flu continued to circulate.
Making a bad year worse, the flu vaccine didn’t work very well. Experts nevertheless say vaccination is still worth it, because it makes illnesses less severe and save lives.
“I’d like to see more people get vaccinated,” Redfield told the AP at an event in New York. “We lost 80,000 people last year to the flu.”
CDC officials do not have exact counts of how many people die from flu each year. Flu is so common that not all flu cases are reported, and flu is not always listed on death certificates. So the CDC uses statistical models, which are periodically revised, to make estimates.
Fatal complications from the flu can include pneumonia, stroke and heart attack. CDC officials called the 80,000 figure preliminary, and it may be slightly revised. But they said it is not expected to go down.
It eclipses the estimates for every flu season going back to the winter of 1976-1977. Estimates for many earlier seasons were not readily available.
Last winter was not the worst flu season on record, however. The 1918 flu pandemic, which lasted nearly two years, killed more than 500,000 Americans, historians estimate.
It’s not easy to compare flu seasons through history, partly because the nation’s population is changing. There are more Americans — and more elderly Americans — today than in decades past, noted Dr. Daniel Jernigan, a CDC flu expert.
U.S. health officials on Thursday are scheduled to hold a media event in Washington, D.C., to stress the importance of vaccinations to protect against whatever flu circulates this coming winter.
And how bad is it going to be? So far, the flu that’s been detected is a milder strain, and early signs are that the vaccine is shaping up to be a good match, Jernigan said.
“We don’t know what’s going to happen, but we’re seeing more encouraging signs than we were early last year,” he said.
— Mike Stobbe
Tom Charland is the founder and CEO of Merchant Medicine, a management consulting firm he founded in 2007 to help hospital systems and large medical groups with urgent care strategy and development. Tom is one of the leading experts on the urgent care and on-demand healthcare industry.
He is formerly the SVP for Strategy and Business Development for MinuteClinic; Executive Director of National Association for Ambulatory Care (NAFAC); CEO Digital Cyclone (acquired by Garmin); Executive Director at Control Data Systems (acquired by British Telecom). In the last several years, he has been quoted regarding walk-in medicine in the Wall Street Journal, New York Times, Chicago Tribune, Boston Globe, Fox News, Dow Jones, and Bloomberg. He also speaks frequently on the subject at investment research meetings and hospital strategy conferences throughout the year. Mr. Charland received a BS in Communications from Boston University. He is a member of the American College of Healthcare Executives (ACHE) and the Urgent Care Association of America (UCAOA).
Tom will present his views on the current state of the urgent care industry, including a look at what we are likely to see over the next five years.
Click here for more conference information.
FRIDAY, Sept. 7, 2018 (HealthDay News) -- For minor ills such as sore throats, privately insured Americans increasingly use urgent care centers rather than hospital emergency rooms, a new study finds.
Researchers at Brigham and Women's Hospital in Boston analyzed 2008-2015 data from Aetna, the commercial health insurance company.
"The drop in emergency department visits is quite striking and represents a substantial shift in where patients go to get care for conditions such as sore throat and minor injuries," study author and emergency physician Dr. Sabrina Poon said in a hospital news release.
Poon and her colleagues found a 36 percent decline in ER visits for minor conditions and injuries during the study period. Meanwhile, use of non-ER services -- including urgent care clinics, retail clinics and telemedicine -- rose 140 percent.
The largest increase (119 percent) in non-ER services was at urgent care centers, according to the study.
Given the high cost of emergency room care, many insurance plans encourage patients to go elsewhere for treatment of trivial problems, the researchers noted.
"The increasing popularity of alternatives to the emergency department is likely being driven by a variety of factors, including cost, convenience, and long wait times," said study co-author Dr. Jay Schuur, an emergency physician at Brigham and Women's.
"In the next few years, it will be important to see how these trends evolve and whether the growth of alternative sites results in lower cost care or more use of medical care," Schuur said.
The findings were published in the Sept. 4 JAMA Internal Medicine.
The American College of Emergency Physicians explains the difference between emergency care and urgent care.
SOURCE: Brigham and Women's Hospital, news release, Sept. 4, 2018
-- Robert Preidt
Last Updated: Sep 7, 2018
Monroe County has the only human fatality from West Nile virus so far this year and two of the four cases of West Nile virus reported outside of New York City, according to state Department of Health data.
The death occurred sometime between Aug. 23 and Sept. 4, according to a statewide mosquito-borne disease activity report posted Sept. 6and confirmed Wednesday by the Monroe County Department of Public Health.
“Since we announced the first human case on Aug. 22, subsequent to that there was a second individual,” said senior public health educator and department spokesman John Ricci. He said the person became seriously ill and eventually died from complications of West Nile virus.
Ricci would only say that the person who died was an older adult and a county resident. No information was available about where the person resided or whether the individual had an underlying health condition.
The county health department did not have records of any previous deaths from West Nile. It investigates cases as they occur but does track each case to its conclusion.
Last month, the county health department issued its annual warning about West Nile,saying that there had been a confirmed case in the county and urging residents to protect themselves from mosquito bites.
Mosquitoes carrying West Nile are active in late summer and early fall. Risk continues until the first heavy frost. Ricci said this is the peak time for risk to humans.
As of Sept. 6, there were 12 cases statewide, with eight in New York City. That Monroe has half of the cases upstate is more a function of small numbers than any outbreak, Ricci said.
“If there were 90 cases and we had 70, there would be more meaning to that,” he said. “Don’t read anything into that there’s greater risk in Monroe County than anywhere else.”
Ricci said the state report lags by a week, and he said there are likely to be more cases throughout upstate in subsequent weeks.
No cases were reported in Livingston, Ontario, Genesee or Wayne counties through Sept. 4.
West Nile is not transmitted from person to person.
Less than 1 percent of mosquitoes carry the virus, according to the federal Centers for Disease Control and Prevention. Of people who are bitten, less than 1 percent become seriously ill. People older than 50 and those with chronic illness are at highest risk for serious illness. There is no vaccine or specific treatment for West Nile, but people who develop symptoms such as high fever and headache should see a doctor.
People at risk for developing serious complications are more likely to be older, male and have high blood pressure or diabetes, according to a report from California health officials that was published in 2007 by the CDC.
The majority of people bitten by an infected mosquito will have no symptoms. About 20 percent will have mild flu-like symptoms.
Health officials provide the following suggestions to reduce the risk of a mosquito bite:
Democrat & Chronicle
Dr. John McLean is a critical care specialists for Velocity Care in Shreveport, Louisiana. He received his medical degree from Louisiana State University School of Medicine and has been in practice for more than 20 years.
Dr. John McLean sees a better future — he’s a visionary and an entrepreneur. He has a passion and a vision for making the world a better place for all to live. Learning something new is his hobby, which explains the many and varied business experiences he’s enjoyed. He even opened a coffee shop and learned how to roast coffee beans! His latest project is the building of a string of micro-hospitals in the U.S. He’s learned something: the atmosphere of a business is the key to its success. So he’s passionate about helping business-owners create workplaces where employees thrive, making many small differences into a big impact.
"Fire her now!" Creating Culture in the Work Place
It's a new world out there, and creating a cohesive work-environment is proving to be key to the success of any size business. This presentation will provide real-life examples of change and specific how-to's as to creating a workplace culture where employees not only enjoy coming to work but thrive as well.
ALBANY, N.Y. (AP) — Public health officials in New York state are encouraging residents to protect themselves against West Nile Virus.
Seven human cases of the mosquito-borne illness have been discovered in New York state so far this year, with three recent cases in Nassau, Westchester and Monroe counties.
Officials at the state Health Department said Thursday that residents can prevent exposure by eliminating standing water, wearing long sleeves and pants when outdoors and using repellant.
Health officials say the virus was first found in New York state in 1999. Since 2000, 497 human cases have been reported in the state.
While most people infected with the virus show no symptoms, others can develop fever, headache, body aches and stiffness.
By Annalise Knudson
STATEN ISLAND, N.Y. -- The Centers for Disease Control and Prevention (CDC) is investigating over 100 cases of measles in 21 states, including New York.
There have been 107 people who have contracted the measles, the CDC reported.
The disease has been reported in Arkansas, California, Connecticut, Florida, Illinois, Indiana, Kansas, Louisiana, Maryland, Michigan, Missouri, Nevada, New Jersey, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, Tennessee, Texas, and Washington and the District of Colombia.
Many of the people who contracted the measles were not vaccinated. However, it hasn't been confirmed if the cases were linked to those without the vaccination.
Measles is a highly contagious virus that lives in the nose and throat mucus of an infected person. It can spread to others through coughing and sneezing.
The virus can live for up to two hours in an airspace where the infected person coughed or sneezed.
It's so contagious that if one person has it, 90 percent of the people close to that person who aren't immune will also become infected.
Infected people can spread measles to others from four days before through four days after the rash appears.
Symptoms include high fever, runny nose, cough, red eyes and a rash that starts on the face and then spreads. In severe cases, patients develop pneumonia and brain swelling.
Measles can be serious for people of all ages, but is especially dangerous for those younger than five years of age and adults older than 20.
The disease is still common in many parts of the world, including Europe, Asia, the Pacific and Africa.
Travelers continue to bring the disease into the U.S. It spreads when it reaches a community in the country where groups of people are not vaccinated.
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