NPs offer a bright spot as primary care practices combat rising costs

ccording to a recent MGMA-ACMPE study (reported in the journal AAFP) over the last 11 years, the cost of running a medical practice in the United States has increased twice as quickly as the consumer price index. This surprising and dramatic gap underscores the significant financial challenges facing many primary care providers, including revenue streams that may fail to counter the rising costs of keeping a practice afloat.

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Allergy symptoms arrive in Charlotte early this year

"I have been sneezing a lot more lately when I am out running or exercising," said Regina Harrison.

As fall approaches, a lot of people suffer from allergies because of the change in weather, but people are noticing the symptoms: itchy and watery eyes, nasal congestion, coughing and sneezing much earlier this year.

Dr. Gray Norris said there has been a recent spike because of all of the rain we have had this summer.

"I think the weeds are a little bit early. I think they have gotten a little bit of a head start with all of the water we have had for them to grow," said Norris.

So far this year, Charlotte has seen more than 35 inches of rain. Normally by this time Charlotte has an average of 28 inches.

All of that wet weather has caused an early rise in ragweed and mold.

Norris said do not expect conditions to change any time soon.

"We are going to have fairly high levels until we get some really cold weather. Once we get a really good freeze that will knock the levels down," said Norris.

Charlotte has already seen a burst of cooler temperatures, but meteorologists don't expect the cold weather to arrive until late October.


By Vicki Graf
September 2, 2013

Fall allergy season arrives, approaching early September peak

Ragweed season is upon us, pollen counts show, and is expected to peak over the next couple of weeks.

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Heavy Traffic Pollution, Wood Fire Smoke May Worsen Asthma Symptoms

A word of caution to asthma-sufferers: Living by busy streets could make your symptoms worse, according to a new study.

Researchers from the University of Melbourne found that heavy traffic pollution seemed to increase asthma symptoms by 80 percent and smoke from wood fires seemed to increase symptoms by 11 percent among people with the condition.

"These findings may have particular importance in developing countries where wood smoke exposure is likely to be high in rural communities due to the use of wood for heating and cooking, and the intensity of air pollution from vehicular traffic in larger cities is significant," study researcher Dr. John Burgess, of the School of Population Health at the University of Melbourne, said in a statement.

Interestingly, researchers did not find an association between asthma onset and exposure to heavy traffic pollution or smoke from wood fires.

The study, published in the journal Respirology, included 1,383 adults, age 44, who were part of the Tasmanian Longitudinal Health Study. The study participants rated their exposure to wood fire smoke and traffic pollution. They were also asked to provide information on frequency of exposure to heavy traffic near their homes, as well as their exposure to wood smoke in the environment during the wintertime. Researchers tracked the participants' asthma symptoms and flare-ups over a year-long period.

Everyday Health previously reported that for traffic pollution in particular, particulate matter and atmospheric ozone are likely the biggest asthma culprits.

"Both pollutants can strain airways in asthma by increasing inflammation and susceptibilities to allergies and infections," Sumita B. Khatri, M.D., who is the co-director of the Cleveland Clinic Respiratory's Institute's Asthma Center, told Everyday Health.


August 21, 2012

Obese Kids More Likely to Have Asthma, With Worse Symptoms

WEDNESDAY, Aug. 7 (HealthDay News) -- Overweight and obese kids are more likely to struggle with asthma than kids of normal weight, according to a new review of more than 623,000 children.

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New Report Shows Most States Fall Behind on Asthma and Allergy School Policies

With millions of children heading back to classrooms in the coming weeks, asthma and food allergies at school present serious concerns, but some states are better than others when it comes to supporting students with these chronic diseases.  A new report by the Asthma and Allergy Foundation of America (AAFA) shows that most states still don't have core policies in place to protect kids and adults in schools nationwide. In fact only 7 states and the District of Columbia currently meet the Foundation's criteria to be listed on the "State Honor Roll™ of Asthma and Allergy Policies for Schools." The report, at, is an annual look at how states compare on 18 core policy issues that affect kids and adults with asthma and allergies while they spend the day learning or working in America's schools.

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How to best prepare and adapt for shared risk and value-based payment: Tips for practice managers

UAS president and CEO, Nick Hollis, was quoted in the most recent Medical Group Management Association (MGMA) members magazine. The article was an industry roundtable on valuable tips for practice managers. Please see the page in the magazine below where Nick is quoted.

MGMA Connexion pg 57

When Allergies Attack! Asthma and Allergies in America (Infographic)

Seeing how combating unhealthy air quality and allergies are the main factors Oransi builds our high quality HEPA air purifiers, we have compiled the most recent statistics on allergies and asthma in the U.S. to show you how important fresh, clean air is to millions of Americans. Some of the facts in this infographic may surprise you. For instance, most Americans believe the air in their home is clean. In reality, indoor air can be up to 100 times more polluted than outdoor air, which is why having air purifiers for allergies can be a huge benefit to your health. Click the infographic to learn more about common triggers, risk factors, and the costs of asthma, allergies and poor indoor air quality in the United States.

Feature Our Asthma & Allergy Infographic on Your Site
You are free to display this infographic on your own website or blog. All you have to do is copy and paste our embed code below to attribute the graphic back to Oransi with a link. It’s really that simple!

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Case Report: Allergic Rhinitis (AR)

Learning Objectives:

1. ) Better understand the seasonal and perennial allergies that Louisianans face, particularly in the summer.
2. ) Learn more about allergy treatment options in the family practice setting.
3. ) Understand the need for primary care providers to provide allergy care.Draft Article:

Allergic Rhinitis (AR) is the fifth leading cause of chronic disease among all Americans1 and a major concern for Louisianans year round. As many as 30 percent of all adults and 40 percent of children suffer from AR nationwide.2 In Louisiana in particular, the humid weather often causes patients to experience more severe symptoms than in other parts of the country. While in other areas summertime is often associated with reduced pollen counts and allergy symptoms, Louisiana’s hot humid, summers foster spikes in mold, grasses and other airborne allergens.

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Providers Prep for New Models of Care

Like it or not, a new healthcare landscape is taking shape that runs counter to just about every convention the industry has ever known.

Instead of furnishing services and automatically getting paid, providers must demonstrate their value through outcomes. Rather than being hospital-centric, healthcare must be shared by a network of post-acute care providers. It is a different mindset that the industry is trying to come to grips with, experts say.

"It is about providers understanding their market, their strengths and their capabilities," says Gary Anthony, head of technology business development and sales operations for Hartford, Conn.-based Aetna Accountable Care. "The market seems to be embracing it, but the pace with which they accept that change is different for different reasons."

Whether the new business model is called an accountable care organization, value-based purchasing or medical home, the goal is the same: to provide cost-effective health services that meet a high standard of quality. And while that may cause some executives to freeze in anticipation of a complex, convoluted transformation, the process is actually simpler than it appears, says Brenda Radke, CEO of the Brevard Physicians Care Network, a group of 270 independent physicians on Florida's Space Coast.

"It is really pretty basic stuff," said Radke, who also serves as executive director at Medical Practitioners of Care ACO, an organization with 150 physicians. "I wish I could say it was a stroke of genius, but it really isn't."

In the months following the organization's launch of an electronic medical record last October, Radke says the physicians are realizing that "they belong to each other" and that "all the focus is on why the patient is there."

Critical to the success of this ACO model is communication, Radke says, because that connection through the EMR enables all physicians to share the same patient data so that they know symptoms, test results and diagnosis before the face-to-face encounter.

"There was a disconnect about the appointments between primary care and specialists - maybe a piece of paper from the primary care that said the patient has an abnormal EKG," she said. "The specialists would then perform the same lab work and diagnostics that the patient already had. There was also a lot of faxing going on back and forth, which was very inefficient."

'Volume to value'

Katherine Schneider, MD, executive vice president and chief medical officer for Wayne, Pa.-based Medecision, characterizes the new healthcare landscape as "the journey from volume to value." In other words, it is shifting from basing revenues on the number of patients treated to becoming invested in how patients are cared for.

The transformation has been slow and gradual for the industry so far, but Schneider says that is a natural part of the evolution.

"The lights don't come on all at once," she said. "It's building blocks. But once you gain momentum, it is hard to put the brakes on. The business model and care model should progress at the same pace, not letting them get ahead of each other. At some point, however, it will have to accelerate so that the revenue part takes over."

As a consultant to providers on ACO formation, Schneider says she wants to instill trust and confidence in her clients by getting them to envision their own futures.

"All our conversations are around 'how are you doing things now, how will you be doing them next year, what will things look like in 2016 and how we can be their partner," she said.

Maximizing health

Physician Jeff Bullard's healthcare philosophy is summed up in the name of his Colleyville, Texas, practice - MaxHealth Family Medicine. As a primary care practitioner, Bullard serves as the anchor for a litany of services provided in his 10,000 square-foot complex, including allergy treatment, mental health and wellness services, physical medicine and rehabilitation, sports medicine, weight loss and cosmetic medicine.

Realizing that the healthcare model was ripe for change, Bullard and his associates set up a "medical home" model five years ago that laid out a roadmap of service extensions.

"When we examined the medical home idea for us, it amounted to a documentation of processes that are already in place," he said. "As a primary care physician, it is quite intimidating to be involved in an ACO where you give up responsibility depending on what measures you are trying to achieve. Our hope is that we can demonstrate cost effectiveness by focusing on prevention. We are in contact with employers on the importance of workplace wellness and our role in addressing it."

Finding a balance

Providers need to study the impact on their service levels as they move away from fee-for-service to a value-based system, added Frank Flosman, vice president and West regional leader for Aetna Consulting.

"They need to look at improving utilization patterns and finding a balance," he said. "As an organization you may see your top line revenue decrease, so what investments can you make in infrastructure for care management capabilities? Some organizations can manage within four walls, but that isn't the real challenge - it is to coordinate and deliver care across the continuum."

Providers must also take greater interest in the population outside the realm of service delivery, Flosman said, such as population health.

"This gives them information about the appropriate level of services," he said. "They need to utilize the data and use it for provision of services. It is a critical shift."


By John Andrews
June 1, 2013