Dr. Jitesh Chawla reviews smoking cessation trials

Dr. Jitesh Chawla's clinical trial research shows that the first anti-nicotine vaccine to enter Phase 3 clinical trial, NicVax, was in it’s the last stage of testing before hitting the market. The product works by inciting the immune system to produce antibodies that bind to nicotine in the bloodstream, much as antibodies would attack an invading microorganism. Once bound, the nicotine cannot cross the blood-brain barrier to enter the brain. It is the neurotransmitters in the brain that cause chemical reactions leading to addictive behavior. The vaccine was therefore expected to diminish the pleasure of smoking and make it easier to quit. Unfortunately, the failure of the vaccine serves as major set-back to harness the immune system’s power to fight additions such as tobacco abuse.

Figure 1.
Trial paper posting by Dr. Chawla

Nevertheless, Micro-electric  current therapy shows a lot of promise. In one trial studied by Dr. Jitesh Chawla, 1,000 cigarette smokers treated between July 2006 and January 2008, 972 (97.2%) lost their craving for cigarettes within 1 to 5 minutes into a 20 minute session of CES. In those who were in the process of quitting and often at the height of their withdrawal symptoms, cravings started to diminish within 2 minutes of initiating CES and usually disappeared within 10 minutes. Several were 2 or 3 weeks into quitting and still experienced craving.

There may be many reasons for the difference between success and failure including the solidity of the product, trial design, lack of capital, tough FDA reviewers but clinical trials. Even after successful trials and FDA approval some smoking cessation products, like the Nicotrol Inhaler, are not adopted well, as the side-effects and limited efficacy with mediocre outcomes serves as a stumbling block. It is time to try something new. Micro-electrical current therapy has a different mechanism of action than any other therapeutic agent for smoking cessation, currently in the market, and is worth a shot. Next time you are searching for a new doctor make sure he or she keeps up with latest research regarding medical treatments for important common problems such as nicotine addition.

Also, keep following this blog for more exciting clinical trial news from Dr. Jitesh Chawla.

Health Insurance Exchanges

The Affordable Healthcare Act may have not only changed the United State's  healthcare system forever, it also may have changed the insurance industry  forever.  The implementation of so called health insurance exchanges, or HIX for short, have helped change the industry forever.  The model is a consumer based  approach, where customers will be able to shop for the best insurance plan for  them.  President Obama focused on allowing states to set up the exchanges  instead of a blanket approach that would make one exchange for the whole  country.

Ideally, the concept will allow people with preexisting conditions to be denied  insurance.  Customers will have to satisfy a smaller amount of conditions in order  to receive insurance.  Lawmakers envisioned this change as a system in which citizens will be allowed to have the same type of variety that members of  Congress have in shopping for their health insurance.  At this point you may be saying, "Great, now how in the world will they  implement this and what does this mean for me?" Let's try to answer this  question! The exchanges can cover a whole state or be broken up in to smaller exchanges in one state.  For instance a state like California may have a Southern  California exchange and Northern California exchange.  As long as the exchange covers a certain geographic area they will be allowed to operate.

States can also partner with other bordering states to create an exchange. As for how the exchanges will be run and affect you, the consumer, lets look at the car insurance model. President Obama has repeatedly compared these  exchanges to car insurance purchasing.  People living in an area that has a HIX  will be able to compare plans online and buy which ever one fits them the best.

There will different levels of coverage, given a gold, silver, or bronze designation. Only companies meeting the standards set forth by ACA regulations will be able  to sell their insurance plans.  According to www.obamacarefacts.com, this alone  will lower insurance premiums 7-10 percent. 

Listed below are the criteria to be  an ACA-approved insurance plan.

All plans must include:

1. Ambulatory patient services

2. Emergency services

3. Hospitalization

4. Maternity and newborn care

5. Mental health and substance use disorder services, including behavioral health treatment

6. Prescription drugs

7. Rehabilitative and rehabilitative services and devices

8. Laboratory services

9. Preventive and wellness services and chronic disease management

10. Pediatric services, including oral and vision care

We have yet to see if these will in fact work in the United States.  In theory,  they sound like a great idea and that they will allow for variety in insurance  shopping.  The hope is that more people will be able to become insured in the  long run.

Dr Chawla reviews Insurance Billing: How to Get Paid For It

Getting a claim paid really starts at the front desk. Make sure you get good information. Get copies of insurance cards, driver’s license or ID. Have your staff verify the patient filled out your patient registration form completely. Verify healthcare insurance and coverage.

Entering Demographic Information
I strongly suggest that the front desk NOT enter the demographic information into the computer system.

Why? Distractions are always there. They are so busy answering phones, checking-in /checking-out patients, and helping patients and physicians, that causes mistakes to happen easily. Just have them enter enough demographic info to make an appointment. Accurate information from the onset makes the claim process go smoothly and quickly.

Additionally, have a good financial agreement for the patient to sign. Most agreements I have seen are only a couple of sentences and are quite inadequate. Include in your agreement collection fees, interest, attorney and court cost. This way if you have to go after the patient for payment they are responsible for the additional costs of collecting what they owe. You may also want to include that they agree to pay for after-hours telephone advice, no-show fees, form fees, prescription refills, and walk-in fees, returned check fees and a billing fee if a patient does not pay their copay at time of service. A good financial agreement gives you the tools you need to collect patient balances.

Charge Posting of Encounter Forms
Along with your front desk not entering demographics and insurance info, they should also not post charges for the same reason, distractions. Charge entry should be done in a quiet location. A claim with the smallest amount of inaccurate data will hold up your payment. Also your nurses or medical assistants provide logs of labwork, sonograms, EKGs or other procedures so that your poster can cross reference the logs to the fee tickets to insure nothing is missed. With EMRs and advance of Health IT, this tracking should become much easier.

Teach your staff good practices from day one. The front staff is essentially in receiving the clinical and financial information that needs to be passed onto billing staff. If a certain protocol is established with best practices is established it will save you a lot of hassle in the long run. The next series of articles will focus on how to train/advise your clinical staff so that your claims get accepted and billing to insurance becomes a bit easier.

Stage 2 Final Rules: Implications for Providers

Dr Jitesh Chawla feels that for the longest time, the fate of health IT was on trial.

Finally, on August 23rd, CMS released Meaningful Use Final Rules for Stage 2 of the EHR Incentive Program. For those of you that are knowledgeable about Meaningful Use and saw the proposed Stage 2 Rules there are major changes that were made based on feedback from the medical community.

Nevertheless, since the final version is now out, it is important for medical providers and hospitals to understand what is expected of them and how the criteria differ from Stage 1. This article is a quick overview of the additions and changes in Stage 2 Rules and will present some tips to how clinicians can be ready. We will not cover hospital requirements here.

 Stage 2 Requirements

Stage 2 represents “Advanced Care Processes” according to the Meaningful Use stages plan as explained by ONC. A central theme is “connectivity” where different EMRs or EHRs can exchange data with each other. Also, the first stage allowed providers to get a certified EHR and  learn how to use it to collect some meaningful data. Now the goal is to have them use more advanced functions of the EHR and collect some of the same data for a larger pool of patients.

Some of these measures are new and others represent higher thresholds from Stage 1 (latter marked by *). Examples of few of these measures are highlighted below.

·         At least 5% of patients must access have access to their online health information

·         Providers must engage in secure messaging with at least 5 % of their patients

To be sensitive to practices in rural areas CMS is granting exclusion to providers without access to broadband internet. Both measures will require internet connectivity to communicate to patients regardless of whether the EHR is web-based or not.

·         Summary of care record for more than 50% of transitions of care and referrals*

·         Transmit summary of care for more than 10% of transitions and referrals to provider even if

       they  have vendor or organizational affiliation*. However, the 2 providers that conduct the

        exchange must be using EHRs from different vendors

·         Eligible providers must select and  report on 9 out of 64 total clinical quality measures (CQMs)

·         Tobacco screening for patients 13 or older is required for 80% or more of patients

In addition, all providers must select Clinical Quality Measures (CQMs) from at least 3 of the 6 key health care policy domains from the Department of Health and Human Services’ National Quality Strategy:

 •Population and Public Health

 •Efficient Use of Healthcare Resources

 •Clinical Processes/Effectiveness

 •Patient and Family Engagement

 •Patient Safety

 •Care Coordination

  

Compared to Stage 1, EPs (eligible providers) must satisfy 20 measures 17 core and 3 / 6 for menu. Reporting will be allowed such so that batches of EPs in the same group can attest together in 1 file. For a full report of Stage 2 measures and requirements visit the CMS website.

Getting Ready

1.The patient portal is likely the medium by which patients will access online information and use email (secure messaging) to communicate with their providers. Make sure to check with your vendor if the patient portal is set-up to support all these features. PP is included as part of all certified EMRs.

Dr. Jitesh Chawla posts a trial version of a patient portal screen

 

(reference: cliniclogo)

2.Ensure policies, procedures and workflow allows collection of data in at least 3 of the 6 domains part of the National Quality Strategy. There should be a logical approach to choosing the 3. Health departments may include Population/Public Health, behavioral health practices include care coordination and practices recognized for Patient Centered Medical Home may include Clinical Processes and Effectiveness. In all 3 examples, the CQM topic represents an area that practice or clinic may focused on as part of their daily operations and so the data is being collected anyways.

3.Adopt the practice of motivational interviewing as patient engagement is bigger theme in this stage of meaningful use. Motivational Interviewing has been becoming a more widely tool in health care, as it has been used in other industries or years.

4.Keep track of the Health Information Exchanges (HIEs) in your area and make sure your HER connects with them. The good part is that Stage 1, required you to test the CCD/CCR function a which is medium by which patient information is summarized and can be submitted in exchange through a standardized format.

Concluding thoughts

The step-wise government push towards the adoption and use of EHRs is not to advocate the use of technology, help vendors with EHR sales or to create some hurdles to jump though just to get free money. But, providers and practices that streamline their work processes, capture the right patient data consistently, strive for increased quality and safety will find that EHRs are actually enablers for those goals and achieving Meaningful Use, though time consuming, is just a little more than a formality.

This certainly feels like a painful trial period for many providers, but Dr. Jitesh Chawla would encourage practices to stay persistent.