Sunday, December 01, 2013

Cheaper or Better Care

I hope that you are all doing well and have " survived " Thanksgiving. Well, I have another turkey for your to digest. According to the attached article published in HEALTH AFFAIRS (November 2013 vol. 32 no. 11 1977-1984) titled "Scope-Of-Practice Laws For Nurse Practitioners Limit Cost Savings That Can Be Achieved In Retail Clinics" in which the authors claim that the elimination of restrictions on NPs’ scope of practice could have a large impact on the cost savings that can be achieved by retail clinics. Using multistate insurance claims data from 2004–07, a period in which many retail clinics opened, the authors analyzed whether the cost per episode associated with the use of retail clinics was lower in states where NPs are allowed to practice independently and to prescribe independently. They also examined whether retail clinic use and scope of practice were associated with emergency department visits and hospitalizations. The authors found that visits to retail clinics were associated with lower costs per episode, compared to episodes of care that did not begin with a retail clinic visit, and the costs were even lower when NPs practiced independently. We have to be prepared to counter these arguments by pinpointing the interface of quality and costs of care and that family physicians have the experience to achieve BOTH. Focusing on costs alone may have a detrimental effect on the quality of care rendered. Yours Bernd Happy Chanukkah to those who celebrate the Jewish holiday.

Medical Marijuana

In today's Miami Herald Paula Dockery argues in favor of legalizing marijuana for medical purposes stating that " legislative leaders refuse to consider the use of medical marijuana despite the growing body of medical evidence as to its beneficial use." She further emphasizes that medical marijuana has many uses and clinical indications and that legalization would provide access to treatment for those suffering from debilitating diseases. But her arguments are based on inflated claims and not facts. Yes, one can find clinical trials using cannabinoid extracts to treat pain and spasticity in multiple sclerosis and to improve nausea in patients undergoing radiation treatment BUT these trials are limited and rely on standardized dosages of cannabinoid extracts which the inhaled delivery of marijuana often cannot provide! There is no growing body of medical evidence as to medical marijuana beneficial effects and I favor clinical research initiatives to further investigate these claims. Meanwhile, the supporters of medical marijuana are deluding the public with premature and even false medical claims. I can only speculate that the prospects of huge profits from the sale of medical marijuana drive these initiatives. But in the end who will pay for the treatment of those who need help to treat their marijuana addiction? Are we again privatizing profits and leaving the cleanup of the mess for the taxpayer to pay for?