As Obamacare Brings Patients, Doctors Not Warm To Medicaid

Klinify Raises $600K To Build An Evernote For Doctors In South Asia

The surve y, by physician staffing and consulting fi rm MerrittHawkins s howedjust 45.7 percent Medicaid acceptance as the Affordable Care Act provides a cash infusion of more than $900 billion in federal dollars from this year to 2022 to expand Medicaid programs for states interested in the proposition. There are, howe ver, about two dozen states, with R epublican governors or GOP legislatures opposed to the expansion that have turned down the federal dollars. There is also separate federal funding to raise Medicaid payments for primary care doctors to the level of payments from the Medicare health insurance program for the elderly through this year. That means an average pay increase of 73 percent for eligible primary care doctors. Tetra Images/Getty Images/Brand X Its unclear exactly how many more doctors will see Medicaid patients under the enhanced payments, but Merritt Hawkins Hawkins analysts, citing their study, dont see Medicaid acceptance changing much in part because more people will have private coverage, which generally pays doctors more than Medicaid or Medicare. Medicaid is the worst and Medicare is not much better and neither are as good as commercial insurance, said Travis Singleton, senior vice president at Merritt Hawkins, a subsidiary of AMN Healthcare (AMN). Doctors, Singleton said, will cherry pick patients depending on what insurance they have. To think physicians are going to change their tune and start accepting patients, Singleton said. Its unlikely to happen. The Medicaid acceptance trend indicates it will take a lot to get doctors to open their doors to Medicaid patients. The average rate of acceptance among family physicians, dermatologists, cardiologists, orthopedic surgeons and obstetrician/gynecologists in all 15 markets surveyed was 45.7 percent last year, according to data gathered from nearly 1,400 medical offices last year. The 2014 survey showed a drop from 55.4 percent acceptance in 2009, Merritt Hawkins said. In 2004, 49.9 percent of doctors surveyed accepted Medicaid patients. If Medicaid acceptance doesnt improve, it could impact choices of doctors for health plans that contract with the program.

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Doctors begin partial strike Monday, Health Ministry disagrees over participation rate

They fail to understand that most ofthe information aregenerated outside clinics through reports and images and that paper will be around for a long time, Krishanthan Surendran (Krish), the startups co-founder said in an interview. The doctors can use Klinifys tablet application to write prescriptions, make diagrams and even refer back to earlier diagnosis, just the way they would write on paper except that theres no paper involved. The users can also access patient records in the cloud from anywhere. I would say our closest competition is Evernote.There are thousands of EMR software out there, but doctors rarely use them to manage patient records. They are used as CRMs/ inventory management or accounting tools mostly; patient records are still paper based around this region, said Krish. With Klinify, the founders are attempting to address two of the most important needs of nearly $3 billion electronic medical record market in Asia ease of use and portability across different platforms. For now, Klinify is targeting around 5,000 doctors with their private clinics in Singapore, but it has plans to expand in other markets of Indonesia, India and even Japan going forward. Currently, a general physician stores about 40,000 records on an average and a specialist around 15,000 patient records in Singapore, according to Klinify. Though still in beta, Klinify has started getting encouraging reviews from senior doctors. Existing EMR solutions address practice inventory and accounts management, but Klinify is the first to provide a smooth solution in managing patients medical records without changing the workflow process, said Dr. C Sivathasan, a cardiac surgeon based in Singapore and an early user of Klinify. Klinify charges doctors on per-patient-per-visit basis, starting at anywhere between S$0.20 to S$6. Klinify started as Doctree.Asia, but its founders Krish and Nishanth Sudharsanam pivoted it into a new product six months later after realizing its not working out. But the learnings helped the founders flesh out Klinify. This is how the founders explained their idea at JFDI.Asia demo day last year: We eventually found out that they (doctors) hated a change in workflow process, and that went as far as their thought process when it came to consulting a patient, added Krish. While Singapore has its own National Electronic Healthcare Record system, its more focused on large hospitals, leaving a huge opportunity for startups such as Klinify to tap into.

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Health Ministry Spokesperson Ahmed Kamel said participation in the partial strike on Monday only reached 19 percent nationwide, while the doctors claimed 50 percent participation. Number of hospitals that took part in the strike is 88 out of 514 hospitals across the country, Kamel told Al-Masry Al-Youm. The strike was partial. It did not completely affect work at the hospitals. It was at some, not all, the external clinics, he added. The ministry formed operations chamber to communicate with heads of the hospitals, ministry deputies across Egypt to follow on the strike and assist patients. Mona Mina, secretary general of the syndicate, said participation within the strike on the first day is less than that of previous strikes. She added that participation rates of governorates of Aswan, Ismailia and Alexandria has not been sent to the syndicate due to urgent circumstances that happened to coordinators of the strike at these governorates. The average rate of participation in strike is 50 percent, which is less than the last average which reached 70 percent, Mina added. Strike at hospitals of Cairo reached 55 percent. In Sohag, Luxor and Qena, strike reached 90 percent. In Gharbiya, strike reached 60 percent. In Qalyoubeya, it reached 50 percent, according to her. The strike also reached 50 percent in Suez, 90 percent in Kafr al-Sheikh, 80 percent in Beheira and 60 percent in Marsa Matrouh, Mina said. The syndicate earlier called for strike against the doctors cadre which was adopted by Health Ministry. Doctors indicate to shortcomings within the cadre regarding the salaries and employment rights.

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Study: Certain Gastroenterologists Likely To Skimp On Biopsy Samples

Many Gastroenterologists Unaware of Appropriate Immunizations for IBD Patients

Unfortunately, not all physicians follow these guidelines, and a new study points to one possible reason. The study , performed by U.S.-based clinicians and published by the European Journal of Gastroenterology & Hepatology, used a large national database to identify all adults who had endoscopies and biopsies for celiac disease between 2006 and 2009. The researchers then analyzed those cases, which involved more than 92,000 people, to determine whether gastroenterologists who performed more endoscopies than the average tended to take fewer samples of the intestinal lining during each procedure. As it turned out, gastroenterologists with a higher procedure volume — in other words, who performed lots of endoscopies — did take fewer intestinal samples. Meanwhile, the study also found that gastroenterologists who worked more closely with other members of their medical specialty tended to take more samples, possibly because of peer-to-peer education. The authors note that most cases of celiac remain undiagnosed in the U.S., in part because too few physicians follow the guidelines calling for at least four samples of the intestinal lining. The moral of this story? If you’re undergoing celiac disease testing , try to choose a gastroenterologist who doesn’t perform tons of endoscopies, or one who works in concert with other gastroenterologists. And, stress during your pre-procedure visit that you expect the gastroenterologist to take at least four samples of your small intestine. Keep up with the latest in the celiac disease/gluten sensitivity world — sign up for my newsletter , connect with me on Facebook and Google+ , or follow me on Twitter – @AboutGlutenFree . Photo Getty Images/Rob Melnychuk

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According to the studies’ authors, many IBD patients are not being vaccinated appropriately. One thousand gastroenterologists, randomly selected from the membership of the American College of Gastroenterology, were asked to complete a 19-question electronic survey regarding suitable vaccines for the immune-competent and immunosupressed IBD patient and the barriers to recommending the vaccines. The researchers also assessed the perceived role of the gastroenterologist versus the PCP. The researchers analyzed 108 responses and found only 56 (52 percent) of the gastroenterologists took an immunization history most or all of the time. There was no significant difference between gastroenterologists with smaller practices (less than 40 IBD patients) compared with those with larger practices (greater than 40 IBD patients) in how often they asked their patients about immunization history. In contrast, more academic physicians (67.5 percent) asked their patients about immunization history most or all of the time compared to 42.4 percent of private physicians. Sixty-nine (64 percent) of the respondents thought the PCP was responsible for determining which vaccinations to administer to the IBD patient and ninety (83 percent) believed the PCP was responsible for administering the vaccine. Sixteen of the 108 surveyed gastroenterologists did not regularly recommend immunization against influenza. The most common reasons included “too busy/forgot,” “no specific reason,” and “did not know my patient needed it.” In addition, the researchers found 20 to 30 percent of gastroenterologists would erroneously recommend any of the three queried live, attenuated vaccines (MMR, herpes zoster, varicella) to their immune-suppressed IBD patient. In addition, 24 to 35 percent of gastroenterologists would incorrectly not give the three queried live, attenuated vaccinations to their immune-competent patients. Of the inactivated vaccines, knowledge regarding the HPV vaccine was particularly poor, with only 71 (66 percent) recommending the vaccine to their immune-competent patients and only 51 (47 percent) recommending the vaccine to their immune-suppressed patients). In general, gastroenterologists were more likely to make the correct vaccine recommendations for their immunocompetent IBD patients. “Gastroenterologist knowledge of the appropriate immunizations to recommend to the IBD patient is limited and may be the primary reason why the majority of gastroenterologists believe that the PCP should be responsible for vaccinations,” said primary author Sharmeel Wasan, MD, MSc, an assistant professor of medicine at BUSM and a gastroenterologist at BMC.

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Gastroenterologists Unlikely To Use Celltrion/Hospira’s Infliximab Biosimilar Due To Lack Of Clinical Data In Inflammatory Bowel Disease

U.S. Secretary of State John Kerry looks out at the Swiss Alps during a helicopter ride from Davos to Zurich January 25, 2014. REUTERS/Gary Cameron

30, 2013 EXTON, Penn., Sept. 30, 2013 /PRNewswire/ — BioTrends Research Group, one of the world’s leading research and advisory firms for specialized biopharmaceutical issues, finds that the majority of surveyed gastroenterologists do not expect to prescribe an infliximab biosimilar, such as Celltrion’s Remsima, in their Crohn’s disease (CD) or ulcerative colitis (UC) patients that has not been clinically tested in inflammatory bowl diseases. The Biosimilars Advisory Service report entitled Physician Perspectives on Pegylated IFN-a and TNF-a Inhibitors in Immune and Infectious Disease provides analysis of survey results from over 90 gastroenterologists, as well as more than 90 rheumatologists in the United States and Europe. The report finds that over 70 percent of surveyed gastroenterologists would not use biosimilar infliximab in CD or UC patients if the clinical trial had only been conducted in rheumatoid arthritis patients. Only a minority of survey respondents believe that indication extrapolation is an overall good idea. The report also finds that surveyed rheumatologists are similarly cautious about indication extrapolation, but most biosimilars of TNF-alpha inhibitors under development are being studied in rheumatoid arthritis patients. This strategy by biosimilar manufacturers could help to alleviate rheumatologists’ concerns about prescribing these biosimilar TNF-alpha inhibitors, but this study also reveals that rheumatologists would prefer a longer treatment duration and more patients to be included in biosimilar clinical trials compared with their gastroenterology counterparts. “The concept of indication extrapolation is particularly relevant to prescribers of TNF-alpha inhibitors because of the breadth of indications that these biologics are used in,” said Biosimilars Research Director Kate Keeping. “The first biosimilar TNF-alpha inhibitor that gastroenterologists will have access to, Celltrion/Hospira’s Inflectra (infliximab), has not been clinically tested in CD or UC patients, which will likely limit uptake in these patients, at least until direct clinical evidence is available.” The Biosimilars Advisory Service provides insight and analysis that is vital to successful business planning in the rapidly evolving biosimilars space. The service includes quarterly webinars detailing major developments, analyst insight addressing key market changes and opportunities, therapeutic area-specific primary research and forecasting modules. About BioTrends Research Group BioTrends Research Group provides syndicated and custom primary market research to pharmaceutical manufacturers competing in clinically evolving, specialty pharmaceutical markets. For information on BioTrends publications and research capabilities, please visit . BioTrends is a Decision Resources Group company. About Decision Resources Group Decision Resources Group is a cohesive portfolio of companies that offers best-in-class, high-value information and insights on important sectors of the healthcare industry. Clients rely on this analysis and data to make informed decisions. Please visit Decision Resources Group at .

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