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Making House Calls: The Doctor Is In

Doctor's Bag

In a recent article featured in The Washington post, reporters examined a “small but growing tribe of doctors, nurses, physician assistants and nurse practitioners … reviving the once-common practice” of performing house calls.

According to a recent article in the journal Clinics in Geriatric Medicine, advancements in technology, lack of financial incentives and lack of coverage by private insurers caused house calls to decline over the years. However, house calls have “been making somewhat of a comeback” after Medicare in 1998 modified its billing procedures to allow payment for home visits to the elderly and chronically ill and increased payments by 50%, the Post reports. The number of physicians performing house calls increased from 1.5 million in 2000 to nearly 2.2 million in 2007, but according to Constance Row, executive director of the American Academy of Home Care Physicians, house calls still account for fewer than 1% of all outpatient visits.

Advocates contend that house calls could help reduce costs and improve quality of care, particularly for home-bound seniors who comprise 5% of the Medicare population but account for more than 43% of the program’s budget. An analysis by George Taler, a physician at Washington, D.C.-based Washington Hospital Center, who performs house calls, found that house calls resulted in a 60% savings to the health care system in general, but that the reduction in emergency department visits and hospital admissions led to less money for the hospital and its programs, as also reported in the Post.

Let us know: Do you make house calls?

Electrode Placements Affect Heart Monitoring

Monitoring of heart failure patients is more effective if electrodes are placed on the left side rather than the more commonly used right side, according to a study published in the March 24 issue of the Journal of the American College of Cardiology.

Dirar S. Khoury, Ph.D., from Methodist Hospital Research Institute in Houston and colleagues implanted cardiac resynchronization therapy systems using standard leads in various configurations in 15 normal dogs, where five were implanted with an additional left atrial pressure lead sensor. They then measured steady-state impedance signals along six different vectors during induction of congestive heart failure over several weeks.The researchers found that during induction of heart failure, impedance fell gradually at different rates for different vectors.

“Impedance vectors employing a left ventricle lead are highly responsive to physiologic changes during congestive heart failure,” Khoury and colleagues conclude. “Measuring multiple impedance signals could be useful for optimizing ambulatory monitoring in heart failure patients.”

Are you using proper Heart Monitoring techniques in your hospital or practice?

News: Some US Doctors are Practicing Preventative Healthcare

Healthy Heart

According to a recent story in the Voice of America News, the rising cost of healthcare has prompted a move towards preventative medicine by most physicians and health care professionals in the United States.

As reported in the story, Brookings Instituion reported that healthcare in the US will account for 20 percent of the nation’s Gross Domestic Product within a decade. The National Coalition on Health Care, a group pushing to lower costs for patients, also states that American medical expenses rose nearly seven percent in 2008. With numbers like these, it may come as no surprise that various workplaces are trimming and cutting healthcare coverage for employees. The result: to trim costs and encourage fewer health problems corporations and practitioners are working together to establish healthier lifestyles through preventative medicine approaches.

At the College Park Family Practice, employees of a major U.S. hotel corporation can receive a range of medical services for free, including help to quit smoking.

For Harris Rosen, President of Rosen Hotels and Resorts, preventing his staff from becoming sick improves productivity and reduces the future cost of employee medical benefits. Rosen said, “We’ve probably saved well over $ 100 million. On an annual basis, I expect we save between 10 and 15 million dollars.”

Several other companies, including Walt Disney World, Darden Restaurants, and Lockheed Martin, have opened clinics for their employees. But although corporations and doctors stress the need for preventive care, the number of U.S. physicians practicing in the field has dropped, according to the American College of Preventive Medicine.

If your company is interested in setting up clinic services for employees in order to reduce the costs of expensive medical treatment, remember that has the tools and supplies you need to get started.

Failing Brakes: How the Brain Does (or Does Not) Respond to Stress

At this point in the 21st century, medical science has taught us much about the human brain. However, doctors and scientists everywhere continue to unearth new knowledge with each passing day. Unsurprisingly, according to, a recent study has identified a new mechanism that may hinder the brain’s natural ability to respond to stress.

Normally, neurons in the hypothalamus, the stress center of the brain, receive signals that tell them to switch on or off, and they can only switch off if adequate levels of the protein KCC2 are maintained. However, according to new research, stress reduces the activity of KCC2, thereby removing the “brakes.” This inability of the brain to slow down might explain some of the negative consequences of stress.

According to Dr. Jaideep Bains, the university of Calgary scientist who presented this research, more work is still needed in this area before any new progress is made in the medical treatment of stress. However, these initial findings have made the medical community aware of emerging avenues for doing so. As with any study, we can only hope as our understanding is deepened, action will follow.

New Campaign for Surgical Checklists


According to a recent report on, the Institute for Healthcare Improvement is trying to get all U.S. Hospitals to test the World Health Organization’s surgical checklist. While IHI doesn’t believe that a government mandate is required, it hopes that peer pressure from hospitals and national organizations that endorse the checklist will lead to universal adoption. The 19-point checklist includes items that surgical teams should check before anesthesia, before skin incision, and before the patient leaves the operating room. From Pulse Oximeters to introductions to the patient, this comprehensive checklist could change the face of healthcare in our nation.

According to an international study of hospitals in eight cities in advanced and developing countries, use of the checklist reduced surgical mortality rates by nearly half, and inpatient complications, by 38 percent. While the checklist probably wouldn’t reduce the death rate as much in the U.S. as in the less developed nations (Indian, Jordan, Philippines, Tanzania) where the protocol was tested, the study found that “all sites had a reduction in the rate of major postoperative complications.”

IHI has posted the checklist and supporting materials on its website. It’s also promoting the “sprint” to test the checklist by April 1 in its e-newsletter, which goes to most hospitals. More than 4,000 facilities participated in IHI’s 5 Million Lives safety campaign, and IHI is using the same network of 70 field offices that organized that campaign to get this one off the ground. Most of these offices use the resources of local organizations, such as state hospital associations and Medicare-contracted quality improvement organizations. According to IHI project director Fran Griffin, groups in 13 states have pledged to get every hospital in their state to try the checklist.

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