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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_3317"
                     title="Healthcare Reform Covers More and Costs More"
                     score="0.01"
                     href="http://www.medpagetoday.com/Washington-Watch/Reform/tb/22089?impressionId=1284018863918"
                     
      &lt;p&gt;WASHINGTON  --  The healthcare reform law will not slow the growth of healthcare spending in the next decade  --  in fact, it will accelerate healthcare spending slightly  --  but it will also significantly expand healthcare coverage, a new government report found.&lt;/p&gt;
&lt;p&gt;The report, issued by Centers for Medicare and Medicaid Services (CMS) Office of the Actuary, casts doubt on predictions from the Obama administration and congressional Democrats that healthcare reform would slow the trajectory of healthcare spending.&lt;/p&gt;
&lt;p&gt;The CMS analysis pegs healthcare spending growth at an average rate of 6.3% over the next decade, or 0.2 percentage points faster than healthcare spending would have grown had the Affordable Care Act (ACA) not become law.&lt;/p&gt;
&lt;p&gt;Put another way, nearly 20% of the U.S. gross domestic product (GDP)  --  or one in five U.S. dollars spent  --  will be devoted to healthcare costs in 2019. (That projection is 0.3 percentage points higher than pre-reform projections).&lt;/p&gt;
&lt;p&gt;However, the projection  --  which was published Thursday in the policy journal &lt;em&gt;Health Affairs&lt;/em&gt;  --  does support another promise of reform  --  to expand coverage to 32 million people.&lt;/p&gt;
&lt;p&gt;The CMS actuaries who wrote the report estimate that nearly 93% of the U.S population will have health insurance in 2019, which is an additional 32.5 million above the current number of insured people.&lt;/p&gt;
&lt;p&gt;This is the second 10-year health spending projection released by CMS this year. The first, which was released in &lt;a href=&quot;http://www.medpagetoday.com/Washington-Watch/Washington-Watch/18302&quot; mce_href=&quot;http://www.medpagetoday.com/Washington-Watch/Washington-Watch/18302&quot; target=&quot;_blank&quot; title=&quot;In&amp;#8200;Bad&amp;#8200;Economy,&amp;#8200;Record&amp;#8200;Growth&amp;#8200;in&amp;#8200;Health&amp;#8200;Spending&quot;&gt;February&lt;/a&gt;, did not account for the impact of the &lt;a href=&quot;http://www.medpagetoday.com/Washington-Watch/Reform/19351&quot; mce_href=&quot;http://www.medpagetoday.com/Washington-Watch/Reform/19351&quot; target=&quot;_blank&quot; title=&quot;What&apos;s&amp;#8200;in&amp;#8200;the&amp;#8200;Healthcare&amp;#8200;Reform&amp;#8200;Law&quot;&gt;Affordable Care Act &lt;/a&gt;(ACA), which was signed into law in March.&lt;/p&gt;
&lt;p&gt;The main driver of increased spending according to this latest report is the estimated $38 billion cost for establishing the new health insurance exchanges. Close behind is the expected $31 billion increase in the cost of Medicaid. Under ACA, any person under the age of 65 who has an income under 138% of the federal poverty level will be eligible for Medicaid.&lt;/p&gt;
&lt;p&gt;Taken together, the insurance exchanges and the Medicaid expansion, provide the new structure that will provide care to the uninsured.&lt;/p&gt;
&lt;p&gt;Healthcare reform could bring down costs after 2019, but the CMS researchers didn&apos;t look beyond the next decade.&lt;/p&gt;
&lt;p&gt;The projection outlines some healthcare spending patterns that will likely emerge over the upcoming years as a result of the ACA.&lt;/p&gt;
&lt;p&gt;For example, in 2010, healthcare spending is estimated to grow at a rate of 5.8%, but it&apos;s scheduled to slow in 2011 to 4.2%.&lt;/p&gt;
&lt;p&gt;But there are problems with that projection since spending slow-down hinges on a planned 23% pay cut for physicians who treat Medicare patients going into effect. In June, Congress passed a &lt;a href=&quot;http://www.medpagetoday.com/Washington-Watch/Washington-Watch/20889&quot; mce_href=&quot;http://www.medpagetoday.com/Washington-Watch/Washington-Watch/20889&quot; target=&quot;_blank&quot; title=&quot;&amp;#8200;Log&amp;#8200;in&amp;#8200;or&amp;#8200;create&amp;#8200;a&amp;#8200;free&amp;#8200;account&amp;#8200;for&amp;#8200;complete&amp;#8200;access&amp;#8200;to&amp;#8200;everything&amp;#8200;MedPage&amp;#8200;Today&amp;#8200;has&amp;#8200;to&amp;#8200;offer!&amp;#8200;House&amp;#8200;Passes&amp;#8200;Six-Month&amp;#8200;SGR&amp;#8200;Delay&quot;&gt;law &lt;/a&gt;to update physician Medicare rates by 2.2%, but that temporary fix runs out on Dec. 1. Come Jan. 1, 2011, physicians would also be slapped with an additional 3% cut in Medicare reimbursement.&lt;/p&gt;
&lt;p&gt;If history is any indication, Congress will likely vote again to override the cut, likely making the projection that healthcare spending will slow in 2011 no longer applicable.&lt;/p&gt;
&lt;p&gt;Some immediate changes brought by the law will cause a near-term spike in total national health expenditures to occur, the researchers found. For example, implementing the &lt;a href=&quot;http://www.medpagetoday.com/Washington-Watch/Reform/20991&quot; mce_href=&quot;http://www.medpagetoday.com/Washington-Watch/Reform/20991&quot; target=&quot;_blank&quot; title=&quot;Enrollment&amp;#8200;in&amp;#8200;Temporary&amp;#8200;High-Risk&amp;#8200;Pools&amp;#8200;Begins&amp;#8200;Today&quot;&gt;temporary high-risk insurance pool&lt;/a&gt;, and providing coverage to dependents under the age of 26 will add more than $10 billion to national health spending through 2013.&lt;/p&gt;
&lt;p&gt;  &lt;/p&gt;
&lt;p&gt;CMS researchers said that while reform won&apos;t tamp down healthcare spending in the next decade, that&apos;s far from the complete picture.&lt;/p&gt;
&lt;p&gt;&quot;While the impacts are relatively moderate on net spending, the underlying effects on coverage and financing are more pronounced,&quot; Andrea Sisko, an economist with CMS&apos; Office of the Actuary and lead author of the study, told reporters Wednesday.&lt;/p&gt;
&lt;p&gt;&quot;When you peel back the onion, and you look past the surface, you start to see much more pronounced impacts,&quot; said John Poisal, deputy director of the National Health Statistics Group at CMS&apos; Office of the Actuary, and one of the authors of the study.&lt;/p&gt;
&lt;p&gt;One of those layers, he said, is the high projected rate of insured people likely by 2019.&lt;/p&gt;
&lt;p&gt;Of the newly insured, about eight million will be enrolled in their state&apos;s Children&apos;s Health Insurance Plan (CHIP), and nearly 31 million will be enrolled in the new insurance exchanges that the ACA will establish beginning in 2014.&lt;/p&gt;
&lt;p&gt;Enrollment in Medicaid and CHIP will increase by one-third over the next decade, and enrollment in private insurance will increase from 15.8 million in 2014 to 30.6 million in 2019, the researchers wrote.&lt;/p&gt;
&lt;p&gt;The researchers also determined that when federally-mandated COBRA subsidies expire in 2011, the unemployed will be stuck paying for a large share of their insurance coverage, which will lead to slightly higher out-of-pocket health costs starting that year. But by 2014, when many people who did not have insurance will be insured, out-of-pocket spending will drop by 1.1%, instead of rising by 6.4% percent, which was the pre-reform projection.&lt;/p&gt;
&lt;p&gt;However, the reduction in out-of-pocket spending won&apos;t last, and, by 2018, employee spending will actually grow faster than had reform not passed. The CMS actuaries told reporters the projected increase would be caused by the tax on high-benefit, expensive plans. The actuaries predicted that employers would do an end-run to avoid the financial penalty for offering the so-called &quot;Cadillac&quot; plans by passing the extra costs onto all employees.&lt;/p&gt;
&lt;p&gt;Finally, crystal balls are notoriously inaccurate so the researchers cautioned that as the provisions of the ACA are implemented, the &quot;actual impacts may well differ considerably form these estimates.&quot;&lt;/p&gt;


    </recommendedItem>
    <recommendedItem id="20100101_19_3316"
                     title="New HIV Cases High Among French MSM (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/clinical-context/HIVAIDS/tb/22088?impressionId=1284018863918"
                     
      &lt;p&gt;HIV appears to be out of control among French men who have sex with men, researchers reported.&lt;/p&gt;
&lt;p&gt;Data for 2008 revealed that men who have sex with men (MSM) accounted for 48% of all new HIV infections in France, according to St&amp;#233;phane Le Vu, PhD, of the French National Institute for Public Health, and colleagues.&lt;/p&gt;
&lt;p&gt;The incidence rate in that population was 1%  --  a rate of 1,006 new infections per 100,000 person-years in 2008  --  and 200 times higher than the rate estimated for French heterosexuals, Le Vu and colleagues reported online in&lt;em&gt;The Lancet&lt;/em&gt; &lt;em&gt;Infectious Diseases.&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;&quot;The HIV epidemic seems to be out of control in the MSM population,&quot; the researchers contended.&lt;/p&gt;
&lt;p&gt;Over the six years from 2003 through 2008, HIV incidence among MSM was &quot;comparatively high and stable,&quot; the researchers reported  --  although the overall incidence of HIV in France fell by about 3.7% a year.&lt;/p&gt;
&lt;p&gt;The new findings are no surprise to those involved in combating the HIV pandemic, said Robert Hogg, MD, of the British Columbia Centre for Excellence in HIV/AIDS in Vancouver.&lt;/p&gt;
&lt;p&gt;&quot;Rates in North America in terms of HIV incidence among MSM have been relatively stable and very high for the last little while,&quot; he told &lt;em&gt;MedPage Toda&lt;/em&gt;y, although the reasons for that remain unclear.&lt;/p&gt;
&lt;p&gt;Most analyses of HIV rates are based on new diagnoses, but the French study added a new wrinkle. Using an enzyme immunoassay, Le VU and colleagues were able to gauge the proportion of recent infections among the new diagnoses.&lt;/p&gt;
&lt;p&gt;After accounting for under-reporting, Le Vu and colleagues estimated that 42,330 people were newly diagnosed with HIV over the study period and that overall HIV incidence decreased significantly from 8,930 new found infections in 2003 to 6,940 in 2008. The decline was significant at &lt;em&gt;P&lt;/em&gt;=0.002.&lt;/p&gt;
&lt;p&gt;The proportion of recent HIV infections, as determined by the immunoassay, remained stable at about 25% a year, they found.&lt;/p&gt;
&lt;p&gt;Among those with recent infection during the study period, MSM led the way with 40%, compared with French-national heterosexual women and men (at 28% and 22%, respectively), heterosexual non-French-national women and men (at 16% and 12%), and injection drug users (at 15%), Le Vu&apos;s team reported.&lt;/p&gt;
&lt;p&gt;In 2008, however, 48% of some 6,940 new infections were found among MSM, the researchers wrote, with only 1% of new infections seen in injection drug users.&lt;/p&gt;
&lt;p&gt;Overall, HIV incidence in 2008 was 17 per 100,000 person-years, they reported, based on rates of: &lt;ul&gt; &lt;li&gt;Nine per 100,000 person-years among heterosexuals&lt;/li&gt; &lt;li&gt;1,006 per 100,000 person-years among MSM&lt;/li&gt; &lt;li&gt;86 per 100,000 person-years among injection drug users&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;In a comment accompanying the French report in &lt;em&gt;The&lt;/em&gt; &lt;em&gt;Lancet,&lt;/em&gt; Hogg and colleagues at the BC Centre argued that one way to reduce those rates would be to employ a multifaceted approach including both individual and population-based prevention strategies.&lt;/p&gt;
&lt;p&gt;As well, they argued, such an approach should take into account the increasing evidence that expanding antiretroviral therapy to all people who meet eligibility criteria would reduce the number of new cases.&lt;/p&gt;
&lt;p&gt;&quot;It&apos;s not treatment or prevention,&quot; Hogg told&lt;em&gt; MedPage Today&lt;/em&gt;. &quot;It&apos;s both.&quot;&lt;/p&gt;
&lt;p&gt;Hogg added that any prevention strategy will also have to account for the way sexual transmission occurs among men who have sex with men. The pattern, he said, is &quot;like a series of random forest fires,&quot; which can be difficult to extinguish.&lt;/p&gt;
&lt;p&gt;That contrasts with injection drug users, where transmission usually occurs within a small circle of people involved in using drugs and prevention efforts can be closely targeted, Hogg said.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by the French National Institute for Public Health Surveillance and the French National Agency for Research on AIDS and Viral Hepatitis. The authors declared they had no conflicts.&lt;/p&gt;&lt;p&gt;Hogg reported financial links with GlaxoSmithKline and Merck Frosst Laboratories.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_3315"
                     title="Ovarian Cancer Subtype Linked to Gene Mutations (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/HematologyOncology/OvarianCancer/tb/22087?impressionId=1284018863918"
                     
      &lt;p&gt;Many cases of deadly clear-cell ovarian cancers and endometrioid carcinomas appear to arise from disruption of a previously-discovered tumor-suppressor gene, according to new RNA sequencing studies of cancer cells.&lt;/p&gt;
&lt;p&gt;Mutations in the tumor suppressor gene &lt;em&gt;ARID1A&lt;/em&gt; occurred in almost half of the clear-cell ovarian cancers and a third of the endometrioid carcinomas analyzed by David G. Huntsman, MD, of the British Columbia Cancer Agency in Vancouver, and colleagues. In contrast, no &lt;em&gt;ARID1A&lt;/em&gt; mutations were identified in a group of high-grade serous ovarian carcinomas.&lt;/p&gt;
&lt;p&gt;&quot;The mechanism by which somatic mutations in &lt;em&gt;ARID1A&lt;/em&gt; enable the progression of benign endometriosis to carcinoma is unclear,&quot; Huntsman and co-authors concluded in an article published online in the &lt;em&gt;New England Journal of Medicine&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;However, our findings are consistent with a critical role for &lt;em&gt;ARID1A&lt;/em&gt; mutations in the genesis of a substantial fraction of ovarian clear-cell and endometrioid carcinomas,&quot; the researchers added.&lt;/p&gt;
&lt;p&gt;Similar findings were published simultaneously in &lt;em&gt;Sciencexpress&lt;/em&gt;, an online edition of &lt;em&gt;Science&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Ovarian clear-cell carcinoma accounts for 12% of all ovarian cancers diagnosed in the U.S. and an even higher proportion of those in Japan, according to background information provided by the authors. Clear-cell carcinoma accounts for the second largest number of deaths from ovarian cancer  --  trailing only high-grade serous carcinomas, which account for 70% of all ovarian cancers.&lt;/p&gt;
&lt;p&gt;Both ovarian clear-cell and endometrioid carcinomas are associated with endometriosis, the authors noted. However, the genetic events associated with malignant transformation had not been determined.&lt;/p&gt;
&lt;p&gt;Aberrations in &lt;em&gt;ARID1A&lt;/em&gt; had been identified in breast- and lung-cancer cell lines. Huntsman&apos;s team had previously identified variants in a small number of clear-cell ovarian carcinomas and cell lines by means of whole-transcriptome RNA sequencing (&lt;em&gt;N Engl J Med&lt;/em&gt;. 2009; 360: 2719-2729, &lt;em&gt;Bioinformatics&lt;/em&gt;. 2010; 26: 730-736).&lt;/p&gt;
&lt;p&gt;Continuing their investigation of &lt;em&gt;ARID1A&lt;/em&gt; in ovarian cancer, Huntsman and colleagues sequenced whole transcriptomes of 210 ovarian carcinomas and an ovarian clear-cell carcinoma cell line. Additionally, the team measured expression of &lt;em&gt;ARID1A&lt;/em&gt;-encoded BAF25a  --  a key protein in chromatin remodeling  --  in 455 ovarian carcinomas.&lt;/p&gt;
&lt;p&gt;The results of their analysis showed &lt;em&gt;ARID1A&lt;/em&gt; mutations in 55 of 119 (46%) ovarian clear-cell carcinomas and 10 of 33 (30%) endometrioid carcinomas  --  but none of 76 high-grade serous ovarian carcinomas.&lt;/p&gt;
&lt;p&gt;Loss of BAF25a had a significant association with &lt;em&gt;ARID1A&lt;/em&gt; mutations (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001) in ovarian clear-cell and endometrioid carcinomas but not high-grade serous carcinoma.&lt;/p&gt;
&lt;p&gt;&quot;The mutations are common in ovarian carcinomas that are associated with endometriosis ... but not in the unrelated high-grade serous carcinoma,&quot; Huntsman and co-authors wrote. &quot;This suggests that the mutations may be pathogenic, rather than random, events.&quot;&lt;/p&gt;
&lt;p&gt;&quot;It is possible that defects in genes that alter the accessibility of transcription factors to chromatin, such as &lt;em&gt;ARID1A&lt;/em&gt; ... will help to define ovarian clear-cell carcinomas and endometrioid carcinomas,&quot; they added.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Huntsman and co-authors reported that they had no relevant disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_3314"
                     title="Sickle Cell Screening May Cause Harm (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/Genetics/GeneticTesting/tb/22082?impressionId=1284018863918"
                     
      A decision by the National Collegiate Athletic Association (NCAA) to require screening for sickle cell carrier status among Division I athletes ultimately may do more harm than good, researchers predict.&lt;br&gt;
&lt;br&gt;The screening program, which goes into effect in the current academic year, resulted from a lawsuit against the NCAA and Rice University following the death from acute exertional rhabdomyolysis of a 19-year-old boy after football practice, according to Vence L. Bonham, JD, of the National Human Genome Research Institute in Bethesda, Md., and colleagues.&lt;br&gt;
&lt;br&gt;Exertional rhabdomyolysis has been linked to carrying the sickle cell trait  --  having one S allele of beta-globin and one normal allele  --  the authors wrote in the Sept. 9 &lt;em&gt;New England Journal of Medicine.&lt;/em&gt;&lt;p&gt;&lt;/p&gt;
&lt;p&gt;Other serious conditions that have been reported in carriers of the sickle cell trait include renal medullary carcinoma and splenic infarction  --  but these conditions are rare, Bonham and colleagues pointed out. Most sickle cell carriers are asymptomatic and have a normal life expectancy, they added.&lt;/p&gt;
&lt;p&gt;In background information provided by the authors, more than two million people in the U.S. were estimated to be carriers of the sickle cell trait  --  including roughly 8% of blacks, 0.5% of Hispanics, and 0.2% of whites.&lt;/p&gt;
&lt;p&gt;&quot;Thus, nearly all NCAA colleges and universities fielding multiple Division I teams will have students who test positive, and the screening program could identify 400 to 500 carriers each year,&quot; Bonham and co-authors wrote.&lt;/p&gt;
&lt;p&gt;Exercise-related sudden death is estimated to be 10 to 30 times higher among carriers, however, and in the 1970s large voluntary screening programs were organized.&lt;/p&gt;
&lt;p&gt;Unfortunately, no provisions were made for education and counseling, and the screening programs resulted in widespread confusion about important concerns such as the difference between sickle cell disease and carriage of the sickle cell trait. Most of those programs were later abandoned or altered, the authors noted.&lt;/p&gt;
&lt;p&gt;&quot;Although the NCAA program differs in scope and purpose from earlier programs, it shares the potential for unintended consequences,&quot; warned Bonham and colleagues.&lt;/p&gt;
&lt;p&gt;They expressed some specific concerns, including the following: &lt;ul&gt; &lt;li&gt;Assistance for athletes and families in decision-making and understanding the implications of test results&lt;/li&gt; &lt;li&gt;The need for follow-up testing to eliminate false positives&lt;/li&gt; &lt;li&gt;Privacy for students who test positive&lt;/li&gt; &lt;li&gt;Special concerns for minors&lt;/li&gt; &lt;li&gt;Implications of testing for students with athletic scholarships&lt;/li&gt; &lt;li&gt;Stigmatization of carriers&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;An earlier military program of testing for the sickle cell trait can be instructive, according to the authors.&lt;/p&gt;
&lt;p&gt;The screening program initially resulted in discrimination against carriers and soldiers who tested positive being prohibited from certain tasks, until research showed that some training modifications and attention to hydration could minimize the risks.&lt;/p&gt;
&lt;p&gt;Screening college athletes for the sickle cell trait also raises questions as to whether there will be additional testing in the future for other risky conditions  --  for example, inherited arrhythmia syndromes and cardiomyopathies  --  if better tests become available, Bonham and colleagues noted.&lt;/p&gt;
&lt;p&gt;&quot;Although the NCAA program may be an enlightened first step toward ensuring the health and well-being of student athletes, it could easily become subject to some of the perils that troubled earlier programs,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;An additional caution is that the screening program might be considered primarily a defensive legal move  --  because students can avoid testing if they can document previous screening or sign a waiver exempting the association and the university from liability.&lt;/p&gt;
&lt;p&gt;Perhaps, suggested the authors, the program should be considered an experiment that has implications for other screening programs and for sickle cell carriers worldwide.&lt;/p&gt;
&lt;p&gt;&quot;If it is indeed an experiment, the related data should be collected and analyzed rigorously, objectively, and transparently so that the costs and benefits of testing can be evaluated,&quot; they concluded.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;All authors declared no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_3313"
                     title="ER First Choice for Many Seeking Care"
                     score="0.01"
                     href="http://www.medpagetoday.com/PublicHealthPolicy/GeneralProfessionalIssues/tb/22085?impressionId=1284018863918"
                     
      &lt;p&gt;WASHINGTON  --  Of the 354 million acute care visits patients made to healthcare providers over a three-year period, more than one-quarter took place in emergency rooms, representing a shift from the old days when general practitioners were the main providers of acute care.&lt;/p&gt;
&lt;p&gt;The study, which was published in the policy journal &lt;em&gt;Health Affairs&lt;/em&gt;, found that, in part because of office-based practitioners&apos; busy schedules, patients are increasingly going to the hospital for treatment for illnesses such as fever and stomach pain  --  ailments which used to be treated in a doctor&apos;s office.&lt;/p&gt;
&lt;p&gt;And fewer than half of all acute care visits involve the patient&apos;s personal physician, wrote the study authors, who were led by Stephen Pitts, MD, associate professor of emergency medicine at Emory University in Atlanta.&lt;/p&gt;
&lt;p&gt;Because most acute care visits took place in a non-primary care setting, only 42% of all visits involved a patient&apos;s personal physician.&lt;/p&gt;
&lt;p&gt;&quot;Americans&apos; access to primary care is in decline,&quot; the authors concluded.&lt;/p&gt;
&lt;p&gt;For the study, the researchers combined data from three large federal surveys of outpatient encounters to determine &quot;where, when, and why Americans seek treatment for acute health problems.&quot; The researchers determined whether the major reason for each visit was &quot;acute&quot; or not.&lt;/p&gt;
&lt;p&gt;They found that between 2001 and 2004, Americans made an average of more than a billion outpatient visits per year to doctors  --  which translates to a rate of 321 visits per 1,000 people per month.&lt;/p&gt;
&lt;p&gt;To compare, a 1961 study found that Americans made 250 &quot;illness visits&quot; per 1,000 adults each month.&lt;/p&gt;
&lt;p&gt;Acute care made up about one-third of all visits in the current study. Most of the visits were for nonacute care, including prenatal checks, physical exams, and managment of chronic diseases.&lt;/p&gt;
&lt;p&gt;Stomach and abdominal pain, chest pain, and fever topped the list for most common reasons for visiting the emergency department, while cough, sore throat, skin rash, and earache were the most common reasons for visiting a family physician&apos;s office.&lt;/p&gt;
&lt;p&gt;The study also broke down which types of doctors treated acute care patients and found: &lt;ul&gt; &lt;li&gt;28% of acute care visits were managed by hospital emergency departments&lt;/li&gt; &lt;li&gt;22% were managed family physicians&lt;/li&gt; &lt;li&gt;20% were managed by non-primary care office-based subspecialists&lt;/li&gt; &lt;li&gt;13% were managed by general pediatricians&lt;/li&gt; &lt;li&gt;10% were managed by general internists&lt;/li&gt; &lt;li&gt;7% were managed by hospital outpatient departments&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;&quot;Apparently, primary care physicians provide much less acute care than in the past,&quot; the authors concluded, adding that using emergency rooms for problems a primary care provider could treat is &quot;not desirable from a societal perspective.&quot;&lt;/p&gt;
&lt;p&gt;&quot;Too often, emergency care is disconnected from patients&apos; ongoing healthcare needs,&quot; the authors wrote. &quot;Lack of shared health information promotes duplicative testing, hinders follow-up, and increases the risk of medical errors.&quot;&lt;/p&gt;
&lt;p&gt;The authors laid out a number of possible reasons for the shift to the emergency room, including office-based primary care doctors not having enough time or space to keep up with patient demand, and fear of litigation driving primary care physicians to refer patients to a hospital.&lt;/p&gt;
&lt;p&gt;The healthcare reform law  --  the Affordable Care Act (ACA)  --  contains a number of provisions that may help move patients back to primary care providers, the authors noted.&lt;/p&gt;
&lt;p&gt;For one, the ACA funds grants to test patient-centered medical home models. The authors said that although the medical home provisions should promote a substantial &quot;scaling-up&quot; of the model, it&apos;s unlikely America will soon become like Germany or the Netherlands, where most patients receive acute care in a doctor&apos;s office.&lt;/p&gt;
&lt;p&gt;In addition, the ACA provides increased reimbursement for primary care doctors.&lt;/p&gt;
&lt;p&gt;&quot;Enhanced rates of reimbursement ... may also spur some practitioners to expand access and may attract more medical students to primary care,&quot; the authors wrote. &quot;But the pipeline will take years, if not decades, to catch up.&quot;&lt;/p&gt;
&lt;p&gt;Also, if Medicare reimbursements are too low, primary care doctors may decide it&apos;s not financially worth it to treat Medicare patients and refer them to a hospital instead, the authors wrote.&lt;/p&gt;
&lt;p&gt;However, it the law does succeed in creating more primary care physicians, then emergency room visits for &quot;primary care treatable&quot; illnesses should decline, they said.&lt;/p&gt;
&lt;p&gt;The authors wrote that some have looked to retail clinics as a way to manage common medical ailments, but that retail clinics and urgent care centers are not &quot;a panacea for access,&quot; because they are poorly suited to manage chronic and acute conditions.&lt;/p&gt;
&lt;p&gt;&quot;Unless they are electronically linked to local hospitals and primary care practices, retail clinics and urgent care centers are likely to further fragment the delivery of health care,&quot; the authors said.&lt;/p&gt;
&lt;p&gt;The study also found some other emergency room trends, including: &lt;ul&gt; &lt;li&gt;While nearly all visits to doctor&apos;s offices and hospital outpatient departments occurred during the weekday, two-thirds of emergency room visits took place on weekends or after office hours. &lt;/li&gt; &lt;li&gt;General practitioners or family physicians saw the highest proportion of privately insured patients, while emergency departments were the most likely to treat Medicare patients, and hospital outpatient and emergency departments were most likely to treat uninsured patients. &lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The authors pointed out a number of limitations to their study, including that visits to retail clinics, urgent care centers, military facilities, and institutional or industrial clinics were beyond the scope of the study. Also, the method used tended to oversample patients who were frequent users of healthcare services.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;One of the study authors, Emily Carrier, a health researcher at the Center for Studying Health System Change and a practicing emergency physician in Washington, reported receiving a training grant from the Centers for Disease Control and Prevention.&lt;/p&gt;&lt;p&gt;The authors listed no financial conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
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