Richard Payerchin

Partnerships, defined roles, communication and data sharing are four principles that should underpin 

 between primary care providers and health care specialists, according to the American College of Physicians (ACP).

 to lay out how lack of care coordination can cause 

, increase risk of error and create frustration for patients and physicians.

The paper, “Beyond the Referral: Principles of Effective, Ongoing Primary and Specialty Care Collaboration,” outlines how the process should be improved.

“The ways in which our health care system coordinates care between primary and specialty care physicians is broken,” ACP President George M. Abraham, MD, said in a press release. “Our patients can find the experience frustrating; physicians can often find information they need about their patients difficult to obtain, and we know that together we could be doing better.”

The ACP paper outlines four guiding principles for primary care and specialty care collaborations:

Clinical care teams should work collaboratively with patients, families, and caregivers to empower them to be active partners in all aspects of their care. Their needs, preferences, and limitations should be actively predicted, solicited, and considered in all care encounters and decisions.

Defined clinical roles and responsibilities.

The roles, responsibilities, and mutual expectations of primary care and specialty care team members should be clear and acceptable to all parties, including the patient and family.

All parties should engage in timely, informative, and focused communication with one another that highlights critical issues or items needing action.

Patient data should be shared in a timely, thorough, actionable, and well-organized manner.

Included with the paper, ACP also published a 39-page 

 that defines what is needed for each specific role or working relationship when more than one clinician is involved in the care of a patient. The playbook outlines critical elements of both a referral request and response.

Abraham presented the paper on April 29 with Carol Greenlee, MD, prior chair of ACP Council of Subspecialty Societies and an author of the paper, and Shari Erickson, ACP chief advocacy officer and senior vice president of governmental affairs and public policy. The panel took place at Internal Medicine Meeting 2022, ACP’s annual scientific meeting, held last month in Chicago.

This article was originally published by sister publication Medical Economics.

Articles

Lack of coordination can lead to fragmentation, errors, patient frustration.

The 4 principles for primary care, specialist collaboration

Whether by mistake or with malice, people within health care organizations can become threats to cybersecurity.

The U.S. Department of Health and Human Services’ 

Health Sector Cybersecurity Coordination Center

 (HC3) published “Insider Threats in Healthcare.” The 

 did not describe a specific security risk, cyberattack or health care system.

Rather, HC3 offered guidance on insider threats, people or contractors with access to assets or information about security practices, data and computer systems.

“The person could use this information in a way that negatively impacts the organization,” through fraud, data theft or system sabotage, the report said.

HC3 cited “alarming results” from the 2021 Healthcare Data Risk Report from New York-based cybersecurity consulting firm 

That company sampled 3 billion files from 58 companies and found:

Every employee had access to 20% of all files.

31,000 sensitive healthcare files were open to everyone.

77% of companies had 500 or more accounts with passwords that do not expire.

Threats may come from careless, negligent workers, malicious or disgruntled employees or third parties.

Negligent insider threats are more common than 

 and “unintentional insider threats pose a major risk to the health sector,” according to HC3.

Examples include an employee leaving unattended an unencrypted mobile device or 

 with sensitive data. Remote workers could create risks by having Amazon Echo and Alexa devices on during meetings.

Malicious insiders are people within an organization that have a grievance and choose to act on it. They could become inside agents, working on behalf of an external group “to compromise an organization’s network and carry out a data breach or other attack.”

“This is dangerous because it provides an outside group with the access and privileges of an insider,” the report said.

Disgruntled employees can be significant threats because of access to systems and because in some cases they feel as if they are owed something, the report said.

Among all organizations, 94% give third parties access to their computer systems and in 72% of case studies, third-party vendors were provided elevated permissions, according to HC3, citing the Varonis study.

Behavioral indicators of potential insider threats could include unprofessional behavior, bullying other employees, personality conflicts and misuse of travel, time or expenses.

Indicators of IT sabotage could be creating backdoor accounts, changing passwords to limit access to data, disabling system logs, installing remote network administration tools or malware, and accessing systems or computers of other workers.

Massive downloading of corporate data, sending data or email attachments to noncorporate addresses, extensive use of corporate printers, and remotely accessing organization servers during nonworking hours, all could indicate data theft, according to HC3.

Federal agency outlines risks, behavioral indicators of disgruntled workers.

Insider threats pose risk to health care cybersecurity

, health care mergers and acquisitions slowed down in the first quarter of 2022 due to a number of factors.

There were 427 total transactions in the first three months of 2022, down 34% from the fourth quarter of 2021 and a third below the quarterly average of 2021, according to 

 “Deal Making Comes Back to Earth,” by consulting firm KPMG.

Private equity deal volume of the first quarter declined by 50%. Funds slowed their pursuit of hospitals and health care systems by 61%. Interest in physicians’ practices dropped 24% from the fourth quarter of 2021, while health care IT and analytics deals rose 4%.

Strategic health care deal volume decreased by 13%, from 277 transactions in the fourth quarter of 2021 to 241 in the first quarter this year. Behavioral health posted the only volume growth, up 17%, according to KPMG.

“There are many reasons for the slowdown,” KPMG Prinicipal Ross Nelson, MD, MBA, said in the report.

 before anticipated changes in tax laws. In early 2022, the 

 omicron variant surge disrupted business.

The Federal Reserve began hiking interest rates and Russia’s invasion of Ukraine “created massive uncertainty across the global economy,” Nelson wrote.

Inflation is expected to continue through the end of the year as energy and food prices rise due to supply chain disruptions, the report said.

Those factors have made investors more cautious, taking their time on deals in 2022, Nelson said.

“In short, 2022 is not likely to yield the extraordinary deal volumes, or values, of 2021,” the report said.

A confluence of the same trends “is putting intense cost pressures on nearly every hospital and health system,” the report said. KPMG predicted a potential spike in insolvencies if hospitals cannot meet debt service requirements.

As pandemic conditions subside, patients have not returned for elective procedures. Federal aid to hospitals is waning and low interest rates “may soon be a distant memory.”

“Add increasing costs for labor and supplies, and the financial health of many hospital and health systems my come into question,” the report said.

Lenders may be willing to take an “amend and extend” approach to terms of loans for hospitals.

The report noted in the last year, “telehealth has attracted new investments from both strategic and (private equity) groups.”

In 2021, Walmart purchased MeMD to compete with CVS and Walgreens, which both have in-store clinics and telehealth offerings.

In February, Amazon announced its partnership with virtual care company Teladoc to launch telehealth through devices. In the first quarter of 2022, health insurer Cigna’s Evernorth acquired MDLive telehealth service.

Report says hospitals could face insolvency as telehealth attracts new investments.



Uncertainty leads to slow down in health care mergers and acquisitions

The American College of Physicians (ACP) has endorsed President Joe Biden’s 

The White House strategy will expand substance use prevention and early intervention strategies and enable physicians to provide treatment to patients with substance use disorder (SUD), the physician group said in a 

“The United States is experiencing a devastating 

 with more than 100,000 drug overdose deaths during a 12-month period,” ACP President George M. Abraham, MD, MPH, said in a statement. “SUD poses a heavy societal burden, endangering individual and family health and well-being, tearing through communities and sapping resources from the health care system, more needs to be done to improve access to care. We look forward to working with the administration to implement policies to help better treat SUD.”

The strategy, announced April 21, would evaluate reimbursement policies for treatments, remove barriers to buprenorphine prescribing, and develop addiction curriculum for medical schools. It also promotes proven harm reduction strategies like expanded access to 

, a potentially life-saving drug that reverses the effects of opioid overdoses, according to ACP.

The organization also supports the administration’s call for reforms in related criminal justice policies, such as promoting alternatives to incarceration and identifying racial inequities in investigation, arrest, and sentencing data and using that to drive policy change.

 is a treatable chronic medical condition like diabetes or hypertension, but 

The White House cited the 2020 National Survey on Drug Use and Health, which stated that among 41.1 million people who needed treatment for SUD, only 2.7 million of them, or 6.5%, received treatment at a specialty treatment facility over the previous year.

On April 25, the White House published a 

 from SUD treatment advocates and lawmakers praising the strategy.

The American College of Physicians (ACP) has given their endorsement for President Joe Biden’s 2022 National Drug Control Strategy.

Biden’s 2022 national drug control strategy receives support from ACP

Physicians are spending an estimated 4.5 hours a day completing electronic health records (EHR), which “leaves less time to attend directly to patients,” according to a new study.

 now are used in 90% of office-based physicians across the United States. Data from published studies showed a median daily physician EHR time ranging from 3.5 to six hours. Logging large amounts of 

 for doctors and patients, co-author James Kahn, MD, MPH said in an online statement.

“Although the EHR can improve access to medical information, it is a data-hungry beast that exacts a huge toll as measured in hours, clinical focus, communication quality, and quite likely clinical outcomes,” 

 for Physicians for a National Health Program. The organization advocates for a universal, comprehensive single-payer health program.

The researchers aimed to estimate the EHR time burden in the United States and potential savings with streamlined records. They compiled information from 10 articles that used direct observation and computer-based methods to track EHR use in family medicine, ambulatory care, primary care, general pediatrics, internal medicine, cardiology, orthopedics, endocrinology, geriatrics, psychiatry, rheumatology and ophthalmology.

“There was no relationship between specialty and result,” the study said. Time dedicated for EHR in the United States was significantly higher than in other countries, where reported daily EHR time was one hour.

, “How Much Time Do Physicians Spend in the EHR?” was published on the website KevinMD.com.

Study compiles data, finds multiple specialties affected.

How much time is being spent on EHRs?

Electronic cigarettes may help people quit smoking, but physicians need more information to talk with patients about them, according to a new study.

, but numerous studies suggest they have lower levels of toxins than cigarettes and cigars. A survey of doctors from 2018 and 2019 found more than 60% incorrectly believed that all tobacco products are equally harmful, according to the researchers.

“As the evidence grows showing e-cigarettes as potentially effective for smoking cessation, they may play a pivotal role in reducing use of cigarettes and subsequently tobacco-caused disease,” study author Michael Steinberg, MD, said in a 

“It’s important to understand physicians’ perspectives on e-cigarettes as a means for harm reduction,” said Steinberg, who is medical director of the Rutgers Tobacco Dependence Program at the Center for Tobacco Studies and division chief in the Department of Medicine at the Rutgers Robert Wood Johnson Medical School.

Instead of burning tobacco, e-cigarettes use a heated liquid containing nicotine. They are known as vapes, vaporizers, vape pens, hookah pens and other names, a formally as electronic nicotine delivery systems.

The study noted the U.S. Food and Drug Administration has not approved e-cigarettes as a cessation device.

Many people ask their physicians about using them as an alternative to tobacco cigarettes or as a way to help them stop smoking. Nearly 70% of the physicians reported patients have asked them about e-cigarettes, and one-third said they were asked in the past 30 days.

“These findings show it is critical to address physicians’ misperceptions and educate them on e-cigarettes’ efficacy, particularly correcting their misperceptions that all tobacco products are equally harmful, as opposed to the fact that combusted tobacco is by far the most dangerous,” lead author Cristine Delnevo, said in a press release. Delnevo is director of the Rutgers Center for Tobacco Studies and professor of Health Behavior, Society and Policy in the Rutgers School of Public Health.

, “Communication Between U.S. Physicians and Patients Regarding Electronic Cigarette Use,” was published in the journal 

Researchers surveyed 2,058 U.S. physicians about their communication with patients about e-cigarettes, and about hypothetical examples.

The researchers asked how they would advise two different patients who wanted to quit smoking: a young woman who is a lighter smoker and had not yet tried to quit and an older man who smoked heavily and had tried to quit many times using different methods.

The study found that physicians were significantly more likely to recommend e-cigarettes for the heavy smoker while recommending FDA-approved medications, like nicotine gum or lozenges, for the light smoker.

Devices could help patients reduce or stop using tobacco, researchers say.