Gain Fitness Launches iPhone App. Gain Fitness, a startup that creates personalized workouts based on certified trainers’ expertise, has launched an iPhone app that allows fitness enthusiasts to access to personal trainer quality exercise without having to research workouts or book expensive trainers.

Web Changing How People Recall Facts. Access to a wealth of information on the Internet is altering what people remember, prompting us to retain fewer facts but more information about how to find those facts, say scientists at Harvard and Columbia.

Second-Hand Smoke Tied to ADHD. Researchers found that of more than 55,000 US children younger than age 12, 6% lived with a smoker. Those kids were more likely to have attention-deficit hyperactivity disorder (ADHD) than children living in smoke-free homes.

Florida Pain Doctor Suspended; 34 Patients Dead. Dr. Joseph Hernandez was suspended earlier this month by the Florida Department of Health for overprescribing opiate painkillers. Of the 761 patients Hernandez saw between January and April 2011, 34 have died.

When Medicaid Paid Better, Kids Had More Dental Visits. When dentists were reimbursed more for preventive visits, kids on Medicaid ended up in their chairs more often, probably because the increased compensation made them more willing to accept those patients, a government researcher said.

Who Pays On A Date Depends On Your Looks. A new study found that men find it easier to imagine paying for dinner if their companions happen to be pretty (duh). Here is where it gets interesting, though: the more attractive a man is, the more women expect him to pay.

FDA Issues US Sprout Warning. The Food and Drug Administration is warning against eating Evergreen Produce brand alfalfa sprouts and spicy sprouts. The sprouts are possibly linked to 20 reported cases of Salmonella Enteritidis in several states. The outbreak is not linked to the European one.

Membership in High-Deductible Health Plans on the Upswing.  Enrollment in high-deductible health plans grew from 10 to 11.4 million members in the year ending January 2011, according to America’s Health Insurance Plans. Experts worry that enrollees don’t understand limitations in their coverage.

Location-Based Services to Hit $10.3 Billion by 2015. That’s according to a report by Pyramid Research, which paints a picture of massive growth in both location-based services and location-based advertising.

Exhibit Shows Government Role in US Diet over the Years. A 1945 government food guide included a butter group and told readers that “in addition to the basic 7 [food groups], eat any other foods you want.” That old poster is part of the National Archives’ exhibition “What’s Cooking, Uncle Sam?”

Next Virus Victim: Your Doctor’s Or Nurse’s iPad? Networked devices used by medical personnel are vulnerable to viruses and security threats, requiring careful teamwork between IT and clinical engineering, experts say.

New York City’s Ban on Smoking Called ‘an Absolute Joke’. In the first month of the Big Apple’s new smoking ban in 1,700 parks and along 14 miles of beaches, the city issued exactly one ticket.

Diabetes Drug May Help Others Lose Weight. The diabetes drug liraglutide (Victoza), touted for its weight-loss effects in that patient population, may also help non-diabetic patients keep pounds off, researchers said.

Nearly 10% of the World’s Adults Have Diabetes. In addition, the prevalence of the disease is rising rapidly, researchers found. Increased obesity and inactivity are the primary reasons in wealthy nations and developing nations as well.

RunKeeper Adds New Integration to its Health Graph. The company has been building a tool to identify correlations between a user’s eating habits, workout schedule, social interactions and more, according to TechCrunch.

One in Three Employers May Drop Health Benefits by 2014. A McKinsey Quarterly report suggests that nearly a third of employers are likely to stop offering health insurance to employees by the time major federal healthcare reform provisions kick in.

Comparing Online Pill Identifiers. iMedicalApps has posted a review of the Pill Identifier Lite app, an offering from Drugs.com that has become the top-selling paid medical app on iTunes. The review also covers similar products by Epocrates and Lexi-Comp

Virtual Workout Partners Spur Better Results. New research from Michigan State reveals that working out with a virtual partner improves motivation during exercise.

Seniors’ Medical Pot Collective Stirs Up Some Smoke. More senior citizens turning to marijuana — legal or not — to ease the aches and pains of aging.

Legislative Changes Let Practices Get Paid for Helping Patients Quit Smoking. Practices can expect to receive $10 to $30 from most insurers for quit smoking sessions provided by trained office personnel.

Navy Calling on Gamers To Help with Security. The Office of Naval Research is rolling out the military’s first-ever online war game open to the public, crowd-sourcing the challenges of maritime security to thousands of “players” sitting in front of their computers.

California Bill Would Give Parents Access To Kids Facebook Pages. Senator Ellen Corbett has introduced legislation that would force social networks like Facebook to give parents access to their child’s account and set all privacy settings to their maximum levels by default.

Scientists Find “Master Switch” Gene for Obesity. Scientists have found a gene that controls the expression other genes which are linked to diabetes risk and cholesterol metabolism. The discovery should help in the search for treatments of obesity-related diseases.

WellPoint Shakes-Up Hospital Payments. The insurance giant announced it will cut off annual payment increases to 1,500 hospitals across the country if they fail to score high enough on a test based on 51 indicators of treatment quality.

Study: ACO Costs Higher Than CMS Says. A study commissioned by the American Hospital Association estimates that the start-up costs for establishing an accountable care organization are several times higher than estimates from the Centers for Medicare and Medicaid Services.

Later this year, federal regulators will begin reviewing requests by private health insurers who wish to raise premiums by 10% or more, year-over-year. The move represents an expansion of federal regulatory power since until now, the review of such proposals has been carried out exclusively by the states.

The new federal guidelines will take effect on July 1, and were called for by provisions in the Affordable Care Act. The guidelines specify methods by which the feds will determine whether the proposal is reasonable. These will include the percentage of premiums spent on direct medical care and whether the rates include higher premiums for some, but not all enrollees with similar health risks.

The new regulations should help Democrats respond to the lambasting they received last fall by the GOP and consumer advocates after several private insurance companies jacked their premiums by 20% or more. At the time, the companies claimed the increases were driven by soaring medical costs as well as certain provisions in the Affordable Care Act, the health reform law that was enacted last March.

In particular, private insurers pointed to provisions in the law which require them to provide more comprehensive benefits to certain populations. They also claimed that rate increases were justified in response to the increasing trend by young and healthy people to forego health insurance, a trend that obligates insurers to raise rates for everyone else.

Spokespeople for private insurers also accuse the Obama administration of demonizing the health insurance industry for political gain. “Without a doubt, this is a political process, not a technical process,” Karen Ignagni, president of America’s Health Insurance Plans has said. (more…)

Several key health care bowl games will be played in 2011. Their outcomes will affect the health and well-being of a hundred million Americans and help determine the timing of the nation’s inevitable economic double-dip. They’ll also help health insurance CEOs decide whether to re-decorate their offices with fur or linoleum, and who knows? They may even help Mrs. Farquhar find a PCP.

Before you gamble your hard-earned reimbursement check on the outcomes of these tilts, be sure to consult our handy bettor’s guide for insights and advice! We’re so sure we can help you get rich quick, we’re offering these guaranteed locks to you for free. If you like what you see here and want an even bigger edge, we recommend contacting the experts listed below. 

Florida Citrus Bowl
Republican-appointed Judges vs. Democrat-appointed Judges: My civics class teacher told me that the judicial branch of government was not subject to partisan politics. So how come every time a GOP-appointed judge rules on the Big O’s health reform law the verdict comes out unconstitutional, and every time a Clinton-Obama appointee rules, it’s cool? This is Bush-Gore 2000 all over again. We know how that turned out. GOP Judges to prevail by a hanging chad.

Sugar Bowl
Contrave vs. the FDA: Drug companies have spent billions developing a pill for obesity and have gornisht to show for it. The FDA gonged rimonabant three years ago and trashed Qnexa and Lorcaserin more recently. But in a shocking development last month, FDA scouts said Orexigen’s Contrave was the real deal. Forget that it was minimally effective and had a lousy side-effect profile! The FDA will probably approve it later this month. Over/Under = 10 pounds lost per user. Take the under.

Alamo Bowl
Texas Governor Rick Perry threatened to pull his state out of Medicaid, then backed-off amid catcalls from his advisors and top docs in the state. It also dawned on Perry that he’d lose $15 billion a year in federal matching funds if he pulled out, and that Texans would still be paying federal taxes and thus subsidizing Medicaid programs in other states. Perry to win the Grady Little Manager of the Year Award.

Fiesta Bowl
EMR companies enjoyed soaring profits and stock prices in 2010, but official scorers refused to re-write the record books saying the performance was wind-aided by HITECH. And even though virtually all reputable EMRs have nailed Meaningful Use by now, their systems still look like they were designed by Rube Goldberg on blotter acid. Fifteen yard penalty for unsportsmanlike conduct!

BCS Championship Bowl
The latest chapter in the health reform grudge match between the Pelosis and the Boehners features a new twist now that the latter kicked serious donkey in the midterms. Casual fans can’t figure out if that’s Mitch McConnell or a wax figure of Mitch McConnell on C-SPAN, but it’s not going to matter. Boehners score early and often, and win by 2 touchdowns.

WHAT THE EXPERTS ARE SAYING ABOUT:
The Doctor-Patient Relationship                                                                                                    MariaYang’s terrific new blog, In White Ink contains short character sketches and vignettes drawn from her work as a psychiatrist and from her observations of the world at large. The pieces are insightful, funny and poignant. In a post titled Lucky, Yang describes a person who hears voices and believes she alone can reunite North and South Korea, yet she is surprisingly capable of an occasional astute observation. In Aging, we observe the mannerisms of an elderly man who is befuddled, if not particularly stressed-out by his surroundings. Our pick to click!

Boomers 2011 is a moving, introspective post by John Schumann over at the GlassHospital Blog. Schumann reminds us that this year, the oldest Baby Boomers turn 65 and hence become eligible for Medicare. Then, to illustrate the challenges faced by these folks, Schumann shares a letter he received from a patient. “Ted” is acutely aware of his growing infirmities, and his letter amounts to a lament for times gone by. Thankfully though, a second patient offers Schumann a fresh approach to helping people like Ted. And the approach has nothing to do with prescribing more drugs or ordering more tests.

Health IT
According to Michael Kirsch at MD Whistleblower, electronic medical records (EMRs) are a double-edged sword when it comes to litigation risk. In his post titled “EMRs: Medical Malpractice Shield or Magnet?” Kirsch presents a balanced summary of their risks and benefits in this regard, but in the end Kirsch remains skeptical: “I fear that, at least in the short term, the legal risks for (physicians) exceed legal protections. We need to be vigilant, not only to protect our patients’ health, but also to protect ourselves.”

Quality and Safety
In a post titled, Joint Commission: Anti-Safety in Action, WhiteCoat lambasts the agency for designating suicides in the emergency department as Sentinel Events. Writing for the CallRoom Blog, WhiteCoat calculates that the incidence of suicide in the ED is about one per 25 million visits. As a result, ED staff is more likely to win the lottery than find a patient who will commit suicide. Nevertheless, WhiteCoat writes, staff must now be on the look-out for suicidal patients and document its activities every step of the way.

In The Downside of Understanding, Nick Fogelson marvels at the deluge of new medical knowledge that has become available since he entered practice 10 years ago. But as he points out, the new information is often complex and nuanced. It’s a challenge, he writes, to present this information in a way that patients can understand. The post appears at Academic OB/GYN.

Legal Matters
For Ed Pullen, the ongoing litigation involving Myriad Genetics and a bevy of plaintiffs led by the ACLU has taken-on personal overtones. Myriad holds patents on a pair of genes in which certain mutations confer increased risk of breast and ovarian cancer. As a result, it owns exclusive rights to tests that detect these mutations. In BRCA Gene Patent, Pullen explains why the matter has become personal for him, and why he feels the patents should be invalidated.

Regulation
In a scathing, hilarious post titled, Zippity Zappity, Powerbands and AMI, Sheepish lauds recent actions by regulators against 3 companies engaged in quackery and shonky medicine in Australia. Despite the interventions, Sheepish reports in his blog, Paper Mask, that at least one  company remains in business, and another still operates a web site (albeit from the USA).

Insurance
Over at Colorado Health Insurance Insider, Louise summarizes the recent expansion of her state’s Medicaid program. The successful expansion, she writes, was driven by a “presumptive eligibility” policy in which applicants are automatically enrolled when they first apply. If they are subsequently determined to be ineligible, they are removed from the program at that time.

Social Media
Over at InsureBlog, Henry Stern skewers Oregon Democrat Earl Blumenauer for overlooking a fundamental tenet of life in Internet Age: Never write anything in an email that you wouldn’t want showing up the next day in the New York Times. The Congressman did just that, and sure enough, the next day his top-secret email was reprinted in the Newspaper of Record. To find out what Blumenauer wrote, please see Henry’s post.

Behavioral Health
Eating healthier is a common New Year’s resolution, but most people find it tough to undertake wholesale dietary changes overnight. Recognizing this, Dr. Charles presents a manageable list of unhealthy foods that consumers will, hopefully, cross-off their shopping lists. The post is titled 7 + 3 Foods to Avoid. It can be found in The Examining Room.

Recognizing that many people experience painful flares of their gout during the holidays, Irwin Lim presents a timely, patient-focused review of the affliction on the BJC Health Blog. Lim’s post reminds us that flares can largely be prevented with a combination of reduced alcohol intake, dietary modification, weight loss and urate-lowering medications.

In a post titled, Universal Curative Processes, psychologist Will Meek offers a list of 10 behaviors (ranging from accepting one’s self to engaging in creative activities) that he believes can be used by most people to improve their sense of well-being.

Thanks to everybody who submitted posts to this week’s Grand Rounds! Have a great day and best of luck in the New Year!

Buyer Beware: This Bettor’s Guide Picked the Team in Red

IBM, one of largest employers in the nation, has decided to waive the $20 co-payments it had charged company-insured employees for visits to their primary care physicians.

Big Blue believes the move can cut its health costs by encouraging people to see their PCPs more frequently which should result in earlier diagnoses and reductions in the number of visits to specialists and ERs.

Randy MacDonald, IBM’s Sr. VP for Human Resources, said the move “is designed to encourage people to get fixed early…we’d rather diagnose a situation and deal with it quickly as opposed to it becoming chronic.”

IBM’s newfound emphasis on primary care is, according to MacDonald, part of its “wellness” strategy which reduces health care costs by preventing illness, or at least treating it earlier. IBM spent $79 million on these programs between 2004 and 2007 and estimates this approach saved the company $191 million.

IBM’s wellness programs pay employees up to $300 per year to take exercise classes or enroll their children in weight-monitoring programs. Soon, it will add a stress relief program to the mix.

“In these economic times, with the loss of home equity and the loss of savings, we are seeing stress-related issues” in employees, MacDonald told the Wall Street Journal.

Helen Darling, president of National Business Group on Health, called IBM’s move “very unusual. The number of employers who cover primary-physician visits without a co-pay is minuscule,” she said.

IBM has 115,000 US employees and spends nearly $1.3 billion per year on their health care. Its benefit practices are watched closely by other employers, and it is known to be a trend-setter in this area.

Fourteen years ago, Harvard researchers revealed that insurance companies were big-time investors in tobacco companies. The seemingly hypocritical position prompted outrage and calls for them to divest.

But when the same scientists recently re-examined the matter, they found the industry had failed to kick the habit.

By reviewing SEC filings and news reports from 2008, J. Wesley Boyd and colleagues determined that US, UK and Canadian-based insurance companies owned at least $4.4 billion worth of stock in companies whose subsidiaries produce cigarettes, cigars, chewing tobacco and related products.

“Despite calls upon the insurance industry to get out of the tobacco business by physicians and others, insurers continue to put their profits above people’s health,” Boyd told Medical News Today. “It’s clear their top priority is making money, not safeguarding people’s well-being.”

The World Health Organization estimates that tobacco products contribute to 5.4 million deaths per year worldwide.

New Jersey-based Prudential Financial Inc., which markets life and disability insurance, has holdings in tobacco firms like Reynolds American and Philip Morris, that total $264 million.
 
These numbers are dwarfed by Toronto-based Sun Life which sells health, disability, life and long-term care insurance. It owns just north of $1 billion in tobacco company stock.

Meanwhile, London-based Prudential Plc, which offers disability, health and long-term care insurance, holds $1.38 billion in British American Tobacco and other such companies.

“Insurance firms have figured out ways to profit from both… investing in tobacco (and) selling life or health insurance. (They) exclude smokers from coverage or, more commonly, charge them higher premiums. Insurers profit - and smokers lose - twice over,” wrote the authors.

Boyd’s group first reported on the matter in a 1995 Lancet article.

The Centers for Medicare and Medicaid Services announced last Wednesday that it was changing its payment rates to providers in 2010.

The new rates will increase payouts to beleaguered primary care practitioners while snubbing radiologists and cardiologists, among others.

Among the perks for PCPs, CMS has proposed a bump in payments for the Initial Preventive Physical Exam, a.k.a. the “Welcome to Medicare” visit to reflect the true complexity of the service.

CMS also proposed to change the way Medicare recognizes professional liability expenses such that Medicare’s support for these costs is redirected to providers experiencing the highest malpractice premiums.

Beyond that, the news was gloomier than Boston’s weather this June. 

CMS is, for example, proposing to remove physician-administered drugs from the definition of “physician services” and to stop paying for consultation codes, which are typically billed by specialists at a rate higher than procedurally similar evaluation and management (E/M) services. 

Overall, the changes would increase payments to GPs, family physicians, internists, and geriatric specialists by 6-8%, according to a CMS press release. The biggest losers will be radiologists, especially interventional radiologists who should see cuts of at least 20% for most imaging tests.

Payments to cardiologists would be cut about 11% overall, with cuts of up to 42% for reading an echocardiogram and 24% for performing cardiac catheterization.

Cuts “like this threaten the successes we have had over the years with reducing heart disease,” ACC president Alfred Bove warned the Wall Street Journal.

Meanwhile Ted Epperly, president of the American Academy of Family Physicians, said the CMS proposal would drive more medical students into primary care, and hailed the pay raise for his constituency as “long overdue.”