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Pediatric telehealth programs are growing, diversifying
MINNEAPOLIS – More pediatric subspecialists are using telehealth as a tool to treat patients, a new study shows.
From 2011 to 2015, the number of inpatient specialties using pediatric telehealth grew by 24% (from 25 to 31 programs), while the diversity of specialties conducting outpatient pediatric programs increased by 61% (from 23 to 37 programs), according to research presented at the American Telemedicine Association annual conference.
Dr. James T. McElligott, vice chair of the ATA Pediatric Special Interest Group and his colleagues, surveyed fellow members of the ATA’s Pediatric Special Interest Group and members of the American Academy of Pediatrics’ Section on Telehealth Care during April-June 2015. Respondents were asked whether their institution offered pediatric telemedicine services for each of the Accreditation Council for Graduate Medical Education specialties for inpatients and outpatients. International pediatric telemedicine services also were evaluated. The results were compared with a similar study conducted in 2011.
In addition to increased inpatient and outpatient specialist use, investigators found international pediatric telemedicine services being offered grew from 5 programs in 2011 to 24 programs in 2015. Some of the new inpatient pediatric telemedicine programs identified in the 2015 survey included hospice and palliative medicine, plastic surgery (including craniofacial surgery), and thoracic surgery (including congenital cardiac surgery). The only new outpatient program identified was that of pain management.
Unique pediatric programs noted in international telemedicine offerings included burn surgery, general pediatrics, infectious disease, nephrology, neonatal-perinatal medicine, nuclear medicine, ophthalmology, pathology, rheumatology, and congenital cardiac surgery.
The research shows there are few stones left unturned when it comes to pediatric specialists using telemedicine, said Dr. McElligott, who is also medical director for telehealth at the Medical University of South Carolina Children’s Hospital, Charleston. He oversees the Center for Telehealth at the university.
“The amount of folks doing telehealth in pediatrics has greatly increased ,and the type of telehealth they’re doing has really diversified in just a few years,” he said in an interview. “It’s just more evidence of this exponential growth in the use of telehealth.”
More physician and patient acceptance of telehealth have contributed to the rise, Dr. McElligott said. Pediatricians are realizing the positive effect telehealth can have on efficiency and the continuum of care.
“Even though you want to do it for the patient, and even though you want to do it for the greater good, if you focus on how the consultant’s life is improved in some way, than your initiative can scale,” he said in an interview. “I think what you see is people’s lives getting better and choosing to use telehealth not just because they have a big heart, but because it’s starting to make sense in changing the efficiency of the care system.”
Dr. McElligott encourages more information-sharing among pediatric telehealth programs as pertains to best practices and successful outcomes. In the past, telehealth discussions have primarily focused on how to build a telehealth program and the administrative hurdles at play. But with the many diverse programs underway, the focus should move to how the clinical services are being delivered and the ways in which they are effective.
“We’ve always been talking about it, but we haven’t had enough programs to start looking at it and evaluating it,” he said. “Our survey really just says, ‘It’s time to start doing that.’ It’s really exciting to get to the point where we’re not just talking about telehealth for kids, but getting down to the specifics.”
The study authors reported no disclosures.
On Twitter @legal_med
MINNEAPOLIS – More pediatric subspecialists are using telehealth as a tool to treat patients, a new study shows.
From 2011 to 2015, the number of inpatient specialties using pediatric telehealth grew by 24% (from 25 to 31 programs), while the diversity of specialties conducting outpatient pediatric programs increased by 61% (from 23 to 37 programs), according to research presented at the American Telemedicine Association annual conference.
Dr. James T. McElligott, vice chair of the ATA Pediatric Special Interest Group and his colleagues, surveyed fellow members of the ATA’s Pediatric Special Interest Group and members of the American Academy of Pediatrics’ Section on Telehealth Care during April-June 2015. Respondents were asked whether their institution offered pediatric telemedicine services for each of the Accreditation Council for Graduate Medical Education specialties for inpatients and outpatients. International pediatric telemedicine services also were evaluated. The results were compared with a similar study conducted in 2011.
In addition to increased inpatient and outpatient specialist use, investigators found international pediatric telemedicine services being offered grew from 5 programs in 2011 to 24 programs in 2015. Some of the new inpatient pediatric telemedicine programs identified in the 2015 survey included hospice and palliative medicine, plastic surgery (including craniofacial surgery), and thoracic surgery (including congenital cardiac surgery). The only new outpatient program identified was that of pain management.
Unique pediatric programs noted in international telemedicine offerings included burn surgery, general pediatrics, infectious disease, nephrology, neonatal-perinatal medicine, nuclear medicine, ophthalmology, pathology, rheumatology, and congenital cardiac surgery.
The research shows there are few stones left unturned when it comes to pediatric specialists using telemedicine, said Dr. McElligott, who is also medical director for telehealth at the Medical University of South Carolina Children’s Hospital, Charleston. He oversees the Center for Telehealth at the university.
“The amount of folks doing telehealth in pediatrics has greatly increased ,and the type of telehealth they’re doing has really diversified in just a few years,” he said in an interview. “It’s just more evidence of this exponential growth in the use of telehealth.”
More physician and patient acceptance of telehealth have contributed to the rise, Dr. McElligott said. Pediatricians are realizing the positive effect telehealth can have on efficiency and the continuum of care.
“Even though you want to do it for the patient, and even though you want to do it for the greater good, if you focus on how the consultant’s life is improved in some way, than your initiative can scale,” he said in an interview. “I think what you see is people’s lives getting better and choosing to use telehealth not just because they have a big heart, but because it’s starting to make sense in changing the efficiency of the care system.”
Dr. McElligott encourages more information-sharing among pediatric telehealth programs as pertains to best practices and successful outcomes. In the past, telehealth discussions have primarily focused on how to build a telehealth program and the administrative hurdles at play. But with the many diverse programs underway, the focus should move to how the clinical services are being delivered and the ways in which they are effective.
“We’ve always been talking about it, but we haven’t had enough programs to start looking at it and evaluating it,” he said. “Our survey really just says, ‘It’s time to start doing that.’ It’s really exciting to get to the point where we’re not just talking about telehealth for kids, but getting down to the specifics.”
The study authors reported no disclosures.
On Twitter @legal_med
MINNEAPOLIS – More pediatric subspecialists are using telehealth as a tool to treat patients, a new study shows.
From 2011 to 2015, the number of inpatient specialties using pediatric telehealth grew by 24% (from 25 to 31 programs), while the diversity of specialties conducting outpatient pediatric programs increased by 61% (from 23 to 37 programs), according to research presented at the American Telemedicine Association annual conference.
Dr. James T. McElligott, vice chair of the ATA Pediatric Special Interest Group and his colleagues, surveyed fellow members of the ATA’s Pediatric Special Interest Group and members of the American Academy of Pediatrics’ Section on Telehealth Care during April-June 2015. Respondents were asked whether their institution offered pediatric telemedicine services for each of the Accreditation Council for Graduate Medical Education specialties for inpatients and outpatients. International pediatric telemedicine services also were evaluated. The results were compared with a similar study conducted in 2011.
In addition to increased inpatient and outpatient specialist use, investigators found international pediatric telemedicine services being offered grew from 5 programs in 2011 to 24 programs in 2015. Some of the new inpatient pediatric telemedicine programs identified in the 2015 survey included hospice and palliative medicine, plastic surgery (including craniofacial surgery), and thoracic surgery (including congenital cardiac surgery). The only new outpatient program identified was that of pain management.
Unique pediatric programs noted in international telemedicine offerings included burn surgery, general pediatrics, infectious disease, nephrology, neonatal-perinatal medicine, nuclear medicine, ophthalmology, pathology, rheumatology, and congenital cardiac surgery.
The research shows there are few stones left unturned when it comes to pediatric specialists using telemedicine, said Dr. McElligott, who is also medical director for telehealth at the Medical University of South Carolina Children’s Hospital, Charleston. He oversees the Center for Telehealth at the university.
“The amount of folks doing telehealth in pediatrics has greatly increased ,and the type of telehealth they’re doing has really diversified in just a few years,” he said in an interview. “It’s just more evidence of this exponential growth in the use of telehealth.”
More physician and patient acceptance of telehealth have contributed to the rise, Dr. McElligott said. Pediatricians are realizing the positive effect telehealth can have on efficiency and the continuum of care.
“Even though you want to do it for the patient, and even though you want to do it for the greater good, if you focus on how the consultant’s life is improved in some way, than your initiative can scale,” he said in an interview. “I think what you see is people’s lives getting better and choosing to use telehealth not just because they have a big heart, but because it’s starting to make sense in changing the efficiency of the care system.”
Dr. McElligott encourages more information-sharing among pediatric telehealth programs as pertains to best practices and successful outcomes. In the past, telehealth discussions have primarily focused on how to build a telehealth program and the administrative hurdles at play. But with the many diverse programs underway, the focus should move to how the clinical services are being delivered and the ways in which they are effective.
“We’ve always been talking about it, but we haven’t had enough programs to start looking at it and evaluating it,” he said. “Our survey really just says, ‘It’s time to start doing that.’ It’s really exciting to get to the point where we’re not just talking about telehealth for kids, but getting down to the specifics.”
The study authors reported no disclosures.
On Twitter @legal_med
AT ATA 2016
Key clinical point: More pediatric subspecialists are using telehealth to treat patients, a new study shows.
Major finding: From 2011 to 2015, the number of inpatient specialties using pediatric telehealth grew by 24%, while the diversity of specialties employing outpatient pediatric programs increased by 61%.
Data source: New research presented at the American Telemedicine Association meeting.
Disclosures: The study authors reported no disclosures.
Prepare early for peer review hearings to avoid negative outcomes
CHICAGO – Being targeted for a peer review can be unnerving for physicians, but proper preparation can help doctors smoothly navigate the process and increase their chances for a favorable outcome.
The first step is taking the situation seriously and remaining calm, said Janet L. Pulliam, a Little Rock, Ark.–based attorney who specializes in health law and employment and labor. Next, hire an experienced attorney and refrain from signing anything without consulting counsel, Ms. Pulliam said at a conference held by the American Bar Association. She also suggested that physicians request an individual meeting with each reviewer before the hearing.
“That’s not to be a lobbying meeting; that’s to be a meeting where you simply, one on one, ask someone who is going to be in judgment of you [to] please keep an open mind until they have heard all of the evidence,” Ms. Pulliam said at the meeting. “Trust me, they’ve already had plenty of information provided to them from the [hospital] administration, so that’s not asking any favors.”
If the peer review stems from a patient interaction or treatment decision, review the patient record in question, but don’t change any documentation, she noted. You can always argue during the hearing that the patient record does not adequately illustrate the encounter or that the charting was inaccurate.
Speak up during peer review meetings and ensure that your case is heard, added Elizabeth A. Snelson, a St. Paul, Minn.–based health law attorney who represents medical staffs, medical societies, and other health professionals.
“Not that it’s easy to put a lawyer in a room and tell her to not talk, but the fact of the matter is that the case will be more successful if it’s the doctor who is addressing the panel, which is usually comprised completely of doctors,” Ms. Snelson said.
Educate the committee, Ms. Pulliam advised. Use the opportunity to explain the protocols specific to your specialty and how they may differ from other specialties.
“It’s your time to educate them,” she said. “The physicians on the committee generally, genuinely want to know what they don’t know, and this is the only shot that you’re going to have to tell them.”
Attend every meeting and be on time. This may sound obvious, but Ms. Pulliam has seen the negative effects a tardy appearance can have on a committee’s perceptions. Making the peer review process a priority and scheduling accordingly is paramount. In addition, ask the hospital for a court reporter to transcribe the hearing. If the hospital refuses, offer to pay for half of the cost, Ms. Pulliam suggested. Accurate documentation is critical and can later be challenged if no record exists. If the hospital declines to share the cost, Ms. Pulliam recommended that doctors foot the entire bill. Make every effort to have a complete transcript, she said.
Be an advocate for a solution when possible, Ms. Pulliam added. Discuss with your attorney potential resolutions, but also know your litigation options. Be prepared to go to court if necessary.
“This is when you need to litigate because procedures and fairness have not been followed in the process,” she said during her presentation. “Courts do allow for equity, declaratory judgments, and injunctions when rights guaranteed to a physician are not followed.”
Knowing those rights and regulations beforehand is key, Ms. Snelson said. States’ peer review laws widely differ. Arkansas law for example, enables physicians to request a hearing officer who is independent and not employed by the hospital and also protects communications by physicians during peer review proceedings. Other states have different features, and some states have nothing regarding peer review on the books, Ms. Snelson said.
“In some states it’s real clear where the peer review requirements are,” she said. “In other states, you really have to go hunting. It could be in the evidence code. It could be all over the place.”
Be aware of appeal rights. Usually, medical staff bylaws allow for an appeal to the governing body of the hospital if a doctor disagrees with a panel’s recommendation. However, sometimes bylaws are silent on appeals, Ms. Snelson said. She noted that the Joint Commission standards refer to peer review hearings and appeals. Thus, if a hospital is accredited by the Joint Commission, and its bylaws do not address appeals, physicians and their attorneys can argue that an appeals process should be in place.
Remember that peer review is not limited to “bad doctors,” and that the process can arise from minor issues, Ms. Snelson said at the meeting.
“Usually when doctors hear ‘peer review,’ they hear ‘discipline,’ ” she said. “[However], It’s not always the ‘bad doctors’; it can be something that is quite minimal that can be escalated. It can be entirely appropriate. What peer review should be is educational ... but sometimes it can be used as a weapon.”
On Twitter @legal_med
CHICAGO – Being targeted for a peer review can be unnerving for physicians, but proper preparation can help doctors smoothly navigate the process and increase their chances for a favorable outcome.
The first step is taking the situation seriously and remaining calm, said Janet L. Pulliam, a Little Rock, Ark.–based attorney who specializes in health law and employment and labor. Next, hire an experienced attorney and refrain from signing anything without consulting counsel, Ms. Pulliam said at a conference held by the American Bar Association. She also suggested that physicians request an individual meeting with each reviewer before the hearing.
“That’s not to be a lobbying meeting; that’s to be a meeting where you simply, one on one, ask someone who is going to be in judgment of you [to] please keep an open mind until they have heard all of the evidence,” Ms. Pulliam said at the meeting. “Trust me, they’ve already had plenty of information provided to them from the [hospital] administration, so that’s not asking any favors.”
If the peer review stems from a patient interaction or treatment decision, review the patient record in question, but don’t change any documentation, she noted. You can always argue during the hearing that the patient record does not adequately illustrate the encounter or that the charting was inaccurate.
Speak up during peer review meetings and ensure that your case is heard, added Elizabeth A. Snelson, a St. Paul, Minn.–based health law attorney who represents medical staffs, medical societies, and other health professionals.
“Not that it’s easy to put a lawyer in a room and tell her to not talk, but the fact of the matter is that the case will be more successful if it’s the doctor who is addressing the panel, which is usually comprised completely of doctors,” Ms. Snelson said.
Educate the committee, Ms. Pulliam advised. Use the opportunity to explain the protocols specific to your specialty and how they may differ from other specialties.
“It’s your time to educate them,” she said. “The physicians on the committee generally, genuinely want to know what they don’t know, and this is the only shot that you’re going to have to tell them.”
Attend every meeting and be on time. This may sound obvious, but Ms. Pulliam has seen the negative effects a tardy appearance can have on a committee’s perceptions. Making the peer review process a priority and scheduling accordingly is paramount. In addition, ask the hospital for a court reporter to transcribe the hearing. If the hospital refuses, offer to pay for half of the cost, Ms. Pulliam suggested. Accurate documentation is critical and can later be challenged if no record exists. If the hospital declines to share the cost, Ms. Pulliam recommended that doctors foot the entire bill. Make every effort to have a complete transcript, she said.
Be an advocate for a solution when possible, Ms. Pulliam added. Discuss with your attorney potential resolutions, but also know your litigation options. Be prepared to go to court if necessary.
“This is when you need to litigate because procedures and fairness have not been followed in the process,” she said during her presentation. “Courts do allow for equity, declaratory judgments, and injunctions when rights guaranteed to a physician are not followed.”
Knowing those rights and regulations beforehand is key, Ms. Snelson said. States’ peer review laws widely differ. Arkansas law for example, enables physicians to request a hearing officer who is independent and not employed by the hospital and also protects communications by physicians during peer review proceedings. Other states have different features, and some states have nothing regarding peer review on the books, Ms. Snelson said.
“In some states it’s real clear where the peer review requirements are,” she said. “In other states, you really have to go hunting. It could be in the evidence code. It could be all over the place.”
Be aware of appeal rights. Usually, medical staff bylaws allow for an appeal to the governing body of the hospital if a doctor disagrees with a panel’s recommendation. However, sometimes bylaws are silent on appeals, Ms. Snelson said. She noted that the Joint Commission standards refer to peer review hearings and appeals. Thus, if a hospital is accredited by the Joint Commission, and its bylaws do not address appeals, physicians and their attorneys can argue that an appeals process should be in place.
Remember that peer review is not limited to “bad doctors,” and that the process can arise from minor issues, Ms. Snelson said at the meeting.
“Usually when doctors hear ‘peer review,’ they hear ‘discipline,’ ” she said. “[However], It’s not always the ‘bad doctors’; it can be something that is quite minimal that can be escalated. It can be entirely appropriate. What peer review should be is educational ... but sometimes it can be used as a weapon.”
On Twitter @legal_med
CHICAGO – Being targeted for a peer review can be unnerving for physicians, but proper preparation can help doctors smoothly navigate the process and increase their chances for a favorable outcome.
The first step is taking the situation seriously and remaining calm, said Janet L. Pulliam, a Little Rock, Ark.–based attorney who specializes in health law and employment and labor. Next, hire an experienced attorney and refrain from signing anything without consulting counsel, Ms. Pulliam said at a conference held by the American Bar Association. She also suggested that physicians request an individual meeting with each reviewer before the hearing.
“That’s not to be a lobbying meeting; that’s to be a meeting where you simply, one on one, ask someone who is going to be in judgment of you [to] please keep an open mind until they have heard all of the evidence,” Ms. Pulliam said at the meeting. “Trust me, they’ve already had plenty of information provided to them from the [hospital] administration, so that’s not asking any favors.”
If the peer review stems from a patient interaction or treatment decision, review the patient record in question, but don’t change any documentation, she noted. You can always argue during the hearing that the patient record does not adequately illustrate the encounter or that the charting was inaccurate.
Speak up during peer review meetings and ensure that your case is heard, added Elizabeth A. Snelson, a St. Paul, Minn.–based health law attorney who represents medical staffs, medical societies, and other health professionals.
“Not that it’s easy to put a lawyer in a room and tell her to not talk, but the fact of the matter is that the case will be more successful if it’s the doctor who is addressing the panel, which is usually comprised completely of doctors,” Ms. Snelson said.
Educate the committee, Ms. Pulliam advised. Use the opportunity to explain the protocols specific to your specialty and how they may differ from other specialties.
“It’s your time to educate them,” she said. “The physicians on the committee generally, genuinely want to know what they don’t know, and this is the only shot that you’re going to have to tell them.”
Attend every meeting and be on time. This may sound obvious, but Ms. Pulliam has seen the negative effects a tardy appearance can have on a committee’s perceptions. Making the peer review process a priority and scheduling accordingly is paramount. In addition, ask the hospital for a court reporter to transcribe the hearing. If the hospital refuses, offer to pay for half of the cost, Ms. Pulliam suggested. Accurate documentation is critical and can later be challenged if no record exists. If the hospital declines to share the cost, Ms. Pulliam recommended that doctors foot the entire bill. Make every effort to have a complete transcript, she said.
Be an advocate for a solution when possible, Ms. Pulliam added. Discuss with your attorney potential resolutions, but also know your litigation options. Be prepared to go to court if necessary.
“This is when you need to litigate because procedures and fairness have not been followed in the process,” she said during her presentation. “Courts do allow for equity, declaratory judgments, and injunctions when rights guaranteed to a physician are not followed.”
Knowing those rights and regulations beforehand is key, Ms. Snelson said. States’ peer review laws widely differ. Arkansas law for example, enables physicians to request a hearing officer who is independent and not employed by the hospital and also protects communications by physicians during peer review proceedings. Other states have different features, and some states have nothing regarding peer review on the books, Ms. Snelson said.
“In some states it’s real clear where the peer review requirements are,” she said. “In other states, you really have to go hunting. It could be in the evidence code. It could be all over the place.”
Be aware of appeal rights. Usually, medical staff bylaws allow for an appeal to the governing body of the hospital if a doctor disagrees with a panel’s recommendation. However, sometimes bylaws are silent on appeals, Ms. Snelson said. She noted that the Joint Commission standards refer to peer review hearings and appeals. Thus, if a hospital is accredited by the Joint Commission, and its bylaws do not address appeals, physicians and their attorneys can argue that an appeals process should be in place.
Remember that peer review is not limited to “bad doctors,” and that the process can arise from minor issues, Ms. Snelson said at the meeting.
“Usually when doctors hear ‘peer review,’ they hear ‘discipline,’ ” she said. “[However], It’s not always the ‘bad doctors’; it can be something that is quite minimal that can be escalated. It can be entirely appropriate. What peer review should be is educational ... but sometimes it can be used as a weapon.”
On Twitter @legal_med
AT THE PHYSICIANS LEGAL ISSUES CONFERENCE
Dermatology lacks diversity
Despite a growing volume of varied skin tones in the United States, the specialists charged with treating these contrasting pigments are lacking in color.
Dermatology is among the least ethnically and racially diverse specialties in medicine, a bleak fact that is becoming worse with time, said Dr. Andrew F. Alexis, chair of dermatology at Mount Sinai St. Luke’s and Mount Sinai West, New York.
“Simply put, the field of dermatology, with respect to the diversity of our workforce, is not keeping up with the diversity of the United States,” said Dr. Alexis, director of The Skin of Color Center of Mount Sinai St. Luke’s and Mount Sinai West.
Today, black dermatologists comprise 3% of all dermatologists, while 12.8% of Americans are black, according to a commentary coauthored by Dr. Alexis and published online in January in the Journal of the American Academy of Dermatology (J Am Acad Dermatol. 2016 Mar;74[3]:584-7). Just over 4% of dermatologists are of Hispanic origin, compared with 16.3% of the general population. By 2060, the number of Hispanics is expected to rise to 129 million, comprising 31% of the population, while 15% of Americans will be black and 8.2% will be Asian, according to Census Bureau estimates.
A diverse dermatology workforce is critical to treating the increasing racial and ethnic makeup of patients, said Dr. Susan C. Taylor, co-founding director of The Skin of Color Center and a Philadelphia-based dermatologist. Studies show that race-concordant visits are longer and have higher ratings of patient satisfaction, according to the JAAD article. Data show that minority physicians are more likely to care for patients of their own race or ethnic group, practice in underserved areas, care for poor patients and those with Medicaid, and treat patients who report poor health status.
“It’s so important to make sure we have a diverse workforce,” Dr. Taylor said in an interview at the annual Skin of Color seminar, recently held in New York City. “Individuals with skin of color, when they’re trained in dermatology, they go back to their communities and really make a difference.”
The dearth of diverse dermatologists and the rising minority population are fueling renewed efforts by dermatology leaders to increase the racial and ethnic variance of their specialty.
“First and foremost, we must make the achievement of racial/ethnic diversity a goal for dermatology,” Dr. Alexis and his coauthors wrote in JAAD. “This is a call to action. The time is now.”
Lack of exposure, mentors spur problem
A number of reasons contribute to the lack of diversity in dermatology, said Dr. Bruce U. Wintroub, vice dean of the University of California, San Francisco, School of Medicine. A narrow pipeline starting early in education is one source of the problem, he said. A large proportion of minority students fail to move from high school to college and from college to medical school, leaving a smaller pool of diverse students heading to medical school.
In addition, “medical students from underrepresented populations do not chose dermatology as frequently as they chose other specialties,” said Dr. Wintroub, who chairs UCSF’s dermatology department. “The question is: Can we attract more of these medical students into dermatology, and how can we be more effective at that?”
Lack of exposure to dermatology leads many students to choose a different route, Dr. Taylor added. Often, medical students are not aware of dermatology as a specialty until they are far advanced in their training, she said. Dr. Taylor herself switched to dermatology after a 3-year internal medicine residency. Had she been exposed to dermatology at an earlier point in her education, she may have pursued the specialty sooner, she noted.
“It’s very important to enlighten and educate medical students about the importance of dermatology as a specialty and see if we can recruit them and interest them in dermatology,” Dr. Taylor said in the interview.
An absence of mentors for minority students throughout their schooling also drives the disparity, said Dr. Amit Pandya, chair of the American Academy of Dermatology Diversity Task Force and a dermatologist at the University of Texas Southwestern Medical Center, Dallas, who is the lead author of the January JAAD article.
“It’s not lack of bright students,” Dr. Pandya said in an interview. “They don’t have the mentorship many times, or the role models or people to guide them to” these areas.
Building diversity in dermatology
To address the gap, the AAD Diversity Task Force created the Diversity Mentorship Program, which provides a stipend to promising medical students from underrepresented backgrounds to spend 1 month with a dermatologist. The program aims to spark interest in the specialty.
The task force is currently developing a program called the Diversity Champion Initiative, Dr. Pandya said. The initiative will gather information about successful diversity activities at medical schools nationwide and replicate such efforts at other institutions. The idea is to help schools learn from each other and build on programs already in practice.
At the University of Texas Southwestern, for example, Dr. Pandya meets with medical students during their first month of training and brings them to his home for a pizza party. The students hear from other dermatologists of color about why they chose dermatology and the importance of drawing more minorities into the specialty. Dr. Pandya holds a similar gathering for local premed college students.
“I offer these students a chance to come to our free clinic in East Dallas so they can observe how important we are to the minority population of Dallas,” he said. “Patients line up starting at 5 in the morning for our 8:30 clinic start because they’re desperate to get skin care. We are only one of two clinics that offer free dermatology services in the Dallas-Fort Worth metropolitan area.”
Dermatologists are making similar efforts to reach minority medical students at UCSF. The dermatology department is working with the school’s residency committee and hiring leaders to broaden selection criteria, said Dr. Eleni Linos, a UCSF dermatologist who leads diversity efforts at the school. The goal is to change criteria to allow for acceptance of more minority residents and physicians.
“Through mentorship programs, we’re ensuring medical students from all backgrounds are exposed to all aspects of dermatology early on,” Dr. Linos said in an interview. “What we want to do, as a next step, is teach all of our faculty about unconscious bias and implicit bias and the way it can affect our clinical practice as well as our hiring and our interaction with students and trainees.”
Mentorship is also a key aspect of the The Skin of Color Center of Mount Sinai St. Luke’s and Mount Sinai West. Cofounded in 1999 by Dr. Taylor, Dr. Vincent A. DeLeo, and Dr. Fran Cook-Bolden, the center specializes in the diagnosis and treatment of skin conditions common to patients of color. Along with conducting research, producing literature, and hosting seminars, the center also trains a number of residents and fellows, Dr. Alexis said.
“Over the past 17 years, the awareness of the nuances of treating common dermatological disorders in patients with skin of color has really advanced,” he said. “We see a growing interest throughout the dermatological community – nationally and internationally – in this area, largely due to early efforts of this center.”
A total of nine ethnic skin centers now exist in the United States. And in 2004, Dr. Taylor helped establish the Skin of Color Society, an international association that promotes awareness and excellence for skin of color dermatology.
More work needed among departments, practices
Dr. Linos encourages more dermatology program directors and residency committees to review their admission and hiring criteria. Criteria should be objective, predefined, and not biased against minority applicants, she said. “We know that relying on test scores alone can be a disadvantage for some minority applicants,” she noted. “Broader criteria that are predefined and explicitly defined are very helpful for ensuring equity and increasing diversity.”
Dermatology leaders want more dermatologists to act as mentors. Talk to high school and college-aged patients from underrepresented groups and encourage them to enter medicine, the JAAD article suggests. Volunteer at schools and encourage minority students to pursue careers in science and health. Contact minority medical school associations and engage the members, Dr. Pandya added.
“Talk to them about why [you] went into medicine and dermatology, he said. “Become their advisor, make [yourself] available for any questions they may have. This helps enormously in getting medical students interested in dermatology.”
On a positive note, dermatology as a specialty is clearly starting to understand the importance of diversity, according to Dr. Alexis. Making “a more concerted effort to feed the pipeline and encourage potential students early on in their career to consider dermatology as a specialty will undoubtedly lead to increased diversity in the future,” he said.
On Twitter @legal_med
Despite a growing volume of varied skin tones in the United States, the specialists charged with treating these contrasting pigments are lacking in color.
Dermatology is among the least ethnically and racially diverse specialties in medicine, a bleak fact that is becoming worse with time, said Dr. Andrew F. Alexis, chair of dermatology at Mount Sinai St. Luke’s and Mount Sinai West, New York.
“Simply put, the field of dermatology, with respect to the diversity of our workforce, is not keeping up with the diversity of the United States,” said Dr. Alexis, director of The Skin of Color Center of Mount Sinai St. Luke’s and Mount Sinai West.
Today, black dermatologists comprise 3% of all dermatologists, while 12.8% of Americans are black, according to a commentary coauthored by Dr. Alexis and published online in January in the Journal of the American Academy of Dermatology (J Am Acad Dermatol. 2016 Mar;74[3]:584-7). Just over 4% of dermatologists are of Hispanic origin, compared with 16.3% of the general population. By 2060, the number of Hispanics is expected to rise to 129 million, comprising 31% of the population, while 15% of Americans will be black and 8.2% will be Asian, according to Census Bureau estimates.
A diverse dermatology workforce is critical to treating the increasing racial and ethnic makeup of patients, said Dr. Susan C. Taylor, co-founding director of The Skin of Color Center and a Philadelphia-based dermatologist. Studies show that race-concordant visits are longer and have higher ratings of patient satisfaction, according to the JAAD article. Data show that minority physicians are more likely to care for patients of their own race or ethnic group, practice in underserved areas, care for poor patients and those with Medicaid, and treat patients who report poor health status.
“It’s so important to make sure we have a diverse workforce,” Dr. Taylor said in an interview at the annual Skin of Color seminar, recently held in New York City. “Individuals with skin of color, when they’re trained in dermatology, they go back to their communities and really make a difference.”
The dearth of diverse dermatologists and the rising minority population are fueling renewed efforts by dermatology leaders to increase the racial and ethnic variance of their specialty.
“First and foremost, we must make the achievement of racial/ethnic diversity a goal for dermatology,” Dr. Alexis and his coauthors wrote in JAAD. “This is a call to action. The time is now.”
Lack of exposure, mentors spur problem
A number of reasons contribute to the lack of diversity in dermatology, said Dr. Bruce U. Wintroub, vice dean of the University of California, San Francisco, School of Medicine. A narrow pipeline starting early in education is one source of the problem, he said. A large proportion of minority students fail to move from high school to college and from college to medical school, leaving a smaller pool of diverse students heading to medical school.
In addition, “medical students from underrepresented populations do not chose dermatology as frequently as they chose other specialties,” said Dr. Wintroub, who chairs UCSF’s dermatology department. “The question is: Can we attract more of these medical students into dermatology, and how can we be more effective at that?”
Lack of exposure to dermatology leads many students to choose a different route, Dr. Taylor added. Often, medical students are not aware of dermatology as a specialty until they are far advanced in their training, she said. Dr. Taylor herself switched to dermatology after a 3-year internal medicine residency. Had she been exposed to dermatology at an earlier point in her education, she may have pursued the specialty sooner, she noted.
“It’s very important to enlighten and educate medical students about the importance of dermatology as a specialty and see if we can recruit them and interest them in dermatology,” Dr. Taylor said in the interview.
An absence of mentors for minority students throughout their schooling also drives the disparity, said Dr. Amit Pandya, chair of the American Academy of Dermatology Diversity Task Force and a dermatologist at the University of Texas Southwestern Medical Center, Dallas, who is the lead author of the January JAAD article.
“It’s not lack of bright students,” Dr. Pandya said in an interview. “They don’t have the mentorship many times, or the role models or people to guide them to” these areas.
Building diversity in dermatology
To address the gap, the AAD Diversity Task Force created the Diversity Mentorship Program, which provides a stipend to promising medical students from underrepresented backgrounds to spend 1 month with a dermatologist. The program aims to spark interest in the specialty.
The task force is currently developing a program called the Diversity Champion Initiative, Dr. Pandya said. The initiative will gather information about successful diversity activities at medical schools nationwide and replicate such efforts at other institutions. The idea is to help schools learn from each other and build on programs already in practice.
At the University of Texas Southwestern, for example, Dr. Pandya meets with medical students during their first month of training and brings them to his home for a pizza party. The students hear from other dermatologists of color about why they chose dermatology and the importance of drawing more minorities into the specialty. Dr. Pandya holds a similar gathering for local premed college students.
“I offer these students a chance to come to our free clinic in East Dallas so they can observe how important we are to the minority population of Dallas,” he said. “Patients line up starting at 5 in the morning for our 8:30 clinic start because they’re desperate to get skin care. We are only one of two clinics that offer free dermatology services in the Dallas-Fort Worth metropolitan area.”
Dermatologists are making similar efforts to reach minority medical students at UCSF. The dermatology department is working with the school’s residency committee and hiring leaders to broaden selection criteria, said Dr. Eleni Linos, a UCSF dermatologist who leads diversity efforts at the school. The goal is to change criteria to allow for acceptance of more minority residents and physicians.
“Through mentorship programs, we’re ensuring medical students from all backgrounds are exposed to all aspects of dermatology early on,” Dr. Linos said in an interview. “What we want to do, as a next step, is teach all of our faculty about unconscious bias and implicit bias and the way it can affect our clinical practice as well as our hiring and our interaction with students and trainees.”
Mentorship is also a key aspect of the The Skin of Color Center of Mount Sinai St. Luke’s and Mount Sinai West. Cofounded in 1999 by Dr. Taylor, Dr. Vincent A. DeLeo, and Dr. Fran Cook-Bolden, the center specializes in the diagnosis and treatment of skin conditions common to patients of color. Along with conducting research, producing literature, and hosting seminars, the center also trains a number of residents and fellows, Dr. Alexis said.
“Over the past 17 years, the awareness of the nuances of treating common dermatological disorders in patients with skin of color has really advanced,” he said. “We see a growing interest throughout the dermatological community – nationally and internationally – in this area, largely due to early efforts of this center.”
A total of nine ethnic skin centers now exist in the United States. And in 2004, Dr. Taylor helped establish the Skin of Color Society, an international association that promotes awareness and excellence for skin of color dermatology.
More work needed among departments, practices
Dr. Linos encourages more dermatology program directors and residency committees to review their admission and hiring criteria. Criteria should be objective, predefined, and not biased against minority applicants, she said. “We know that relying on test scores alone can be a disadvantage for some minority applicants,” she noted. “Broader criteria that are predefined and explicitly defined are very helpful for ensuring equity and increasing diversity.”
Dermatology leaders want more dermatologists to act as mentors. Talk to high school and college-aged patients from underrepresented groups and encourage them to enter medicine, the JAAD article suggests. Volunteer at schools and encourage minority students to pursue careers in science and health. Contact minority medical school associations and engage the members, Dr. Pandya added.
“Talk to them about why [you] went into medicine and dermatology, he said. “Become their advisor, make [yourself] available for any questions they may have. This helps enormously in getting medical students interested in dermatology.”
On a positive note, dermatology as a specialty is clearly starting to understand the importance of diversity, according to Dr. Alexis. Making “a more concerted effort to feed the pipeline and encourage potential students early on in their career to consider dermatology as a specialty will undoubtedly lead to increased diversity in the future,” he said.
On Twitter @legal_med
Despite a growing volume of varied skin tones in the United States, the specialists charged with treating these contrasting pigments are lacking in color.
Dermatology is among the least ethnically and racially diverse specialties in medicine, a bleak fact that is becoming worse with time, said Dr. Andrew F. Alexis, chair of dermatology at Mount Sinai St. Luke’s and Mount Sinai West, New York.
“Simply put, the field of dermatology, with respect to the diversity of our workforce, is not keeping up with the diversity of the United States,” said Dr. Alexis, director of The Skin of Color Center of Mount Sinai St. Luke’s and Mount Sinai West.
Today, black dermatologists comprise 3% of all dermatologists, while 12.8% of Americans are black, according to a commentary coauthored by Dr. Alexis and published online in January in the Journal of the American Academy of Dermatology (J Am Acad Dermatol. 2016 Mar;74[3]:584-7). Just over 4% of dermatologists are of Hispanic origin, compared with 16.3% of the general population. By 2060, the number of Hispanics is expected to rise to 129 million, comprising 31% of the population, while 15% of Americans will be black and 8.2% will be Asian, according to Census Bureau estimates.
A diverse dermatology workforce is critical to treating the increasing racial and ethnic makeup of patients, said Dr. Susan C. Taylor, co-founding director of The Skin of Color Center and a Philadelphia-based dermatologist. Studies show that race-concordant visits are longer and have higher ratings of patient satisfaction, according to the JAAD article. Data show that minority physicians are more likely to care for patients of their own race or ethnic group, practice in underserved areas, care for poor patients and those with Medicaid, and treat patients who report poor health status.
“It’s so important to make sure we have a diverse workforce,” Dr. Taylor said in an interview at the annual Skin of Color seminar, recently held in New York City. “Individuals with skin of color, when they’re trained in dermatology, they go back to their communities and really make a difference.”
The dearth of diverse dermatologists and the rising minority population are fueling renewed efforts by dermatology leaders to increase the racial and ethnic variance of their specialty.
“First and foremost, we must make the achievement of racial/ethnic diversity a goal for dermatology,” Dr. Alexis and his coauthors wrote in JAAD. “This is a call to action. The time is now.”
Lack of exposure, mentors spur problem
A number of reasons contribute to the lack of diversity in dermatology, said Dr. Bruce U. Wintroub, vice dean of the University of California, San Francisco, School of Medicine. A narrow pipeline starting early in education is one source of the problem, he said. A large proportion of minority students fail to move from high school to college and from college to medical school, leaving a smaller pool of diverse students heading to medical school.
In addition, “medical students from underrepresented populations do not chose dermatology as frequently as they chose other specialties,” said Dr. Wintroub, who chairs UCSF’s dermatology department. “The question is: Can we attract more of these medical students into dermatology, and how can we be more effective at that?”
Lack of exposure to dermatology leads many students to choose a different route, Dr. Taylor added. Often, medical students are not aware of dermatology as a specialty until they are far advanced in their training, she said. Dr. Taylor herself switched to dermatology after a 3-year internal medicine residency. Had she been exposed to dermatology at an earlier point in her education, she may have pursued the specialty sooner, she noted.
“It’s very important to enlighten and educate medical students about the importance of dermatology as a specialty and see if we can recruit them and interest them in dermatology,” Dr. Taylor said in the interview.
An absence of mentors for minority students throughout their schooling also drives the disparity, said Dr. Amit Pandya, chair of the American Academy of Dermatology Diversity Task Force and a dermatologist at the University of Texas Southwestern Medical Center, Dallas, who is the lead author of the January JAAD article.
“It’s not lack of bright students,” Dr. Pandya said in an interview. “They don’t have the mentorship many times, or the role models or people to guide them to” these areas.
Building diversity in dermatology
To address the gap, the AAD Diversity Task Force created the Diversity Mentorship Program, which provides a stipend to promising medical students from underrepresented backgrounds to spend 1 month with a dermatologist. The program aims to spark interest in the specialty.
The task force is currently developing a program called the Diversity Champion Initiative, Dr. Pandya said. The initiative will gather information about successful diversity activities at medical schools nationwide and replicate such efforts at other institutions. The idea is to help schools learn from each other and build on programs already in practice.
At the University of Texas Southwestern, for example, Dr. Pandya meets with medical students during their first month of training and brings them to his home for a pizza party. The students hear from other dermatologists of color about why they chose dermatology and the importance of drawing more minorities into the specialty. Dr. Pandya holds a similar gathering for local premed college students.
“I offer these students a chance to come to our free clinic in East Dallas so they can observe how important we are to the minority population of Dallas,” he said. “Patients line up starting at 5 in the morning for our 8:30 clinic start because they’re desperate to get skin care. We are only one of two clinics that offer free dermatology services in the Dallas-Fort Worth metropolitan area.”
Dermatologists are making similar efforts to reach minority medical students at UCSF. The dermatology department is working with the school’s residency committee and hiring leaders to broaden selection criteria, said Dr. Eleni Linos, a UCSF dermatologist who leads diversity efforts at the school. The goal is to change criteria to allow for acceptance of more minority residents and physicians.
“Through mentorship programs, we’re ensuring medical students from all backgrounds are exposed to all aspects of dermatology early on,” Dr. Linos said in an interview. “What we want to do, as a next step, is teach all of our faculty about unconscious bias and implicit bias and the way it can affect our clinical practice as well as our hiring and our interaction with students and trainees.”
Mentorship is also a key aspect of the The Skin of Color Center of Mount Sinai St. Luke’s and Mount Sinai West. Cofounded in 1999 by Dr. Taylor, Dr. Vincent A. DeLeo, and Dr. Fran Cook-Bolden, the center specializes in the diagnosis and treatment of skin conditions common to patients of color. Along with conducting research, producing literature, and hosting seminars, the center also trains a number of residents and fellows, Dr. Alexis said.
“Over the past 17 years, the awareness of the nuances of treating common dermatological disorders in patients with skin of color has really advanced,” he said. “We see a growing interest throughout the dermatological community – nationally and internationally – in this area, largely due to early efforts of this center.”
A total of nine ethnic skin centers now exist in the United States. And in 2004, Dr. Taylor helped establish the Skin of Color Society, an international association that promotes awareness and excellence for skin of color dermatology.
More work needed among departments, practices
Dr. Linos encourages more dermatology program directors and residency committees to review their admission and hiring criteria. Criteria should be objective, predefined, and not biased against minority applicants, she said. “We know that relying on test scores alone can be a disadvantage for some minority applicants,” she noted. “Broader criteria that are predefined and explicitly defined are very helpful for ensuring equity and increasing diversity.”
Dermatology leaders want more dermatologists to act as mentors. Talk to high school and college-aged patients from underrepresented groups and encourage them to enter medicine, the JAAD article suggests. Volunteer at schools and encourage minority students to pursue careers in science and health. Contact minority medical school associations and engage the members, Dr. Pandya added.
“Talk to them about why [you] went into medicine and dermatology, he said. “Become their advisor, make [yourself] available for any questions they may have. This helps enormously in getting medical students interested in dermatology.”
On a positive note, dermatology as a specialty is clearly starting to understand the importance of diversity, according to Dr. Alexis. Making “a more concerted effort to feed the pipeline and encourage potential students early on in their career to consider dermatology as a specialty will undoubtedly lead to increased diversity in the future,” he said.
On Twitter @legal_med
ACLU sues CMS over reproductive care complaints
The American Civil Liberties Union (ACLU) is asking a federal court to compel the Centers for Medicare & Medicaid Services to turn over complaints about Catholic hospitals that have allegedly refused women reproductive care because of religious directives.
The Freedom of Information Act (FOIA) lawsuit, filed May 24, seeks grievances about Catholic hospitals by women who were reportedly denied emergency treatment or information, in violation of federal law. The ACLU filed a FOIA request with CMS in 2014 asking for the same information, but received no meaningful response, according to ACLU Senior Staff Attorney Brigitte Amiri.
“We’ve heard heartbreaking stories from women who rushed to a Catholic hospital in an emergency but were turned away because the hospital let religious rules written by bishops dictate what medical care could be provided,” Ms. Amiri said in a statement. “We are seeking complaints filed with the government about these unlawful and harmful practices. We call on the government to undertake a systematic investigation into the denial of appropriate care in Catholic hospitals and to take action to protect women and ensure that they get the care they need.”
A spokeswoman for CMS said the agency does not comment on pending litigation.
The legal challenge follows an ACLU report released in May that found a 22% increase in the number of Catholic hospitals since 2001. The report featured accounts from patients allegedly denied appropriate care at Catholic hospitals and stories from health care providers allegedly prevented from providing critical care because of the directives.
For example, one patient with a brain tumor claimed she was denied a tubal ligation at the time of her scheduled cesarean section, although she was advised by her other doctors that another pregnancy would increase risks posed by her tumors. In some states, more than 40% of all hospital beds are in a Catholic facility, leaving some regions without options for certain reproductive health care, according to the report.
The Catholic Health Association of the United States (CHA) called the accusations in the ACLU report, “unsubstantiated and irresponsible.” The Ethical and Religious Directives for Catholic Healthcare Services, the guidelines by which all Catholic hospitals operate, are consistent with the delivery of safe, effective medical care, said Sister Carol Keehan, CHA president & CEO.
“To frighten families with scary, one-sided stories and exaggerated data is grossly disrespectful to the thousands of physicians, midwives, and nurses working in Catholic hospitals who are so devoted to their patients and to the care they deliver,” Sister Keehan said in a May 9 statement.
A CHA spokesman declined to comment on the ACLU’s lawsuit against CMS, referencing the association’s prior statement on the issue. In its May 9 statement, CHA stressed that nothing in the Ethical and Religious Directives prevents the provision of quality clinical care for mothers and infants in obstetric emergencies.
“Catholic hospitals are not only safe for women and their infants but also the choice of so many patients who seek holistic care from a trusted, compassionate provider,” Sister Keehan said in the statement. “Physicians, too, choose Catholic health care – not only for its quality care but also often because of its deep concern for those who are vulnerable.”
A related lawsuit by the ACLU against Trinity Health, in Michigan, is ongoing. In that challenge, ACLU claims that Trinity repeatedly and systematically failed to provide women who were experiencing pregnancy complications with clinically appropriate emergency abortions. Trinity argues that the ACLU lacks standing and has failed to state a proper claim. The U.S. District Court for the Eastern District of Michigan Southern Division agreed and dismissed the suit. The ACLU has asked the court to reconsider, and the motion for reconsideration is pending, Ms. Amiri said.
In April, the American Congress of Obstetricians and Gynecologists (ACOG) outlined its concerns about the growing number of hospitals and health systems that limit the scope of reproductive services based on religious beliefs. In addition to reporting insufficient, withheld, or restrictive care, physicians should strive to identify resources and alternative solutions for patients to maximize their available health care options, ACOG said in the position statement.
“Women should have access to scientifically-based health care,” the position statement read. “Prohibitions on essential care that are based on religious or other nonscientific ground can jeopardize women’s health and safety. Restrictive hospital policies can damage the patient-physician relationship.”
On Twitter @legal_med
The American Civil Liberties Union (ACLU) is asking a federal court to compel the Centers for Medicare & Medicaid Services to turn over complaints about Catholic hospitals that have allegedly refused women reproductive care because of religious directives.
The Freedom of Information Act (FOIA) lawsuit, filed May 24, seeks grievances about Catholic hospitals by women who were reportedly denied emergency treatment or information, in violation of federal law. The ACLU filed a FOIA request with CMS in 2014 asking for the same information, but received no meaningful response, according to ACLU Senior Staff Attorney Brigitte Amiri.
“We’ve heard heartbreaking stories from women who rushed to a Catholic hospital in an emergency but were turned away because the hospital let religious rules written by bishops dictate what medical care could be provided,” Ms. Amiri said in a statement. “We are seeking complaints filed with the government about these unlawful and harmful practices. We call on the government to undertake a systematic investigation into the denial of appropriate care in Catholic hospitals and to take action to protect women and ensure that they get the care they need.”
A spokeswoman for CMS said the agency does not comment on pending litigation.
The legal challenge follows an ACLU report released in May that found a 22% increase in the number of Catholic hospitals since 2001. The report featured accounts from patients allegedly denied appropriate care at Catholic hospitals and stories from health care providers allegedly prevented from providing critical care because of the directives.
For example, one patient with a brain tumor claimed she was denied a tubal ligation at the time of her scheduled cesarean section, although she was advised by her other doctors that another pregnancy would increase risks posed by her tumors. In some states, more than 40% of all hospital beds are in a Catholic facility, leaving some regions without options for certain reproductive health care, according to the report.
The Catholic Health Association of the United States (CHA) called the accusations in the ACLU report, “unsubstantiated and irresponsible.” The Ethical and Religious Directives for Catholic Healthcare Services, the guidelines by which all Catholic hospitals operate, are consistent with the delivery of safe, effective medical care, said Sister Carol Keehan, CHA president & CEO.
“To frighten families with scary, one-sided stories and exaggerated data is grossly disrespectful to the thousands of physicians, midwives, and nurses working in Catholic hospitals who are so devoted to their patients and to the care they deliver,” Sister Keehan said in a May 9 statement.
A CHA spokesman declined to comment on the ACLU’s lawsuit against CMS, referencing the association’s prior statement on the issue. In its May 9 statement, CHA stressed that nothing in the Ethical and Religious Directives prevents the provision of quality clinical care for mothers and infants in obstetric emergencies.
“Catholic hospitals are not only safe for women and their infants but also the choice of so many patients who seek holistic care from a trusted, compassionate provider,” Sister Keehan said in the statement. “Physicians, too, choose Catholic health care – not only for its quality care but also often because of its deep concern for those who are vulnerable.”
A related lawsuit by the ACLU against Trinity Health, in Michigan, is ongoing. In that challenge, ACLU claims that Trinity repeatedly and systematically failed to provide women who were experiencing pregnancy complications with clinically appropriate emergency abortions. Trinity argues that the ACLU lacks standing and has failed to state a proper claim. The U.S. District Court for the Eastern District of Michigan Southern Division agreed and dismissed the suit. The ACLU has asked the court to reconsider, and the motion for reconsideration is pending, Ms. Amiri said.
In April, the American Congress of Obstetricians and Gynecologists (ACOG) outlined its concerns about the growing number of hospitals and health systems that limit the scope of reproductive services based on religious beliefs. In addition to reporting insufficient, withheld, or restrictive care, physicians should strive to identify resources and alternative solutions for patients to maximize their available health care options, ACOG said in the position statement.
“Women should have access to scientifically-based health care,” the position statement read. “Prohibitions on essential care that are based on religious or other nonscientific ground can jeopardize women’s health and safety. Restrictive hospital policies can damage the patient-physician relationship.”
On Twitter @legal_med
The American Civil Liberties Union (ACLU) is asking a federal court to compel the Centers for Medicare & Medicaid Services to turn over complaints about Catholic hospitals that have allegedly refused women reproductive care because of religious directives.
The Freedom of Information Act (FOIA) lawsuit, filed May 24, seeks grievances about Catholic hospitals by women who were reportedly denied emergency treatment or information, in violation of federal law. The ACLU filed a FOIA request with CMS in 2014 asking for the same information, but received no meaningful response, according to ACLU Senior Staff Attorney Brigitte Amiri.
“We’ve heard heartbreaking stories from women who rushed to a Catholic hospital in an emergency but were turned away because the hospital let religious rules written by bishops dictate what medical care could be provided,” Ms. Amiri said in a statement. “We are seeking complaints filed with the government about these unlawful and harmful practices. We call on the government to undertake a systematic investigation into the denial of appropriate care in Catholic hospitals and to take action to protect women and ensure that they get the care they need.”
A spokeswoman for CMS said the agency does not comment on pending litigation.
The legal challenge follows an ACLU report released in May that found a 22% increase in the number of Catholic hospitals since 2001. The report featured accounts from patients allegedly denied appropriate care at Catholic hospitals and stories from health care providers allegedly prevented from providing critical care because of the directives.
For example, one patient with a brain tumor claimed she was denied a tubal ligation at the time of her scheduled cesarean section, although she was advised by her other doctors that another pregnancy would increase risks posed by her tumors. In some states, more than 40% of all hospital beds are in a Catholic facility, leaving some regions without options for certain reproductive health care, according to the report.
The Catholic Health Association of the United States (CHA) called the accusations in the ACLU report, “unsubstantiated and irresponsible.” The Ethical and Religious Directives for Catholic Healthcare Services, the guidelines by which all Catholic hospitals operate, are consistent with the delivery of safe, effective medical care, said Sister Carol Keehan, CHA president & CEO.
“To frighten families with scary, one-sided stories and exaggerated data is grossly disrespectful to the thousands of physicians, midwives, and nurses working in Catholic hospitals who are so devoted to their patients and to the care they deliver,” Sister Keehan said in a May 9 statement.
A CHA spokesman declined to comment on the ACLU’s lawsuit against CMS, referencing the association’s prior statement on the issue. In its May 9 statement, CHA stressed that nothing in the Ethical and Religious Directives prevents the provision of quality clinical care for mothers and infants in obstetric emergencies.
“Catholic hospitals are not only safe for women and their infants but also the choice of so many patients who seek holistic care from a trusted, compassionate provider,” Sister Keehan said in the statement. “Physicians, too, choose Catholic health care – not only for its quality care but also often because of its deep concern for those who are vulnerable.”
A related lawsuit by the ACLU against Trinity Health, in Michigan, is ongoing. In that challenge, ACLU claims that Trinity repeatedly and systematically failed to provide women who were experiencing pregnancy complications with clinically appropriate emergency abortions. Trinity argues that the ACLU lacks standing and has failed to state a proper claim. The U.S. District Court for the Eastern District of Michigan Southern Division agreed and dismissed the suit. The ACLU has asked the court to reconsider, and the motion for reconsideration is pending, Ms. Amiri said.
In April, the American Congress of Obstetricians and Gynecologists (ACOG) outlined its concerns about the growing number of hospitals and health systems that limit the scope of reproductive services based on religious beliefs. In addition to reporting insufficient, withheld, or restrictive care, physicians should strive to identify resources and alternative solutions for patients to maximize their available health care options, ACOG said in the position statement.
“Women should have access to scientifically-based health care,” the position statement read. “Prohibitions on essential care that are based on religious or other nonscientific ground can jeopardize women’s health and safety. Restrictive hospital policies can damage the patient-physician relationship.”
On Twitter @legal_med
Oklahoma governor vetoes anti-abortion bill, South Carolina measure lingers
UPDATE: On May 25, 2016, Gov. Nikki Haley (R-S.C.) signed into law the Pain-Capable Unborn Child Protection Act,” banning abortions after 19 weeks.
In a surprising move, Oklahoma Gov. Mary Fallin (R) vetoed a controversial bill that would have made performing an abortion a felony in the state.
The governor, known for her stanch anti-abortion beliefs, struck down the legislation on May 20, saying it would not withstand a court challenge.
“The bill is so ambiguous and so vague that doctors cannot be certain what medical circumstances would be considered ‘necessary to preserve the life of the mother,’ ” Gov. Fallin said in a statement. “The absence of any definition, analysis, or medical standard renders this exception vague, indefinite, and vulnerable to subjective interpretation and application.”
The news was welcomed by the American Congress of Obstetricians and Gynecologists (ACOG), which had sent Gov. Fallin a letter urging the veto.
“We were excited to see the veto,” said Dr. Dana Stone, legislative liaison for ACOG’s Oklahoma section. “I was not expecting that at all. We considered this a very dangerous law, and the most extreme law brought forward in Oklahoma.”
At this article’s deadline, the anti-abortion groups Oklahomans For Life, National Right to Life, and Americans United for Life had not responded to requests for comments. Oklahoma Sen. Nathan Dahm (R), who authored Senate Bill 1552, also did not respond to requests. On May 20, Sen. Dahm told the Associated Press he was undecided on whether he would attempt to override the governor’s veto.
SB 1552 would have classified the act of performing an abortion as “unprofessional conduct” by a physician, and prevented abortion providers from maintaining, obtaining, or renewing a medical license. Physicians convicted under the measure could have faced 1-3 years in prison. The bill contained a provision that excluded abortions necessary to save a woman’s life.
If Oklahoma legislators successfully override the veto, the measure would likely be headed to the courts, Dr. Stone said. Abortion rights groups have said the bill is a direct violation of Roe v. Wade and that they would sue over the legislation if it stands.
ACOG is also keeping a close eye on a South Carolina bill that would ban abortions after 19 weeks, even if women are victims of rape or incest. The South Carolina legislature passed SB 3114 on May 17, and the bill is currently before South Carolina Gov. Nikki Haley (R). She has indicated that she will sign the bill.
Similar abortion laws are in effect in 12 states, according to statistics from the Guttmacher Institute, but most measures are facing court challenges. In a letter to Gov. Haley, ACOG urged her to veto SB 3114, saying the bill will tie the hands of doctors seeking to help patients.
“It is bad medicine, based on the thoroughly debunked fallacy that a 20-week fetus – which is not viable – can feel pain,” doctors with ACOG’s South Carolina section wrote to the governor. “It would undoubtedly place us in the unconscionable position of having to watch our patients and their loved ones undergo additional emotional trauma, illness, and suffering during what is already a difficult time.”
South Carolina Rep. Wendy Nanney (R), the bill’s sponsor, said SB 3114 protects life, and that she hopes the bill will effectively end all abortions in South Carolina.
“Life begins at conception,” she said on her website. “By giving legal status to life in the womb, this bill would be a huge step in the right direction towards ending abortion in our state.”
On Twitter @legal_med
UPDATE: On May 25, 2016, Gov. Nikki Haley (R-S.C.) signed into law the Pain-Capable Unborn Child Protection Act,” banning abortions after 19 weeks.
In a surprising move, Oklahoma Gov. Mary Fallin (R) vetoed a controversial bill that would have made performing an abortion a felony in the state.
The governor, known for her stanch anti-abortion beliefs, struck down the legislation on May 20, saying it would not withstand a court challenge.
“The bill is so ambiguous and so vague that doctors cannot be certain what medical circumstances would be considered ‘necessary to preserve the life of the mother,’ ” Gov. Fallin said in a statement. “The absence of any definition, analysis, or medical standard renders this exception vague, indefinite, and vulnerable to subjective interpretation and application.”
The news was welcomed by the American Congress of Obstetricians and Gynecologists (ACOG), which had sent Gov. Fallin a letter urging the veto.
“We were excited to see the veto,” said Dr. Dana Stone, legislative liaison for ACOG’s Oklahoma section. “I was not expecting that at all. We considered this a very dangerous law, and the most extreme law brought forward in Oklahoma.”
At this article’s deadline, the anti-abortion groups Oklahomans For Life, National Right to Life, and Americans United for Life had not responded to requests for comments. Oklahoma Sen. Nathan Dahm (R), who authored Senate Bill 1552, also did not respond to requests. On May 20, Sen. Dahm told the Associated Press he was undecided on whether he would attempt to override the governor’s veto.
SB 1552 would have classified the act of performing an abortion as “unprofessional conduct” by a physician, and prevented abortion providers from maintaining, obtaining, or renewing a medical license. Physicians convicted under the measure could have faced 1-3 years in prison. The bill contained a provision that excluded abortions necessary to save a woman’s life.
If Oklahoma legislators successfully override the veto, the measure would likely be headed to the courts, Dr. Stone said. Abortion rights groups have said the bill is a direct violation of Roe v. Wade and that they would sue over the legislation if it stands.
ACOG is also keeping a close eye on a South Carolina bill that would ban abortions after 19 weeks, even if women are victims of rape or incest. The South Carolina legislature passed SB 3114 on May 17, and the bill is currently before South Carolina Gov. Nikki Haley (R). She has indicated that she will sign the bill.
Similar abortion laws are in effect in 12 states, according to statistics from the Guttmacher Institute, but most measures are facing court challenges. In a letter to Gov. Haley, ACOG urged her to veto SB 3114, saying the bill will tie the hands of doctors seeking to help patients.
“It is bad medicine, based on the thoroughly debunked fallacy that a 20-week fetus – which is not viable – can feel pain,” doctors with ACOG’s South Carolina section wrote to the governor. “It would undoubtedly place us in the unconscionable position of having to watch our patients and their loved ones undergo additional emotional trauma, illness, and suffering during what is already a difficult time.”
South Carolina Rep. Wendy Nanney (R), the bill’s sponsor, said SB 3114 protects life, and that she hopes the bill will effectively end all abortions in South Carolina.
“Life begins at conception,” she said on her website. “By giving legal status to life in the womb, this bill would be a huge step in the right direction towards ending abortion in our state.”
On Twitter @legal_med
UPDATE: On May 25, 2016, Gov. Nikki Haley (R-S.C.) signed into law the Pain-Capable Unborn Child Protection Act,” banning abortions after 19 weeks.
In a surprising move, Oklahoma Gov. Mary Fallin (R) vetoed a controversial bill that would have made performing an abortion a felony in the state.
The governor, known for her stanch anti-abortion beliefs, struck down the legislation on May 20, saying it would not withstand a court challenge.
“The bill is so ambiguous and so vague that doctors cannot be certain what medical circumstances would be considered ‘necessary to preserve the life of the mother,’ ” Gov. Fallin said in a statement. “The absence of any definition, analysis, or medical standard renders this exception vague, indefinite, and vulnerable to subjective interpretation and application.”
The news was welcomed by the American Congress of Obstetricians and Gynecologists (ACOG), which had sent Gov. Fallin a letter urging the veto.
“We were excited to see the veto,” said Dr. Dana Stone, legislative liaison for ACOG’s Oklahoma section. “I was not expecting that at all. We considered this a very dangerous law, and the most extreme law brought forward in Oklahoma.”
At this article’s deadline, the anti-abortion groups Oklahomans For Life, National Right to Life, and Americans United for Life had not responded to requests for comments. Oklahoma Sen. Nathan Dahm (R), who authored Senate Bill 1552, also did not respond to requests. On May 20, Sen. Dahm told the Associated Press he was undecided on whether he would attempt to override the governor’s veto.
SB 1552 would have classified the act of performing an abortion as “unprofessional conduct” by a physician, and prevented abortion providers from maintaining, obtaining, or renewing a medical license. Physicians convicted under the measure could have faced 1-3 years in prison. The bill contained a provision that excluded abortions necessary to save a woman’s life.
If Oklahoma legislators successfully override the veto, the measure would likely be headed to the courts, Dr. Stone said. Abortion rights groups have said the bill is a direct violation of Roe v. Wade and that they would sue over the legislation if it stands.
ACOG is also keeping a close eye on a South Carolina bill that would ban abortions after 19 weeks, even if women are victims of rape or incest. The South Carolina legislature passed SB 3114 on May 17, and the bill is currently before South Carolina Gov. Nikki Haley (R). She has indicated that she will sign the bill.
Similar abortion laws are in effect in 12 states, according to statistics from the Guttmacher Institute, but most measures are facing court challenges. In a letter to Gov. Haley, ACOG urged her to veto SB 3114, saying the bill will tie the hands of doctors seeking to help patients.
“It is bad medicine, based on the thoroughly debunked fallacy that a 20-week fetus – which is not viable – can feel pain,” doctors with ACOG’s South Carolina section wrote to the governor. “It would undoubtedly place us in the unconscionable position of having to watch our patients and their loved ones undergo additional emotional trauma, illness, and suffering during what is already a difficult time.”
South Carolina Rep. Wendy Nanney (R), the bill’s sponsor, said SB 3114 protects life, and that she hopes the bill will effectively end all abortions in South Carolina.
“Life begins at conception,” she said on her website. “By giving legal status to life in the womb, this bill would be a huge step in the right direction towards ending abortion in our state.”
On Twitter @legal_med
Judge says feds overstepped on ACA cost-sharing subsidies
The Obama administration suffered another legal judgment against the Affordable Care Act when a district court judge ruled that the government has wrongly spent billions of dollars to repay insurers for health insurance provided to certain low-income patients
Congress never appropriated the money for those payments and “no public money can be spent without [an appropriation],” Judge Rosemary M. Collyer of the U.S. District Court for the District of Columbia wrote in her May 12 opinion.
If the ruling stands, the reimbursements could end, making health insurance too expensive for the millions of low-income patients who benefit from the ACA’s cost-sharing subsides, according to Jay Mark Waxman, a Boston-based health law attorney.
“If premiums become too expensive, you have people pulling out, then you have the so-called death spiral,” Mr. Waxman said in an interview. “The law could remain intact, but you could end up with not having very many people taking advantage of the marketplace, particularly the Silver Plan.”
The case in question, U.S. House of Representatives v. Burwell, revolves around two sections of the ACA. Section 1401 provides tax credits to certain patients in order to make insurance premiums more affordable, while Section 1402 requires insurers to reduce copayments, deductibles, and other out-of-pocket costs for certain low-income patients. The health law requires the federal government to reimburse insurers for the cost of these two sections.
While the first section received funding through the congressional appropriations process, the second section did not. In January 2014, HHS started repaying repay cost-sharing subsidies to insurers using federal funds. The House sued, claiming that HHS is illegally spending monies that Congress never appropriated. HHS has argued that other statutory provisions of the ACA authorize expenditures for cost-sharing reimbursements.
Judge Collyer ruled in the House’s favor, writing that paying out reimbursements without an appropriation violates the Constitution.
House members praised the court decision, calling it a victory for “the rule of law and the American taxpayer.”
“We received vindication of what we have known for quite some time – that the administration does not have the authority to spend over $150 billion for payments to insurance companies without an appropriation from Congress,” House Energy and Commerce Committee Chairman Fred Upton (R-Mich.) said in a statement. “The court’s message was clear: Complying with Article I of the Constitution is not optional for President Obama.”
White House Press Secretary Josh Earnest countered that the administration has seen its share of lawsuits over the ACA and that such legal challenges generally end in a government victory.
“This is not the first time that we’ve seen opponents of the Affordable Care Act go through the motions to try to win this political fight in the court system,” Mr. Earnest said during a press conference. “And it’s unfortunate that Republicans have resorted to a taxpayer-funded lawsuit to refight a political fight that they keep losing. They’ve been losing this fight for 6 years. And they’ll lose it again.”
It’s too early to predict how the legal case might be resolved, said Katherine Hempstead, who directs health insurance coverage for the Robert Wood Johnson Foundation.
“There’s a lot of potential endings that don’t lead to people losing their cost-sharing reductions,” Ms. Hempstead said in an interview. “There are a lot of twists and turns ahead, and the probability of people losing their reductions is remote.”
The House could lose the case on appeal, she said. Such a ruling could be made on the merits of the case or on procedural grounds. Whether the House has standing to sue HHS has been questioned as well, she noted. HHS continues to argue that the House has not established a concrete or imminent injury and therefore, the suit should be thrown out. In addition, some have suggested that the federal ruling could be interpreted as requiring Congress to appropriate money to pay for the cost-sharing reductions, she said.
The ultimate resolution could come from the U.S. Supreme Court, Mr. Waxman added. Another possibility is that the next administration will decline to pursue the case.
“Depending on the timing, it could just stop in the court of appeals,” he said. “The next administration could say, ‘We’re happy with where it is and not take it up. You don’t know what’s going to happen.”
Mr. Earnest said the U.S. Department of Justice is reviewing the ruling and will make an announcement about the next step after the analysis.
On Twitter @legal_med
The Obama administration suffered another legal judgment against the Affordable Care Act when a district court judge ruled that the government has wrongly spent billions of dollars to repay insurers for health insurance provided to certain low-income patients
Congress never appropriated the money for those payments and “no public money can be spent without [an appropriation],” Judge Rosemary M. Collyer of the U.S. District Court for the District of Columbia wrote in her May 12 opinion.
If the ruling stands, the reimbursements could end, making health insurance too expensive for the millions of low-income patients who benefit from the ACA’s cost-sharing subsides, according to Jay Mark Waxman, a Boston-based health law attorney.
“If premiums become too expensive, you have people pulling out, then you have the so-called death spiral,” Mr. Waxman said in an interview. “The law could remain intact, but you could end up with not having very many people taking advantage of the marketplace, particularly the Silver Plan.”
The case in question, U.S. House of Representatives v. Burwell, revolves around two sections of the ACA. Section 1401 provides tax credits to certain patients in order to make insurance premiums more affordable, while Section 1402 requires insurers to reduce copayments, deductibles, and other out-of-pocket costs for certain low-income patients. The health law requires the federal government to reimburse insurers for the cost of these two sections.
While the first section received funding through the congressional appropriations process, the second section did not. In January 2014, HHS started repaying repay cost-sharing subsidies to insurers using federal funds. The House sued, claiming that HHS is illegally spending monies that Congress never appropriated. HHS has argued that other statutory provisions of the ACA authorize expenditures for cost-sharing reimbursements.
Judge Collyer ruled in the House’s favor, writing that paying out reimbursements without an appropriation violates the Constitution.
House members praised the court decision, calling it a victory for “the rule of law and the American taxpayer.”
“We received vindication of what we have known for quite some time – that the administration does not have the authority to spend over $150 billion for payments to insurance companies without an appropriation from Congress,” House Energy and Commerce Committee Chairman Fred Upton (R-Mich.) said in a statement. “The court’s message was clear: Complying with Article I of the Constitution is not optional for President Obama.”
White House Press Secretary Josh Earnest countered that the administration has seen its share of lawsuits over the ACA and that such legal challenges generally end in a government victory.
“This is not the first time that we’ve seen opponents of the Affordable Care Act go through the motions to try to win this political fight in the court system,” Mr. Earnest said during a press conference. “And it’s unfortunate that Republicans have resorted to a taxpayer-funded lawsuit to refight a political fight that they keep losing. They’ve been losing this fight for 6 years. And they’ll lose it again.”
It’s too early to predict how the legal case might be resolved, said Katherine Hempstead, who directs health insurance coverage for the Robert Wood Johnson Foundation.
“There’s a lot of potential endings that don’t lead to people losing their cost-sharing reductions,” Ms. Hempstead said in an interview. “There are a lot of twists and turns ahead, and the probability of people losing their reductions is remote.”
The House could lose the case on appeal, she said. Such a ruling could be made on the merits of the case or on procedural grounds. Whether the House has standing to sue HHS has been questioned as well, she noted. HHS continues to argue that the House has not established a concrete or imminent injury and therefore, the suit should be thrown out. In addition, some have suggested that the federal ruling could be interpreted as requiring Congress to appropriate money to pay for the cost-sharing reductions, she said.
The ultimate resolution could come from the U.S. Supreme Court, Mr. Waxman added. Another possibility is that the next administration will decline to pursue the case.
“Depending on the timing, it could just stop in the court of appeals,” he said. “The next administration could say, ‘We’re happy with where it is and not take it up. You don’t know what’s going to happen.”
Mr. Earnest said the U.S. Department of Justice is reviewing the ruling and will make an announcement about the next step after the analysis.
On Twitter @legal_med
The Obama administration suffered another legal judgment against the Affordable Care Act when a district court judge ruled that the government has wrongly spent billions of dollars to repay insurers for health insurance provided to certain low-income patients
Congress never appropriated the money for those payments and “no public money can be spent without [an appropriation],” Judge Rosemary M. Collyer of the U.S. District Court for the District of Columbia wrote in her May 12 opinion.
If the ruling stands, the reimbursements could end, making health insurance too expensive for the millions of low-income patients who benefit from the ACA’s cost-sharing subsides, according to Jay Mark Waxman, a Boston-based health law attorney.
“If premiums become too expensive, you have people pulling out, then you have the so-called death spiral,” Mr. Waxman said in an interview. “The law could remain intact, but you could end up with not having very many people taking advantage of the marketplace, particularly the Silver Plan.”
The case in question, U.S. House of Representatives v. Burwell, revolves around two sections of the ACA. Section 1401 provides tax credits to certain patients in order to make insurance premiums more affordable, while Section 1402 requires insurers to reduce copayments, deductibles, and other out-of-pocket costs for certain low-income patients. The health law requires the federal government to reimburse insurers for the cost of these two sections.
While the first section received funding through the congressional appropriations process, the second section did not. In January 2014, HHS started repaying repay cost-sharing subsidies to insurers using federal funds. The House sued, claiming that HHS is illegally spending monies that Congress never appropriated. HHS has argued that other statutory provisions of the ACA authorize expenditures for cost-sharing reimbursements.
Judge Collyer ruled in the House’s favor, writing that paying out reimbursements without an appropriation violates the Constitution.
House members praised the court decision, calling it a victory for “the rule of law and the American taxpayer.”
“We received vindication of what we have known for quite some time – that the administration does not have the authority to spend over $150 billion for payments to insurance companies without an appropriation from Congress,” House Energy and Commerce Committee Chairman Fred Upton (R-Mich.) said in a statement. “The court’s message was clear: Complying with Article I of the Constitution is not optional for President Obama.”
White House Press Secretary Josh Earnest countered that the administration has seen its share of lawsuits over the ACA and that such legal challenges generally end in a government victory.
“This is not the first time that we’ve seen opponents of the Affordable Care Act go through the motions to try to win this political fight in the court system,” Mr. Earnest said during a press conference. “And it’s unfortunate that Republicans have resorted to a taxpayer-funded lawsuit to refight a political fight that they keep losing. They’ve been losing this fight for 6 years. And they’ll lose it again.”
It’s too early to predict how the legal case might be resolved, said Katherine Hempstead, who directs health insurance coverage for the Robert Wood Johnson Foundation.
“There’s a lot of potential endings that don’t lead to people losing their cost-sharing reductions,” Ms. Hempstead said in an interview. “There are a lot of twists and turns ahead, and the probability of people losing their reductions is remote.”
The House could lose the case on appeal, she said. Such a ruling could be made on the merits of the case or on procedural grounds. Whether the House has standing to sue HHS has been questioned as well, she noted. HHS continues to argue that the House has not established a concrete or imminent injury and therefore, the suit should be thrown out. In addition, some have suggested that the federal ruling could be interpreted as requiring Congress to appropriate money to pay for the cost-sharing reductions, she said.
The ultimate resolution could come from the U.S. Supreme Court, Mr. Waxman added. Another possibility is that the next administration will decline to pursue the case.
“Depending on the timing, it could just stop in the court of appeals,” he said. “The next administration could say, ‘We’re happy with where it is and not take it up. You don’t know what’s going to happen.”
Mr. Earnest said the U.S. Department of Justice is reviewing the ruling and will make an announcement about the next step after the analysis.
On Twitter @legal_med
VIDEO: Telehealth program cuts cost, hospitalizations for chronic patients
It’s well known that complex, chronic patients are some of the costliest patients in the health care system and utilize a disproportionate amount of health care resources.
To address this population, Banner Health Network (BHN) recently began a series of innovative programs that incorporate telehealth, including Banner iCare, which uses advanced technology and high-touch services to treat patients with multiple, chronic conditions.
Banner Health is a multihospital health system that operates in seven Western states and includes primary care clinics, skilled nursing facilities, surgery centers, hospitals, and home health care services. BHN is an accountable care organization of Banner Health based in the broader Phoenix area.
In a video interview at the American Telemedicine Association annual conference, Deb Dahl, BHN vice president of patient innovation, discussed how Banner’s telehealth program was designed, its operations, and the challenges faced by leaders along the way.
She also highlighted the program’s progress thus far, which includes a 27% reduction in cost of care and a 45% reduction in hospitalizations. Finally, Ms. Dahl spoke on reimbursement within the program and whether the initiative can work for other practices and health systems.
On Twitter @legal_med
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
It’s well known that complex, chronic patients are some of the costliest patients in the health care system and utilize a disproportionate amount of health care resources.
To address this population, Banner Health Network (BHN) recently began a series of innovative programs that incorporate telehealth, including Banner iCare, which uses advanced technology and high-touch services to treat patients with multiple, chronic conditions.
Banner Health is a multihospital health system that operates in seven Western states and includes primary care clinics, skilled nursing facilities, surgery centers, hospitals, and home health care services. BHN is an accountable care organization of Banner Health based in the broader Phoenix area.
In a video interview at the American Telemedicine Association annual conference, Deb Dahl, BHN vice president of patient innovation, discussed how Banner’s telehealth program was designed, its operations, and the challenges faced by leaders along the way.
She also highlighted the program’s progress thus far, which includes a 27% reduction in cost of care and a 45% reduction in hospitalizations. Finally, Ms. Dahl spoke on reimbursement within the program and whether the initiative can work for other practices and health systems.
On Twitter @legal_med
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
It’s well known that complex, chronic patients are some of the costliest patients in the health care system and utilize a disproportionate amount of health care resources.
To address this population, Banner Health Network (BHN) recently began a series of innovative programs that incorporate telehealth, including Banner iCare, which uses advanced technology and high-touch services to treat patients with multiple, chronic conditions.
Banner Health is a multihospital health system that operates in seven Western states and includes primary care clinics, skilled nursing facilities, surgery centers, hospitals, and home health care services. BHN is an accountable care organization of Banner Health based in the broader Phoenix area.
In a video interview at the American Telemedicine Association annual conference, Deb Dahl, BHN vice president of patient innovation, discussed how Banner’s telehealth program was designed, its operations, and the challenges faced by leaders along the way.
She also highlighted the program’s progress thus far, which includes a 27% reduction in cost of care and a 45% reduction in hospitalizations. Finally, Ms. Dahl spoke on reimbursement within the program and whether the initiative can work for other practices and health systems.
On Twitter @legal_med
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT ATA 2016
VIDEO: Building a pediatric telehealth program
MINNEAPOLIS – In 2014, Children’s Hospitals and Clinics of Minnesota began a pediatric telehealth program aimed at improving access to care for children living in remote areas.
A year and a half later, the health system has made significant headway toward these goals, Kristi Moline, the organization’s telehealth program manager, said at the American Telemedicine Association annual conference. The program’s telehealth services include pediatric emergency medicine consultations with outlying hospitals and virtual hematology appointments for children with rare bleeding disorders.
In this video, Ms. Moline discusses the need for the program in Minnesota and how the initiative developed. She also notes challenges the health system faced along the way and offers advice to other practices interested in starting similar telehealth programs.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @legal_med
MINNEAPOLIS – In 2014, Children’s Hospitals and Clinics of Minnesota began a pediatric telehealth program aimed at improving access to care for children living in remote areas.
A year and a half later, the health system has made significant headway toward these goals, Kristi Moline, the organization’s telehealth program manager, said at the American Telemedicine Association annual conference. The program’s telehealth services include pediatric emergency medicine consultations with outlying hospitals and virtual hematology appointments for children with rare bleeding disorders.
In this video, Ms. Moline discusses the need for the program in Minnesota and how the initiative developed. She also notes challenges the health system faced along the way and offers advice to other practices interested in starting similar telehealth programs.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @legal_med
MINNEAPOLIS – In 2014, Children’s Hospitals and Clinics of Minnesota began a pediatric telehealth program aimed at improving access to care for children living in remote areas.
A year and a half later, the health system has made significant headway toward these goals, Kristi Moline, the organization’s telehealth program manager, said at the American Telemedicine Association annual conference. The program’s telehealth services include pediatric emergency medicine consultations with outlying hospitals and virtual hematology appointments for children with rare bleeding disorders.
In this video, Ms. Moline discusses the need for the program in Minnesota and how the initiative developed. She also notes challenges the health system faced along the way and offers advice to other practices interested in starting similar telehealth programs.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @legal_med
AT ATA 2016
Mastering MACRA: How to thrive under new payment models
As MACRA makes quality-based care the law of the land, don’t just glide under the new expectations, thrive. That advice comes from accountable care experts who are seeing firsthand the tools leading to success in the new payment landscape.
Rule No. 1: Step up to the plate, said Julian D. “Bo” Bobbitt, a Raleigh, N.C.–based health law attorney and accountable care organization (ACO) specialist.
“MACRA changes everything,” he said in an interview. “This is massive. Indecision will not stop your placement in the value-based payment system. Why not control your destiny to achieve your professional and financial goals?”
On May 9, the Centers for Medicare & Medicaid Services published a proposed final rule that outlines key payment provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The proposal establishes parameters for the new Quality Payment Program, which includes the Merit-based Incentive Payment System (MIPS) and advanced Alternative Payment Models (APMs). Once final, the rule will consolidate three Medicare quality programs into MIPS: the Physician Quality Reporting System, the Value-Based Modifier Program; and the Meaningful Use program. CMS also proposes an APM pathway in which eligible clinicians can earn incentives.
The MACRA basics go as follows: From 2019 through 2024, well-performing physicians will be eligible for a bonus payment of up to 10% from a $500 million pool, according to CMS guidance released April 27. Poorly performing clinicians will see a pay cut of up to 4% in 2019, which increases to a max of 9% in 2022.
Taking small steps that focus on value now is key to excelling under MACRA, according to Jeb Dunkelberger, vice president for accountable care services at McKesson. “As an organization, ask: How can I get myself into a situation where I can maintain one foot on the boat and one foot on the dock, and be successful in the fee-for-service world, while starting to expose myself to fee-for-value?”
Starting a Medicare Shared Savings ACO is one way to accomplish this, Mr. Dunkelberger said in an interview. Track 1 of that program provides doctors with the potential for shared savings, while protecting them from financial risk. In his experience, practices have become successful after starting such ACOs, combined with a chronic care management initiative. Under this option, providers receive a fee-for-service payment, but they are also reaching out to patients and delivering preventive care, he said.
“You still have a traditional fee-for-service mechanism,” he said. “Your revenue cycle doesn’t change. Your coding doesn’t change. But at the same time, you’re simultaneously developing a competency that will be perceived as high-value in a futuristic world where we shift the location of care delivery and incentivize wellness and prevention more so than ever before.”
Joining an ACO sooner, rather than later, makes sense on many levels, Mr. Bobbitt added.
“Accountable care organizations seem to be an ideal vehicle to increase your value contribution and your reimbursement,” he said. “The law gives a 5% bump if you are in a qualifying ACO. There’s work involved and there’s infrastructure cost, but you can get into the plus side under MACRA and avoid the negative side, and you’re still open to the upside of the rewards for high performance.”
Transitioning early from volume to value has paid off for Dr. Grace E. Terrell and her large multispecialty group based in High Point, N.C. The group began adding components of value-based care in 2011 and is now part of an ACO with multiple payers and partners.
“We did this by changing the way we were providing care in specific care models and also investing substantially in information integration as well as changing our contracts so we were being paid based upon our outcomes, quality, and cost-effectiveness, rather than just fee-for-service,” said Dr. Terrell, the group’s president and CEO.
Since making the changes, the group has improved quality of care while reducing cost, said Dr. Terrell, who serves on the federal advisory committee for MACRA, officially known as the Physician-Focused Payment Model Technical Advisory Committee. Dr. Terrell said that her practice group had the sixth-highest quality score and the fourth-lowest cost among providers in the 2014 Medicare Shared Savings Program. The group has also launched a population health management company in collaboration with an academic medical center and a testing laboratory.
Maintaining a patient-focused viewpoint is essential to switching from volume to value, Dr. Terrell said. For example, her group focused on patients with severe chronic obstructive pulmonary disease and teamed them with a respiratory therapist, particularly after hospitalizations. Their efforts reduced 30-day hospital readmissions from 12% to 6%. They also created clinics for patients who have five or more chronic conditions; physicians are linked with nurse navigators, social workers, and other professionals to offer a more holistic approach.
“All of these different models focused foremost on patients,” Dr. Terrell said. “They also focused on teamwork. Even though physicians were leading the team, it involved integrated medicine. It also involved integration across the spectrum of care so we had to work very carefully with our hospital partners.”
Collaboration is a critical piece to quality-based success, Mr. Dunkelberger said, but he advises taking the time and effort to find the right partners. Thoroughly vet potential partners, he said. Ask for case studies and overall impact of work. Be wary of flashy flowcharts and “too good to be true” promises.
“Look for a partner and not [necessarily] a vendor,” Mr. Dunkelberger said. “Make sure their incentives align with yours.”
Take stock of readiness to participate in alternative payment models, advised Edith Coakley Stowe, a health care attorney in Washington. The ability to meet electronic health record expectations, a category under MACRA now called Advancing Care Information, is extremely important, she said. Equally important – especially in primary care – are strategies for managing patients between visits. Decide whether your practice should build, buy, or enter into a joint venture to achieve these goals.
“The good news is that what gets tested in alternative payment models generally finds its way into policies and programs applicable across the Medicare program,” Ms. Stowe said in an interview. “That means that participants in alternative payment models get a head start. Despite the blind corners and complexity of options facing physician groups right now, having a mentality of testing, trying, and continuously evaluating is going to stand them in the best stead.”
On Twitter @legal_med
As MACRA makes quality-based care the law of the land, don’t just glide under the new expectations, thrive. That advice comes from accountable care experts who are seeing firsthand the tools leading to success in the new payment landscape.
Rule No. 1: Step up to the plate, said Julian D. “Bo” Bobbitt, a Raleigh, N.C.–based health law attorney and accountable care organization (ACO) specialist.
“MACRA changes everything,” he said in an interview. “This is massive. Indecision will not stop your placement in the value-based payment system. Why not control your destiny to achieve your professional and financial goals?”
On May 9, the Centers for Medicare & Medicaid Services published a proposed final rule that outlines key payment provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The proposal establishes parameters for the new Quality Payment Program, which includes the Merit-based Incentive Payment System (MIPS) and advanced Alternative Payment Models (APMs). Once final, the rule will consolidate three Medicare quality programs into MIPS: the Physician Quality Reporting System, the Value-Based Modifier Program; and the Meaningful Use program. CMS also proposes an APM pathway in which eligible clinicians can earn incentives.
The MACRA basics go as follows: From 2019 through 2024, well-performing physicians will be eligible for a bonus payment of up to 10% from a $500 million pool, according to CMS guidance released April 27. Poorly performing clinicians will see a pay cut of up to 4% in 2019, which increases to a max of 9% in 2022.
Taking small steps that focus on value now is key to excelling under MACRA, according to Jeb Dunkelberger, vice president for accountable care services at McKesson. “As an organization, ask: How can I get myself into a situation where I can maintain one foot on the boat and one foot on the dock, and be successful in the fee-for-service world, while starting to expose myself to fee-for-value?”
Starting a Medicare Shared Savings ACO is one way to accomplish this, Mr. Dunkelberger said in an interview. Track 1 of that program provides doctors with the potential for shared savings, while protecting them from financial risk. In his experience, practices have become successful after starting such ACOs, combined with a chronic care management initiative. Under this option, providers receive a fee-for-service payment, but they are also reaching out to patients and delivering preventive care, he said.
“You still have a traditional fee-for-service mechanism,” he said. “Your revenue cycle doesn’t change. Your coding doesn’t change. But at the same time, you’re simultaneously developing a competency that will be perceived as high-value in a futuristic world where we shift the location of care delivery and incentivize wellness and prevention more so than ever before.”
Joining an ACO sooner, rather than later, makes sense on many levels, Mr. Bobbitt added.
“Accountable care organizations seem to be an ideal vehicle to increase your value contribution and your reimbursement,” he said. “The law gives a 5% bump if you are in a qualifying ACO. There’s work involved and there’s infrastructure cost, but you can get into the plus side under MACRA and avoid the negative side, and you’re still open to the upside of the rewards for high performance.”
Transitioning early from volume to value has paid off for Dr. Grace E. Terrell and her large multispecialty group based in High Point, N.C. The group began adding components of value-based care in 2011 and is now part of an ACO with multiple payers and partners.
“We did this by changing the way we were providing care in specific care models and also investing substantially in information integration as well as changing our contracts so we were being paid based upon our outcomes, quality, and cost-effectiveness, rather than just fee-for-service,” said Dr. Terrell, the group’s president and CEO.
Since making the changes, the group has improved quality of care while reducing cost, said Dr. Terrell, who serves on the federal advisory committee for MACRA, officially known as the Physician-Focused Payment Model Technical Advisory Committee. Dr. Terrell said that her practice group had the sixth-highest quality score and the fourth-lowest cost among providers in the 2014 Medicare Shared Savings Program. The group has also launched a population health management company in collaboration with an academic medical center and a testing laboratory.
Maintaining a patient-focused viewpoint is essential to switching from volume to value, Dr. Terrell said. For example, her group focused on patients with severe chronic obstructive pulmonary disease and teamed them with a respiratory therapist, particularly after hospitalizations. Their efforts reduced 30-day hospital readmissions from 12% to 6%. They also created clinics for patients who have five or more chronic conditions; physicians are linked with nurse navigators, social workers, and other professionals to offer a more holistic approach.
“All of these different models focused foremost on patients,” Dr. Terrell said. “They also focused on teamwork. Even though physicians were leading the team, it involved integrated medicine. It also involved integration across the spectrum of care so we had to work very carefully with our hospital partners.”
Collaboration is a critical piece to quality-based success, Mr. Dunkelberger said, but he advises taking the time and effort to find the right partners. Thoroughly vet potential partners, he said. Ask for case studies and overall impact of work. Be wary of flashy flowcharts and “too good to be true” promises.
“Look for a partner and not [necessarily] a vendor,” Mr. Dunkelberger said. “Make sure their incentives align with yours.”
Take stock of readiness to participate in alternative payment models, advised Edith Coakley Stowe, a health care attorney in Washington. The ability to meet electronic health record expectations, a category under MACRA now called Advancing Care Information, is extremely important, she said. Equally important – especially in primary care – are strategies for managing patients between visits. Decide whether your practice should build, buy, or enter into a joint venture to achieve these goals.
“The good news is that what gets tested in alternative payment models generally finds its way into policies and programs applicable across the Medicare program,” Ms. Stowe said in an interview. “That means that participants in alternative payment models get a head start. Despite the blind corners and complexity of options facing physician groups right now, having a mentality of testing, trying, and continuously evaluating is going to stand them in the best stead.”
On Twitter @legal_med
As MACRA makes quality-based care the law of the land, don’t just glide under the new expectations, thrive. That advice comes from accountable care experts who are seeing firsthand the tools leading to success in the new payment landscape.
Rule No. 1: Step up to the plate, said Julian D. “Bo” Bobbitt, a Raleigh, N.C.–based health law attorney and accountable care organization (ACO) specialist.
“MACRA changes everything,” he said in an interview. “This is massive. Indecision will not stop your placement in the value-based payment system. Why not control your destiny to achieve your professional and financial goals?”
On May 9, the Centers for Medicare & Medicaid Services published a proposed final rule that outlines key payment provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The proposal establishes parameters for the new Quality Payment Program, which includes the Merit-based Incentive Payment System (MIPS) and advanced Alternative Payment Models (APMs). Once final, the rule will consolidate three Medicare quality programs into MIPS: the Physician Quality Reporting System, the Value-Based Modifier Program; and the Meaningful Use program. CMS also proposes an APM pathway in which eligible clinicians can earn incentives.
The MACRA basics go as follows: From 2019 through 2024, well-performing physicians will be eligible for a bonus payment of up to 10% from a $500 million pool, according to CMS guidance released April 27. Poorly performing clinicians will see a pay cut of up to 4% in 2019, which increases to a max of 9% in 2022.
Taking small steps that focus on value now is key to excelling under MACRA, according to Jeb Dunkelberger, vice president for accountable care services at McKesson. “As an organization, ask: How can I get myself into a situation where I can maintain one foot on the boat and one foot on the dock, and be successful in the fee-for-service world, while starting to expose myself to fee-for-value?”
Starting a Medicare Shared Savings ACO is one way to accomplish this, Mr. Dunkelberger said in an interview. Track 1 of that program provides doctors with the potential for shared savings, while protecting them from financial risk. In his experience, practices have become successful after starting such ACOs, combined with a chronic care management initiative. Under this option, providers receive a fee-for-service payment, but they are also reaching out to patients and delivering preventive care, he said.
“You still have a traditional fee-for-service mechanism,” he said. “Your revenue cycle doesn’t change. Your coding doesn’t change. But at the same time, you’re simultaneously developing a competency that will be perceived as high-value in a futuristic world where we shift the location of care delivery and incentivize wellness and prevention more so than ever before.”
Joining an ACO sooner, rather than later, makes sense on many levels, Mr. Bobbitt added.
“Accountable care organizations seem to be an ideal vehicle to increase your value contribution and your reimbursement,” he said. “The law gives a 5% bump if you are in a qualifying ACO. There’s work involved and there’s infrastructure cost, but you can get into the plus side under MACRA and avoid the negative side, and you’re still open to the upside of the rewards for high performance.”
Transitioning early from volume to value has paid off for Dr. Grace E. Terrell and her large multispecialty group based in High Point, N.C. The group began adding components of value-based care in 2011 and is now part of an ACO with multiple payers and partners.
“We did this by changing the way we were providing care in specific care models and also investing substantially in information integration as well as changing our contracts so we were being paid based upon our outcomes, quality, and cost-effectiveness, rather than just fee-for-service,” said Dr. Terrell, the group’s president and CEO.
Since making the changes, the group has improved quality of care while reducing cost, said Dr. Terrell, who serves on the federal advisory committee for MACRA, officially known as the Physician-Focused Payment Model Technical Advisory Committee. Dr. Terrell said that her practice group had the sixth-highest quality score and the fourth-lowest cost among providers in the 2014 Medicare Shared Savings Program. The group has also launched a population health management company in collaboration with an academic medical center and a testing laboratory.
Maintaining a patient-focused viewpoint is essential to switching from volume to value, Dr. Terrell said. For example, her group focused on patients with severe chronic obstructive pulmonary disease and teamed them with a respiratory therapist, particularly after hospitalizations. Their efforts reduced 30-day hospital readmissions from 12% to 6%. They also created clinics for patients who have five or more chronic conditions; physicians are linked with nurse navigators, social workers, and other professionals to offer a more holistic approach.
“All of these different models focused foremost on patients,” Dr. Terrell said. “They also focused on teamwork. Even though physicians were leading the team, it involved integrated medicine. It also involved integration across the spectrum of care so we had to work very carefully with our hospital partners.”
Collaboration is a critical piece to quality-based success, Mr. Dunkelberger said, but he advises taking the time and effort to find the right partners. Thoroughly vet potential partners, he said. Ask for case studies and overall impact of work. Be wary of flashy flowcharts and “too good to be true” promises.
“Look for a partner and not [necessarily] a vendor,” Mr. Dunkelberger said. “Make sure their incentives align with yours.”
Take stock of readiness to participate in alternative payment models, advised Edith Coakley Stowe, a health care attorney in Washington. The ability to meet electronic health record expectations, a category under MACRA now called Advancing Care Information, is extremely important, she said. Equally important – especially in primary care – are strategies for managing patients between visits. Decide whether your practice should build, buy, or enter into a joint venture to achieve these goals.
“The good news is that what gets tested in alternative payment models generally finds its way into policies and programs applicable across the Medicare program,” Ms. Stowe said in an interview. “That means that participants in alternative payment models get a head start. Despite the blind corners and complexity of options facing physician groups right now, having a mentality of testing, trying, and continuously evaluating is going to stand them in the best stead.”
On Twitter @legal_med
DACA: High Court ruling could squash dreams of becoming a doctor
Growing up, Denisse Rojas Marquez rarely visited the doctor. As undocumented immigrants from Mexico, her family viewed medical care as a luxury and sought it only in emergencies.
“I would always wait until it was very severe to see a doctor,” said Ms. Rojas Marquez, who came to the United States as a toddler. “That’s still a mentality I have to train myself out of. Growing up, going to the doctor meant very expensive bills and navigating through very complex systems.”
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
At 26, Ms. Rojas Marquez is determined to become a physician and help bridge the gap between undocumented immigrants and medical care. She is close to making that dream a reality because of a 2012 policy called the Deferred Action for Childhood Arrivals (DACA), which protects undocumented immigrants brought to the United States as children from deportation and offers access to work authorization. The policy enabled Ms. Rojas Marquez to become one of the first undocumented students to attend the Icahn School of Medicine at Mount Sinai in New York.
But the fate of Ms. Rojas Marquez’s medical education is in flux as the U.S. Supreme Court considers protections for undocumented immigrants in the case of Texas v. United States. In dispute is the constitutionality of two of President Obama’s immigration policies: the Deferred Action for Parents of Americans and Lawful Permanent Residents (DAPA) and expanded DACA. The former protects undocumented immigrants who are parents of U.S. citizens from deportation, if they meet certain criteria. The second extends work authorization under the original DACA program from 2 years to 3 years and broadens age requirements.
Texas and 25 other states have sued over the programs, arguing the president does not have the authority to issue the new immigration policies, and that the programs violate the Constitution as well as the Administrative Procedure Act for notice-and-comment rule making. High court justices heard oral arguments April 18.
The ruling could impact the growing number of medical students with DACA status across the country, and jeopardize the funding invested in their training. Sixty-one medical schools now accept applications from DACA applicants, according to data from the Association of American Medical Colleges (AAMC). In 2015, 46 students with DACA status applied to U.S. medical schools and 20 were enrolled. In 2016, more than double (112) applied, although enrollment data will not be available until year’s end. Neither AAMC nor the National Resident Matching Program collect data on residents with DACA status.
A high court ruling in favor of the states could lead to DACA’s undoing, said Michael M. Hethmon, an attorney for the Immigration Reform Law Institute in Washington, D.C. The institute issued a brief to the Supreme Court in support of Texas.
If Texas prevails, “it’ll be a matter of weeks before a similar challenge will be levied against DACA and a number of other related programs,” Mr. Hethmon said in an interview. “There will be no more legal justification for those programs that exist.”
Saving talent or wasting money?
Loyola University in Chicago has accepted more students with DACA status than any other U.S. medical school. The reasons are simple, said Mark Kuczewski, Ph.D., chair of medical education at Loyola’s Stritch School of Medicine.
“We’re in the business of taking outstanding students,” Dr. Kuczewski said in an interview. “If the student is outstanding, we want them in our applicant pool. Second, being bilingual and bicultural is extremely important. We have patient populations out there that are diverse and underserved. We want to utilize this talent.”
In the fall of 2014, Stritch enrolled seven medical students with DACA status; in 2014, they doubled that enrollment. The students competed on the same playing field as other applicants and received no special treatment, Dr. Kuczewski said.
DACA students do pose funding challenges, he acknowledged. Although the students are protected from deportation and receive work authorization, they don’t qualify for federal student loans. Medical schools must find unique ways to help DACA students finance their education. A major Catholic health system provides student loan packages for several DACA students at Stritch, Dr. Kuczewski said. DACA students can also apply for financial assistance through an AAMC assistance program.
“Medical students use copious amounts of federal student loans,” he said. “Somehow the school has to make up that difference. We’ve found partners, but they don’t have infinite capacity, so we have to keep going back and finding new partners each year.”
The University of California, San Francisco, also has opened its doors to DACA students. Now in his third year, Jirayut New Latthivongskorn is UCSF’s first undocumented medical student. His education is financed by grants, private funding, and donations, said Mr. Latthivongskorn who came to the United States from Thailand when he was 9 years old. He is cofounder of Pre-Health Dreamers, a network of undocumented students who plan to pursue medical careers.
Before DACA granted his entry into UCSF, Mr. Latthivongskorn was accustomed to barriers because of his undocumented status, including having to turn down a nearly full-ride scholarship from the University of California, Davis, after high school.
“It was devastating,” Mr. Latthivongskorn said in an interview. “It was one of the very first times where I felt different and thought, ‘This is not going to work. You are undocumented.’”
Mr. Latthivongskorn and his family scraped together money for him to complete his undergraduate degree at the University of California, Berkeley. California has since passed the DREAM Act, a law that allows undocumented immigrants to receive private scholarships funded through public universities.
Not everyone believes undocumented immigrants should get the chance to become U.S. physicians. Dr. Jane M. Orient, executive director of the Association of American Physicians and Surgeons, argued that undocumented immigrants are not the answer to curbing the physician shortage.
“In a country that’s supposed to be ruled by law, it seems incomprehensible that people who are violating the law should be given privileges over people who are here legally,” she said in an interview. “We desperately do need more physicians, but we should not be blocking Americans from having this opportunity.”
Dr. Shirie Leng, a Boston anesthesiologist, said DACA is promising in theory, but falls short in practical application.
“There’s no particular reason why [undocumented students] wouldn’t make great doctors,” said Dr. Leng. “The problem is funding related. You can give kids all the opportunity you want, but if you can’t pay for it, that seems to me to be the biggest sticking point.”
Basing admission policies on programs that are vulnerable could end poorly for schools and students, Dr. Leng added.
If DACA is revoked, “it’s not just a waste of money for the school, but a waste of time for the kids,” she said.
Protections hinge on Supreme Court … and next president
During oral arguments earlier this month, justices appeared to disagree on whether DAPA and expanded DACA were properly executed.
Associate Justice Anthony M. Kennedy indicated that the normal order of government policy making had been “turned upside down,” by the creation of the programs. Associate Justice Sonia Sotomayor, meanwhile, noted that immigration policies with broader reaches have been similarly instituted in the past.
A ruling for the government would mean the president can use his executive power to enact policies that run contrary to immigration laws already in place, said Mr. Hethmon, the D.C. attorney. Current immigration laws trump informal agency discretion and do not allow for the government’s “arbitrary and capricious creation of a massive classification of nonstatus alien beneficiaries,” Mr. Hethmon wrote in his high court brief.
A decision that favors Texas would unravel opportunities for undocumented immigrants and prevent their ability to contribute to society, said Ignacia Rodriguez, a legal fellow at the National Immigration Law Center, which authored a brief in support of the government.
“What’s at stake is providing a stable environment for U.S. citizen children to grow, and providing people with the opportunity and tools to be able to contribute to the workforce [and] to the economy,” she said in an interview. “This is a payoff for everybody, not just those receiving the benefit.”
Regardless of what the Supreme Court decides, the next president could have the last word, according Ashley C. Parrish, a Washington D.C. attorney who cowrote a brief in support of the states. Mr. Parrish takes no position on the merits of the immigration programs, but rather, he is concerned with the administration’s failure to follow the Administrative Procedure Act’s requirements for notice-and-comment rule making.
“If the program were adopted as a legal rule after notice and comment, it could not be changed without going through a new notice-and-comment process,” he said. “If it is just a bare statement of policy, it can be changed at any time, without notice to anyone. The next administration could say, ‘Thank you for coming out of the shadows; we are now going to deport all of you.’ ”
Among the Democrats running for president, former Secretary of State Hillary Clinton has said she will defend DACA and Sen. Bernie Sanders (I-Vt.) has said he supports DACA and DAPA, and plans to expand them if elected.
Conversely, presumed Republican presidential nominee Donald Trump has indicated he would rescind DACA and related programs if elected.
After spending most of her life terrified of deportation, Ms. Rojas Marquez said she is not wasting time worrying about the Supreme Court’s decision or whether the next president will overturn the policy. She is keeping her studies foremost in her mind and the goal of becoming a doctor firmly in her heart.
“I have always lived with what-ifs,” she said. “This time around, I’m not going to be living in fear of the removing of DACA, because I wouldn’t have made it this far if I always lived in fear. My plan is no matter what happens, I’m going to finish medical school, and from there, I pray that I will be able to practice in the U.S.”
The Supreme Court is expected to issue its decision by June.
On Twitter @legal_med
Growing up, Denisse Rojas Marquez rarely visited the doctor. As undocumented immigrants from Mexico, her family viewed medical care as a luxury and sought it only in emergencies.
“I would always wait until it was very severe to see a doctor,” said Ms. Rojas Marquez, who came to the United States as a toddler. “That’s still a mentality I have to train myself out of. Growing up, going to the doctor meant very expensive bills and navigating through very complex systems.”
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
At 26, Ms. Rojas Marquez is determined to become a physician and help bridge the gap between undocumented immigrants and medical care. She is close to making that dream a reality because of a 2012 policy called the Deferred Action for Childhood Arrivals (DACA), which protects undocumented immigrants brought to the United States as children from deportation and offers access to work authorization. The policy enabled Ms. Rojas Marquez to become one of the first undocumented students to attend the Icahn School of Medicine at Mount Sinai in New York.
But the fate of Ms. Rojas Marquez’s medical education is in flux as the U.S. Supreme Court considers protections for undocumented immigrants in the case of Texas v. United States. In dispute is the constitutionality of two of President Obama’s immigration policies: the Deferred Action for Parents of Americans and Lawful Permanent Residents (DAPA) and expanded DACA. The former protects undocumented immigrants who are parents of U.S. citizens from deportation, if they meet certain criteria. The second extends work authorization under the original DACA program from 2 years to 3 years and broadens age requirements.
Texas and 25 other states have sued over the programs, arguing the president does not have the authority to issue the new immigration policies, and that the programs violate the Constitution as well as the Administrative Procedure Act for notice-and-comment rule making. High court justices heard oral arguments April 18.
The ruling could impact the growing number of medical students with DACA status across the country, and jeopardize the funding invested in their training. Sixty-one medical schools now accept applications from DACA applicants, according to data from the Association of American Medical Colleges (AAMC). In 2015, 46 students with DACA status applied to U.S. medical schools and 20 were enrolled. In 2016, more than double (112) applied, although enrollment data will not be available until year’s end. Neither AAMC nor the National Resident Matching Program collect data on residents with DACA status.
A high court ruling in favor of the states could lead to DACA’s undoing, said Michael M. Hethmon, an attorney for the Immigration Reform Law Institute in Washington, D.C. The institute issued a brief to the Supreme Court in support of Texas.
If Texas prevails, “it’ll be a matter of weeks before a similar challenge will be levied against DACA and a number of other related programs,” Mr. Hethmon said in an interview. “There will be no more legal justification for those programs that exist.”
Saving talent or wasting money?
Loyola University in Chicago has accepted more students with DACA status than any other U.S. medical school. The reasons are simple, said Mark Kuczewski, Ph.D., chair of medical education at Loyola’s Stritch School of Medicine.
“We’re in the business of taking outstanding students,” Dr. Kuczewski said in an interview. “If the student is outstanding, we want them in our applicant pool. Second, being bilingual and bicultural is extremely important. We have patient populations out there that are diverse and underserved. We want to utilize this talent.”
In the fall of 2014, Stritch enrolled seven medical students with DACA status; in 2014, they doubled that enrollment. The students competed on the same playing field as other applicants and received no special treatment, Dr. Kuczewski said.
DACA students do pose funding challenges, he acknowledged. Although the students are protected from deportation and receive work authorization, they don’t qualify for federal student loans. Medical schools must find unique ways to help DACA students finance their education. A major Catholic health system provides student loan packages for several DACA students at Stritch, Dr. Kuczewski said. DACA students can also apply for financial assistance through an AAMC assistance program.
“Medical students use copious amounts of federal student loans,” he said. “Somehow the school has to make up that difference. We’ve found partners, but they don’t have infinite capacity, so we have to keep going back and finding new partners each year.”
The University of California, San Francisco, also has opened its doors to DACA students. Now in his third year, Jirayut New Latthivongskorn is UCSF’s first undocumented medical student. His education is financed by grants, private funding, and donations, said Mr. Latthivongskorn who came to the United States from Thailand when he was 9 years old. He is cofounder of Pre-Health Dreamers, a network of undocumented students who plan to pursue medical careers.
Before DACA granted his entry into UCSF, Mr. Latthivongskorn was accustomed to barriers because of his undocumented status, including having to turn down a nearly full-ride scholarship from the University of California, Davis, after high school.
“It was devastating,” Mr. Latthivongskorn said in an interview. “It was one of the very first times where I felt different and thought, ‘This is not going to work. You are undocumented.’”
Mr. Latthivongskorn and his family scraped together money for him to complete his undergraduate degree at the University of California, Berkeley. California has since passed the DREAM Act, a law that allows undocumented immigrants to receive private scholarships funded through public universities.
Not everyone believes undocumented immigrants should get the chance to become U.S. physicians. Dr. Jane M. Orient, executive director of the Association of American Physicians and Surgeons, argued that undocumented immigrants are not the answer to curbing the physician shortage.
“In a country that’s supposed to be ruled by law, it seems incomprehensible that people who are violating the law should be given privileges over people who are here legally,” she said in an interview. “We desperately do need more physicians, but we should not be blocking Americans from having this opportunity.”
Dr. Shirie Leng, a Boston anesthesiologist, said DACA is promising in theory, but falls short in practical application.
“There’s no particular reason why [undocumented students] wouldn’t make great doctors,” said Dr. Leng. “The problem is funding related. You can give kids all the opportunity you want, but if you can’t pay for it, that seems to me to be the biggest sticking point.”
Basing admission policies on programs that are vulnerable could end poorly for schools and students, Dr. Leng added.
If DACA is revoked, “it’s not just a waste of money for the school, but a waste of time for the kids,” she said.
Protections hinge on Supreme Court … and next president
During oral arguments earlier this month, justices appeared to disagree on whether DAPA and expanded DACA were properly executed.
Associate Justice Anthony M. Kennedy indicated that the normal order of government policy making had been “turned upside down,” by the creation of the programs. Associate Justice Sonia Sotomayor, meanwhile, noted that immigration policies with broader reaches have been similarly instituted in the past.
A ruling for the government would mean the president can use his executive power to enact policies that run contrary to immigration laws already in place, said Mr. Hethmon, the D.C. attorney. Current immigration laws trump informal agency discretion and do not allow for the government’s “arbitrary and capricious creation of a massive classification of nonstatus alien beneficiaries,” Mr. Hethmon wrote in his high court brief.
A decision that favors Texas would unravel opportunities for undocumented immigrants and prevent their ability to contribute to society, said Ignacia Rodriguez, a legal fellow at the National Immigration Law Center, which authored a brief in support of the government.
“What’s at stake is providing a stable environment for U.S. citizen children to grow, and providing people with the opportunity and tools to be able to contribute to the workforce [and] to the economy,” she said in an interview. “This is a payoff for everybody, not just those receiving the benefit.”
Regardless of what the Supreme Court decides, the next president could have the last word, according Ashley C. Parrish, a Washington D.C. attorney who cowrote a brief in support of the states. Mr. Parrish takes no position on the merits of the immigration programs, but rather, he is concerned with the administration’s failure to follow the Administrative Procedure Act’s requirements for notice-and-comment rule making.
“If the program were adopted as a legal rule after notice and comment, it could not be changed without going through a new notice-and-comment process,” he said. “If it is just a bare statement of policy, it can be changed at any time, without notice to anyone. The next administration could say, ‘Thank you for coming out of the shadows; we are now going to deport all of you.’ ”
Among the Democrats running for president, former Secretary of State Hillary Clinton has said she will defend DACA and Sen. Bernie Sanders (I-Vt.) has said he supports DACA and DAPA, and plans to expand them if elected.
Conversely, presumed Republican presidential nominee Donald Trump has indicated he would rescind DACA and related programs if elected.
After spending most of her life terrified of deportation, Ms. Rojas Marquez said she is not wasting time worrying about the Supreme Court’s decision or whether the next president will overturn the policy. She is keeping her studies foremost in her mind and the goal of becoming a doctor firmly in her heart.
“I have always lived with what-ifs,” she said. “This time around, I’m not going to be living in fear of the removing of DACA, because I wouldn’t have made it this far if I always lived in fear. My plan is no matter what happens, I’m going to finish medical school, and from there, I pray that I will be able to practice in the U.S.”
The Supreme Court is expected to issue its decision by June.
On Twitter @legal_med
Growing up, Denisse Rojas Marquez rarely visited the doctor. As undocumented immigrants from Mexico, her family viewed medical care as a luxury and sought it only in emergencies.
“I would always wait until it was very severe to see a doctor,” said Ms. Rojas Marquez, who came to the United States as a toddler. “That’s still a mentality I have to train myself out of. Growing up, going to the doctor meant very expensive bills and navigating through very complex systems.”
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
At 26, Ms. Rojas Marquez is determined to become a physician and help bridge the gap between undocumented immigrants and medical care. She is close to making that dream a reality because of a 2012 policy called the Deferred Action for Childhood Arrivals (DACA), which protects undocumented immigrants brought to the United States as children from deportation and offers access to work authorization. The policy enabled Ms. Rojas Marquez to become one of the first undocumented students to attend the Icahn School of Medicine at Mount Sinai in New York.
But the fate of Ms. Rojas Marquez’s medical education is in flux as the U.S. Supreme Court considers protections for undocumented immigrants in the case of Texas v. United States. In dispute is the constitutionality of two of President Obama’s immigration policies: the Deferred Action for Parents of Americans and Lawful Permanent Residents (DAPA) and expanded DACA. The former protects undocumented immigrants who are parents of U.S. citizens from deportation, if they meet certain criteria. The second extends work authorization under the original DACA program from 2 years to 3 years and broadens age requirements.
Texas and 25 other states have sued over the programs, arguing the president does not have the authority to issue the new immigration policies, and that the programs violate the Constitution as well as the Administrative Procedure Act for notice-and-comment rule making. High court justices heard oral arguments April 18.
The ruling could impact the growing number of medical students with DACA status across the country, and jeopardize the funding invested in their training. Sixty-one medical schools now accept applications from DACA applicants, according to data from the Association of American Medical Colleges (AAMC). In 2015, 46 students with DACA status applied to U.S. medical schools and 20 were enrolled. In 2016, more than double (112) applied, although enrollment data will not be available until year’s end. Neither AAMC nor the National Resident Matching Program collect data on residents with DACA status.
A high court ruling in favor of the states could lead to DACA’s undoing, said Michael M. Hethmon, an attorney for the Immigration Reform Law Institute in Washington, D.C. The institute issued a brief to the Supreme Court in support of Texas.
If Texas prevails, “it’ll be a matter of weeks before a similar challenge will be levied against DACA and a number of other related programs,” Mr. Hethmon said in an interview. “There will be no more legal justification for those programs that exist.”
Saving talent or wasting money?
Loyola University in Chicago has accepted more students with DACA status than any other U.S. medical school. The reasons are simple, said Mark Kuczewski, Ph.D., chair of medical education at Loyola’s Stritch School of Medicine.
“We’re in the business of taking outstanding students,” Dr. Kuczewski said in an interview. “If the student is outstanding, we want them in our applicant pool. Second, being bilingual and bicultural is extremely important. We have patient populations out there that are diverse and underserved. We want to utilize this talent.”
In the fall of 2014, Stritch enrolled seven medical students with DACA status; in 2014, they doubled that enrollment. The students competed on the same playing field as other applicants and received no special treatment, Dr. Kuczewski said.
DACA students do pose funding challenges, he acknowledged. Although the students are protected from deportation and receive work authorization, they don’t qualify for federal student loans. Medical schools must find unique ways to help DACA students finance their education. A major Catholic health system provides student loan packages for several DACA students at Stritch, Dr. Kuczewski said. DACA students can also apply for financial assistance through an AAMC assistance program.
“Medical students use copious amounts of federal student loans,” he said. “Somehow the school has to make up that difference. We’ve found partners, but they don’t have infinite capacity, so we have to keep going back and finding new partners each year.”
The University of California, San Francisco, also has opened its doors to DACA students. Now in his third year, Jirayut New Latthivongskorn is UCSF’s first undocumented medical student. His education is financed by grants, private funding, and donations, said Mr. Latthivongskorn who came to the United States from Thailand when he was 9 years old. He is cofounder of Pre-Health Dreamers, a network of undocumented students who plan to pursue medical careers.
Before DACA granted his entry into UCSF, Mr. Latthivongskorn was accustomed to barriers because of his undocumented status, including having to turn down a nearly full-ride scholarship from the University of California, Davis, after high school.
“It was devastating,” Mr. Latthivongskorn said in an interview. “It was one of the very first times where I felt different and thought, ‘This is not going to work. You are undocumented.’”
Mr. Latthivongskorn and his family scraped together money for him to complete his undergraduate degree at the University of California, Berkeley. California has since passed the DREAM Act, a law that allows undocumented immigrants to receive private scholarships funded through public universities.
Not everyone believes undocumented immigrants should get the chance to become U.S. physicians. Dr. Jane M. Orient, executive director of the Association of American Physicians and Surgeons, argued that undocumented immigrants are not the answer to curbing the physician shortage.
“In a country that’s supposed to be ruled by law, it seems incomprehensible that people who are violating the law should be given privileges over people who are here legally,” she said in an interview. “We desperately do need more physicians, but we should not be blocking Americans from having this opportunity.”
Dr. Shirie Leng, a Boston anesthesiologist, said DACA is promising in theory, but falls short in practical application.
“There’s no particular reason why [undocumented students] wouldn’t make great doctors,” said Dr. Leng. “The problem is funding related. You can give kids all the opportunity you want, but if you can’t pay for it, that seems to me to be the biggest sticking point.”
Basing admission policies on programs that are vulnerable could end poorly for schools and students, Dr. Leng added.
If DACA is revoked, “it’s not just a waste of money for the school, but a waste of time for the kids,” she said.
Protections hinge on Supreme Court … and next president
During oral arguments earlier this month, justices appeared to disagree on whether DAPA and expanded DACA were properly executed.
Associate Justice Anthony M. Kennedy indicated that the normal order of government policy making had been “turned upside down,” by the creation of the programs. Associate Justice Sonia Sotomayor, meanwhile, noted that immigration policies with broader reaches have been similarly instituted in the past.
A ruling for the government would mean the president can use his executive power to enact policies that run contrary to immigration laws already in place, said Mr. Hethmon, the D.C. attorney. Current immigration laws trump informal agency discretion and do not allow for the government’s “arbitrary and capricious creation of a massive classification of nonstatus alien beneficiaries,” Mr. Hethmon wrote in his high court brief.
A decision that favors Texas would unravel opportunities for undocumented immigrants and prevent their ability to contribute to society, said Ignacia Rodriguez, a legal fellow at the National Immigration Law Center, which authored a brief in support of the government.
“What’s at stake is providing a stable environment for U.S. citizen children to grow, and providing people with the opportunity and tools to be able to contribute to the workforce [and] to the economy,” she said in an interview. “This is a payoff for everybody, not just those receiving the benefit.”
Regardless of what the Supreme Court decides, the next president could have the last word, according Ashley C. Parrish, a Washington D.C. attorney who cowrote a brief in support of the states. Mr. Parrish takes no position on the merits of the immigration programs, but rather, he is concerned with the administration’s failure to follow the Administrative Procedure Act’s requirements for notice-and-comment rule making.
“If the program were adopted as a legal rule after notice and comment, it could not be changed without going through a new notice-and-comment process,” he said. “If it is just a bare statement of policy, it can be changed at any time, without notice to anyone. The next administration could say, ‘Thank you for coming out of the shadows; we are now going to deport all of you.’ ”
Among the Democrats running for president, former Secretary of State Hillary Clinton has said she will defend DACA and Sen. Bernie Sanders (I-Vt.) has said he supports DACA and DAPA, and plans to expand them if elected.
Conversely, presumed Republican presidential nominee Donald Trump has indicated he would rescind DACA and related programs if elected.
After spending most of her life terrified of deportation, Ms. Rojas Marquez said she is not wasting time worrying about the Supreme Court’s decision or whether the next president will overturn the policy. She is keeping her studies foremost in her mind and the goal of becoming a doctor firmly in her heart.
“I have always lived with what-ifs,” she said. “This time around, I’m not going to be living in fear of the removing of DACA, because I wouldn’t have made it this far if I always lived in fear. My plan is no matter what happens, I’m going to finish medical school, and from there, I pray that I will be able to practice in the U.S.”
The Supreme Court is expected to issue its decision by June.
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