The Hospitalist

Justin Kimsey, Alabama

Mohammed N.Y. Shah, MD, Alaska

Katharina Beeler, MD, Arizona

Khoi Nguyen, MD, Arizona

Vinay Saini, MD, Arizona

Maria Aceves, PA-C, California

Sarvenaz Alibeigi, California

Peter Cadman, MD, California

Katrina Chapman, DO, MPH, California

Cheryll Gallardo-Villena, MD, California

Sripriya Ganesan, California

Alice Gong, MD, California

Henry Kwang, MD, California

Kevin Li, California

Anthony Murphy, MD, California

Dan Nguyen, California

Daniel Oh, California

Joon Parle, California

Katie Raffel, California

Darshana Sarathchandra, MD, California

Lifang Zhang, California

Jaime Baker, MD, Colorado

Eric Johnson, PA-C, Colorado

Juan Lessing, MD, Colorado

Benjamin Ruckman, DO, Colorado

Rehaan Shaffie, MD, Colorado

Deborah Casey, MD, Connecticut

Daniel Heacock, PA-C, Connecticut

Shabana Ansari, DO, Delaware

Madhu Prattipati, MD, Delaware

Pallavi Aneja, MD, Florida

Satcha Borgella, MD, Florida

Thendrex H. Estrella, MD, Florida

Abid Hussain, MD, Florida

Daphnee Hutchinson, DO, Florida

Muhammad Jaffer, Florida

Sue Lee, ANP, Florida

Melissa Odermann, DO, Florida

Jose Guillermo Revelo Paiz, MD, Florida

Rafael J. Rolon Rivera, MD, Florida

Eleonor Rongo, Florida

Esther Roth, Florida

Shitaye Argaw, MD, Georgia

Taryn DeGrazia, Georgia

Becca Feistritzer, Georgia

Jamal Fitts, Georgia

Kristen Flint, Georgia

Zachary Hermes, Georgia

Mukesh Kumar, Georgia

Kajal Patel, Georgia

Madeline Smith, Georgia

Wade Flowers, PharmD, Idaho

Ajay Bhandare, Illinois

Kimberly Brighton, Illinois

Hristo D. Hristov, MD, Illinois

Sidney Iriana, Illinois

Aurelian Ivan, Illinois

Ming Lee, MD, Illinois

Michelle Lundholm, Illinois

Idrees Mohiuddin, MD, Illinois

Murr Murray, Illinois

Tad Nair, MD, Illinois

Shalini Reddy, MD, Illinois

Richard Rethorst, MD, Illinois

Kelly Robertshaw, Illinois

Gracelene Wegrzyn, Illinois

Evan Yates, Illinois

Lora J. Jones McClure, MD, Indiana

Carleigh Wilson, DO, Indiana

Erin Brown, ARNP, Iowa

Adam Gray, Iowa

Paul Greco, MD, Iowa

Shelly McGurk, ACNP, ARNP, Iowa

Julie Stanik-Hutt, ACNP, CNS, PhD, Iowa

Elizabeth Cozad, DO, Kansas

Roshan Pais, Kentucky

Mark Youssef, MD, Kentucky

Heather Kahn, MD, Louisiana

Danielle Parrott, PA-C, Maine

Erica Lafferty, ACNP, Maryland

Andrea Limpuangthip, Maryland

Steven Schwartz, CCM, MD, Maryland

Eisha Azhar, MBBS, Massachusetts

Badal Kalamkar, MD, MPH, Massachusetts

Bhavya Rajanna, MD, Massachusetts

Sahib Baljinder Singh, MD, Massachusetts

Kathryn Adams, Michigan

Haseeb Aslam, MD, MBBS, Michigan

Hilda Crispin, MD, Michigan

Sharmistha Dev, MD, Michigan

Tristan Feierabend, MD, Michigan

Sonal Kamalia, MD, MBBS, Michigan

Matthew Luzum, MD, Michigan

Daniel Mitzel, MD, Michigan

Richard Raad, Michigan

Mythri Ramegowda, MD, Michigan

Katie Scally, MD, Michigan

Linden Spital, MSN, NP, Michigan

Porama Koy Thanaporn, MD, Michigan

Chanteil Ulatowski, Michigan

Tingting Xiong, MD, Michigan

Adam Zahr, Michigan

Mike Beste, MD, Minnesota

Elise Haupt, PA-C, Minnesota

Lobsang Trasar, MD, Minnesota

Kari Goan, DO, Mississippi

David C. Pierre, Mississippi

Sudheer Tangella, MD, Mississippi

Tahani Atieh, Missouri

Nicholas Arnold, Missouri

Amanda Calhoun, Missouri

Jyotirmoy Das, Missouri

Umber Dube, Missouri

Daniel Gaughan, Missouri

Woojin Joo, Missouri

Khaled Jumean, MBBS, Missouri

Salma Kazmi, MBBS, MD, Missouri

Yoon Kook (Danny) Kim, Missouri

Ryan Kronen, Missouri

Alyssa Kroner, Missouri

Randy Laine, Missouri

Edward Lee, Missouri

Cerena Leung, Missouri

Patricia Lithrow, Missouri

Brandt Lydon, Missouri

Mary Morgan Scott, Missouri

Jay Patel, Missouri

Justin Porter, Missouri

Danelle Reagin, FNP-C, Missouri

Amanda Reis, Missouri

Awik Som, Missouri

Abby Sung, Missouri

Mary Sutherland, Missouri

Maggie Wang, Missouri

Noah Wasserman, Missouri

Alexis Webber, Missouri

Ryan White, Missouri

Amy Xu, Missouri

Ran Xu, Missouri

Michael Yang, Missouri

Christopher Dietrich, MD, Montana

Jason Kunz, DO, Montana

Jodi Cantrell, MD, Nebraska

Steven Hart, MD, Nebraska

Kurt Kapels, MD, Nebraska

Brian Keegan, MD, Nebraska

Shaun Jang, MD, Nevada

Gurpinder Singh, MD, New Hampshire

Pragati Banda, MD, New Jersey

Sahai Donaldson, MBBS, New Jersey

Ashesha Mechineni, MD, New Jersey

Alisa Clark, New Mexico

Prajit Arora, MBBS, New Mexico

Crystal Cardwell, New Mexico

Landon Casaus, New Mexico

Tapuwa Mupfumira, MD, New Mexico

Eric Rightley, New Mexico

David S. Anderson, New York

Joan Bosco, MD, New York

Jessica Caro, New York

Anna Dewan, New York

Amrita Dhillon, MBBS, New York

Julia Frydman, New York

Radhika Gali, MBBS, MDS, New York

Allison Guttmann, MD, New York

Aryles Hedjar, MD, New York

Peter Janes, New York

Nadine Kalavazoff, New York

Jeffrey Lach, DO, New York

Keron Lezama, MD, New York

Yingheng Liu, New York

Taimur Mirza, New York

Cyrus Nensey, MD, New York

Nekee Pandya, MD, New York

Thushara Paul, MD, New York

Yu Sung, New York

Joel Boggan, MD, North Carolina

Angela Fletcher, North Carolina

Rebecca Gimpert, PA-C, North Carolina

Samantha Levering, PA-C, North Carolina

Nancy Martin, North Carolina

Richard Sherwood, North Carolina

Kranthi K. Sitammagari, MD, North Carolina

Aaron Swedberg, MPAS, PA-C, North Carolina

Yih-Cherng Tsai, North Carolina

Richard Bakker, MD, PhD, Ohio

Matthew Broderick, MD, Ohio

Subbaraju Budharaju, MD, MS, Ohio

Steven Bumb, MD, Ohio

Ahmed Eltelbany, MD, Ohio

Tracey Hardin, MS, Ohio

Patricia Hardman, APRN, Ohio

Michael Lewis, MD, Ohio

Volodymyr Manko, Ohio

Rebecca Stone, Ohio

Chaitanya Valluri, Ohio

Holly Wierzbicki, CNP, Ohio

Jamie Yockey, APRN, CNP, Ohio

Mahdi Mussa, MD, Oklahoma

Monica Saemz, DO, Oklahoma

Peter Ganter, MD, Oregon

Bethany Roy, MD, Oregon

Mary Clare Bohnett, Oregon

Molly Rabinowitz, Oregon

Abdullateef Abdulkareem, MD, MPH, Pennsylvania

David Ahamba, MD, MPH, Pennsylvania

David Chin, MD, Pennsylvania

Thomas Conlon, Pennsylvania

Dan Giesler, MD, Pennsylvania

Umair Randhawa, MD, Pennsylvania

Syed Yusuf, MBBS, Pennsylvania

Michael Rigatti, Pennsylvania

Thaylon Barreto, Rhode Island

Jessica Cook, MD, South Carolina

Robin Malik, MD, South Carolina

John Busigin, Tennessee

Shefali Paranjape, MD, Tennessee

Thai Dang, MD, Texas

Matthew Glover, MD, Texas

Snigdha Jain, MD, Texas

David Kellenberger, Texas

Sumeet Kumar, Texas

Kyle McClendon, PA-C, Texas

Sowjanya Mohan, Texas

Akhil D. Vats, MD, Texas

Samatha Vellanki, Texas

Lee-Anna Burgess, MD, Vermont

Rick Hildebrant, MD, Vermont

Matthew Backens, MD, Virginia

Megan Coe, Virginia

Kevin Dehaan, Virginia

Stephen Fox, Virginia

Amber Inofuentes, MD, Virginia

Jessica Keiser, MD, Virginia

Joseph Perez, MD, FAAFP, MBA, Virginia

Kanwapreet S. Saini, MD, Virginia

Erin Vipler, MD, Virginia

Naveen Voore, MBBS, Virginia

Abhishek Agarwal, MD, MBBS, Washington

Robert Cooney, MD, Washington

Cynthia Horton, MD, Washington

Rich A. Kukreja, MD, Washington

Ji Young Nam, MD, Washington

Kai Wilhelm, MD, Washington

In Kyu Yoo, Washington

Temu Brown, Wisconsin

Pablo Colon Nieves, Wisconsin

Christina Evans, PAC, Wisconsin

Swetha Karturi, MBBS, Wisconsin

Mark Babcock, DO, Wyoming

Ahmad Von Schlegell, Canada

Anand Kartha, Japan

Mohamed Sadek, Qatar

Amine Rakab, MD, Qatar

Abazar Saeed, Qatar

Joao Guerra, MD

Justin Kimsey, Alabama

Mohammed N.Y. Shah, MD, Alaska

Katharina Beeler, MD, Arizona

Khoi Nguyen, MD, Arizona

Vinay Saini, MD, Arizona

Maria Aceves, PA-C, California

Sarvenaz Alibeigi, California

Peter Cadman, MD, California

Katrina Chapman, DO, MPH, California

Cheryll Gallardo-Villena, MD, California

Sripriya Ganesan, California

Alice Gong, MD, California

Henry Kwang, MD, California

Kevin Li, California

Anthony Murphy, MD, California

Dan Nguyen, California

Daniel Oh, California

Joon Parle, California

Katie Raffel, California

Darshana Sarathchandra, MD, California

Lifang Zhang, California

Jaime Baker, MD, Colorado

Eric Johnson, PA-C, Colorado

Juan Lessing, MD, Colorado

Benjamin Ruckman, DO, Colorado

Rehaan Shaffie, MD, Colorado

Deborah Casey, MD, Connecticut

Daniel Heacock, PA-C, Connecticut

Shabana Ansari, DO, Delaware

Madhu Prattipati, MD, Delaware

Pallavi Aneja, MD, Florida

Satcha Borgella, MD, Florida

Thendrex H. Estrella, MD, Florida

Abid Hussain, MD, Florida

Daphnee Hutchinson, DO, Florida

Muhammad Jaffer, Florida

Sue Lee, ANP, Florida

Melissa Odermann, DO, Florida

Jose Guillermo Revelo Paiz, MD, Florida

Rafael J. Rolon Rivera, MD, Florida

Eleonor Rongo, Florida

Esther Roth, Florida

Shitaye Argaw, MD, Georgia

Taryn DeGrazia, Georgia

Becca Feistritzer, Georgia

Jamal Fitts, Georgia

Kristen Flint, Georgia

Zachary Hermes, Georgia

Mukesh Kumar, Georgia

Kajal Patel, Georgia

Madeline Smith, Georgia

Wade Flowers, PharmD, Idaho

Ajay Bhandare, Illinois

Kimberly Brighton, Illinois

Hristo D. Hristov, MD, Illinois

Sidney Iriana, Illinois

Aurelian Ivan, Illinois

Ming Lee, MD, Illinois

Michelle Lundholm, Illinois

Idrees Mohiuddin, MD, Illinois

Murr Murray, Illinois

Tad Nair, MD, Illinois

Shalini Reddy, MD, Illinois

Richard Rethorst, MD, Illinois

Kelly Robertshaw, Illinois

Gracelene Wegrzyn, Illinois

Evan Yates, Illinois

Lora J. Jones McClure, MD, Indiana

Carleigh Wilson, DO, Indiana

Erin Brown, ARNP, Iowa

Adam Gray, Iowa

Paul Greco, MD, Iowa

Shelly McGurk, ACNP, ARNP, Iowa

Julie Stanik-Hutt, ACNP, CNS, PhD, Iowa

Elizabeth Cozad, DO, Kansas

Roshan Pais, Kentucky

Mark Youssef, MD, Kentucky

Heather Kahn, MD, Louisiana

Danielle Parrott, PA-C, Maine

Erica Lafferty, ACNP, Maryland

Andrea Limpuangthip, Maryland

Steven Schwartz, CCM, MD, Maryland

Eisha Azhar, MBBS, Massachusetts

Badal Kalamkar, MD, MPH, Massachusetts

Bhavya Rajanna, MD, Massachusetts

Sahib Baljinder Singh, MD, Massachusetts

Kathryn Adams, Michigan

Haseeb Aslam, MD, MBBS, Michigan

Hilda Crispin, MD, Michigan

Sharmistha Dev, MD, Michigan

Tristan Feierabend, MD, Michigan

Sonal Kamalia, MD, MBBS, Michigan

Matthew Luzum, MD, Michigan

Daniel Mitzel, MD, Michigan

Richard Raad, Michigan

Mythri Ramegowda, MD, Michigan

Katie Scally, MD, Michigan

Linden Spital, MSN, NP, Michigan

Porama Koy Thanaporn, MD, Michigan

Chanteil Ulatowski, Michigan

Tingting Xiong, MD, Michigan

Adam Zahr, Michigan

Mike Beste, MD, Minnesota

Elise Haupt, PA-C, Minnesota

Lobsang Trasar, MD, Minnesota

Kari Goan, DO, Mississippi

David C. Pierre, Mississippi

Sudheer Tangella, MD, Mississippi

Tahani Atieh, Missouri

Nicholas Arnold, Missouri

Amanda Calhoun, Missouri

Jyotirmoy Das, Missouri

Umber Dube, Missouri

Daniel Gaughan, Missouri

Woojin Joo, Missouri

Khaled Jumean, MBBS, Missouri

Salma Kazmi, MBBS, MD, Missouri

Yoon Kook (Danny) Kim, Missouri

Ryan Kronen, Missouri

Alyssa Kroner, Missouri

Randy Laine, Missouri

Edward Lee, Missouri

Cerena Leung, Missouri

Patricia Lithrow, Missouri

Brandt Lydon, Missouri

Mary Morgan Scott, Missouri

Jay Patel, Missouri

Justin Porter, Missouri

Danelle Reagin, FNP-C, Missouri

Amanda Reis, Missouri

Awik Som, Missouri

Abby Sung, Missouri

Mary Sutherland, Missouri

Maggie Wang, Missouri

Noah Wasserman, Missouri

Alexis Webber, Missouri

Ryan White, Missouri

Amy Xu, Missouri

Ran Xu, Missouri

Michael Yang, Missouri

Christopher Dietrich, MD, Montana

Jason Kunz, DO, Montana

Jodi Cantrell, MD, Nebraska

Steven Hart, MD, Nebraska

Kurt Kapels, MD, Nebraska

Brian Keegan, MD, Nebraska

Shaun Jang, MD, Nevada

Gurpinder Singh, MD, New Hampshire

Pragati Banda, MD, New Jersey

Sahai Donaldson, MBBS, New Jersey

Ashesha Mechineni, MD, New Jersey

Alisa Clark, New Mexico

Prajit Arora, MBBS, New Mexico

Crystal Cardwell, New Mexico

Landon Casaus, New Mexico

Tapuwa Mupfumira, MD, New Mexico

Eric Rightley, New Mexico

David S. Anderson, New York

Joan Bosco, MD, New York

Jessica Caro, New York

Anna Dewan, New York

Amrita Dhillon, MBBS, New York

Julia Frydman, New York

Radhika Gali, MBBS, MDS, New York

Allison Guttmann, MD, New York

Aryles Hedjar, MD, New York

Peter Janes, New York

Nadine Kalavazoff, New York

Jeffrey Lach, DO, New York

Keron Lezama, MD, New York

Yingheng Liu, New York

Taimur Mirza, New York

Cyrus Nensey, MD, New York

Nekee Pandya, MD, New York

Thushara Paul, MD, New York

Yu Sung, New York

Joel Boggan, MD, North Carolina

Angela Fletcher, North Carolina

Rebecca Gimpert, PA-C, North Carolina

Samantha Levering, PA-C, North Carolina

Nancy Martin, North Carolina

Richard Sherwood, North Carolina

Kranthi K. Sitammagari, MD, North Carolina

Aaron Swedberg, MPAS, PA-C, North Carolina

Yih-Cherng Tsai, North Carolina

Richard Bakker, MD, PhD, Ohio

Matthew Broderick, MD, Ohio

Subbaraju Budharaju, MD, MS, Ohio

Steven Bumb, MD, Ohio

Ahmed Eltelbany, MD, Ohio

Tracey Hardin, MS, Ohio

Patricia Hardman, APRN, Ohio

Michael Lewis, MD, Ohio

Volodymyr Manko, Ohio

Rebecca Stone, Ohio

Chaitanya Valluri, Ohio

Holly Wierzbicki, CNP, Ohio

Jamie Yockey, APRN, CNP, Ohio

Mahdi Mussa, MD, Oklahoma

Monica Saemz, DO, Oklahoma

Peter Ganter, MD, Oregon

Bethany Roy, MD, Oregon

Mary Clare Bohnett, Oregon

Molly Rabinowitz, Oregon

Abdullateef Abdulkareem, MD, MPH, Pennsylvania

David Ahamba, MD, MPH, Pennsylvania

David Chin, MD, Pennsylvania

Thomas Conlon, Pennsylvania

Dan Giesler, MD, Pennsylvania

Umair Randhawa, MD, Pennsylvania

Syed Yusuf, MBBS, Pennsylvania

Michael Rigatti, Pennsylvania

Thaylon Barreto, Rhode Island

Jessica Cook, MD, South Carolina

Robin Malik, MD, South Carolina

John Busigin, Tennessee

Shefali Paranjape, MD, Tennessee

Thai Dang, MD, Texas

Matthew Glover, MD, Texas

Snigdha Jain, MD, Texas

David Kellenberger, Texas

Sumeet Kumar, Texas

Kyle McClendon, PA-C, Texas

Sowjanya Mohan, Texas

Akhil D. Vats, MD, Texas

Samatha Vellanki, Texas

Lee-Anna Burgess, MD, Vermont

Rick Hildebrant, MD, Vermont

Matthew Backens, MD, Virginia

Megan Coe, Virginia

Kevin Dehaan, Virginia

Stephen Fox, Virginia

Amber Inofuentes, MD, Virginia

Jessica Keiser, MD, Virginia

Joseph Perez, MD, FAAFP, MBA, Virginia

Kanwapreet S. Saini, MD, Virginia

Erin Vipler, MD, Virginia

Naveen Voore, MBBS, Virginia

Abhishek Agarwal, MD, MBBS, Washington

Robert Cooney, MD, Washington

Cynthia Horton, MD, Washington

Rich A. Kukreja, MD, Washington

Ji Young Nam, MD, Washington

Kai Wilhelm, MD, Washington

In Kyu Yoo, Washington

Temu Brown, Wisconsin

Pablo Colon Nieves, Wisconsin

Christina Evans, PAC, Wisconsin

Swetha Karturi, MBBS, Wisconsin

Mark Babcock, DO, Wyoming

Ahmad Von Schlegell, Canada

Anand Kartha, Japan

Mohamed Sadek, Qatar

Amine Rakab, MD, Qatar

Abazar Saeed, Qatar

Joao Guerra, MD

Justin Kimsey, Alabama

Mohammed N.Y. Shah, MD, Alaska

Katharina Beeler, MD, Arizona

Khoi Nguyen, MD, Arizona

Vinay Saini, MD, Arizona

Maria Aceves, PA-C, California

Sarvenaz Alibeigi, California

Peter Cadman, MD, California

Katrina Chapman, DO, MPH, California

Cheryll Gallardo-Villena, MD, California

Sripriya Ganesan, California

Alice Gong, MD, California

Henry Kwang, MD, California

Kevin Li, California

Anthony Murphy, MD, California

Dan Nguyen, California

Daniel Oh, California

Joon Parle, California

Katie Raffel, California

Darshana Sarathchandra, MD, California

Lifang Zhang, California

Jaime Baker, MD, Colorado

Eric Johnson, PA-C, Colorado

Juan Lessing, MD, Colorado

Benjamin Ruckman, DO, Colorado

Rehaan Shaffie, MD, Colorado

Deborah Casey, MD, Connecticut

Daniel Heacock, PA-C, Connecticut

Shabana Ansari, DO, Delaware

Madhu Prattipati, MD, Delaware

Pallavi Aneja, MD, Florida

Satcha Borgella, MD, Florida

Thendrex H. Estrella, MD, Florida

Abid Hussain, MD, Florida

Daphnee Hutchinson, DO, Florida

Muhammad Jaffer, Florida

Sue Lee, ANP, Florida

Melissa Odermann, DO, Florida

Jose Guillermo Revelo Paiz, MD, Florida

Rafael J. Rolon Rivera, MD, Florida

Eleonor Rongo, Florida

Esther Roth, Florida

Shitaye Argaw, MD, Georgia

Taryn DeGrazia, Georgia

Becca Feistritzer, Georgia

Jamal Fitts, Georgia

Kristen Flint, Georgia

Zachary Hermes, Georgia

Mukesh Kumar, Georgia

Kajal Patel, Georgia

Madeline Smith, Georgia

Wade Flowers, PharmD, Idaho

Ajay Bhandare, Illinois

Kimberly Brighton, Illinois

Hristo D. Hristov, MD, Illinois

Sidney Iriana, Illinois

Aurelian Ivan, Illinois

Ming Lee, MD, Illinois

Michelle Lundholm, Illinois

Idrees Mohiuddin, MD, Illinois

Murr Murray, Illinois

Tad Nair, MD, Illinois

Shalini Reddy, MD, Illinois

Richard Rethorst, MD, Illinois

Kelly Robertshaw, Illinois

Gracelene Wegrzyn, Illinois

Evan Yates, Illinois

Lora J. Jones McClure, MD, Indiana

Carleigh Wilson, DO, Indiana

Erin Brown, ARNP, Iowa

Adam Gray, Iowa

Paul Greco, MD, Iowa

Shelly McGurk, ACNP, ARNP, Iowa

Julie Stanik-Hutt, ACNP, CNS, PhD, Iowa

Elizabeth Cozad, DO, Kansas

Roshan Pais, Kentucky

Mark Youssef, MD, Kentucky

Heather Kahn, MD, Louisiana

Danielle Parrott, PA-C, Maine

Erica Lafferty, ACNP, Maryland

Andrea Limpuangthip, Maryland

Steven Schwartz, CCM, MD, Maryland

Eisha Azhar, MBBS, Massachusetts

Badal Kalamkar, MD, MPH, Massachusetts

Bhavya Rajanna, MD, Massachusetts

Sahib Baljinder Singh, MD, Massachusetts

Kathryn Adams, Michigan

Haseeb Aslam, MD, MBBS, Michigan

Hilda Crispin, MD, Michigan

Sharmistha Dev, MD, Michigan

Tristan Feierabend, MD, Michigan

Sonal Kamalia, MD, MBBS, Michigan

Matthew Luzum, MD, Michigan

Daniel Mitzel, MD, Michigan

Richard Raad, Michigan

Mythri Ramegowda, MD, Michigan

Katie Scally, MD, Michigan

Linden Spital, MSN, NP, Michigan

Porama Koy Thanaporn, MD, Michigan

Chanteil Ulatowski, Michigan

Tingting Xiong, MD, Michigan

Adam Zahr, Michigan

Mike Beste, MD, Minnesota

Elise Haupt, PA-C, Minnesota

Lobsang Trasar, MD, Minnesota

Kari Goan, DO, Mississippi

David C. Pierre, Mississippi

Sudheer Tangella, MD, Mississippi

Tahani Atieh, Missouri

Nicholas Arnold, Missouri

Amanda Calhoun, Missouri

Jyotirmoy Das, Missouri

Umber Dube, Missouri

Daniel Gaughan, Missouri

Woojin Joo, Missouri

Khaled Jumean, MBBS, Missouri

Salma Kazmi, MBBS, MD, Missouri

Yoon Kook (Danny) Kim, Missouri

Ryan Kronen, Missouri

Alyssa Kroner, Missouri

Randy Laine, Missouri

Edward Lee, Missouri

Cerena Leung, Missouri

Patricia Lithrow, Missouri

Brandt Lydon, Missouri

Mary Morgan Scott, Missouri

Jay Patel, Missouri

Justin Porter, Missouri

Danelle Reagin, FNP-C, Missouri

Amanda Reis, Missouri

Awik Som, Missouri

Abby Sung, Missouri

Mary Sutherland, Missouri

Maggie Wang, Missouri

Noah Wasserman, Missouri

Alexis Webber, Missouri

Ryan White, Missouri

Amy Xu, Missouri

Ran Xu, Missouri

Michael Yang, Missouri

Christopher Dietrich, MD, Montana

Jason Kunz, DO, Montana

Jodi Cantrell, MD, Nebraska

Steven Hart, MD, Nebraska

Kurt Kapels, MD, Nebraska

Brian Keegan, MD, Nebraska

Shaun Jang, MD, Nevada

Gurpinder Singh, MD, New Hampshire

Pragati Banda, MD, New Jersey

Sahai Donaldson, MBBS, New Jersey

Ashesha Mechineni, MD, New Jersey

Alisa Clark, New Mexico

Prajit Arora, MBBS, New Mexico

Crystal Cardwell, New Mexico

Landon Casaus, New Mexico

Tapuwa Mupfumira, MD, New Mexico

Eric Rightley, New Mexico

David S. Anderson, New York

Joan Bosco, MD, New York

Jessica Caro, New York

Anna Dewan, New York

Amrita Dhillon, MBBS, New York

Julia Frydman, New York

Radhika Gali, MBBS, MDS, New York

Allison Guttmann, MD, New York

Aryles Hedjar, MD, New York

Peter Janes, New York

Nadine Kalavazoff, New York

Jeffrey Lach, DO, New York

Keron Lezama, MD, New York

Yingheng Liu, New York

Taimur Mirza, New York

Cyrus Nensey, MD, New York

Nekee Pandya, MD, New York

Thushara Paul, MD, New York

Yu Sung, New York

Joel Boggan, MD, North Carolina

Angela Fletcher, North Carolina

Rebecca Gimpert, PA-C, North Carolina

Samantha Levering, PA-C, North Carolina

Nancy Martin, North Carolina

Richard Sherwood, North Carolina

Kranthi K. Sitammagari, MD, North Carolina

Aaron Swedberg, MPAS, PA-C, North Carolina

Yih-Cherng Tsai, North Carolina

Richard Bakker, MD, PhD, Ohio

Matthew Broderick, MD, Ohio

Subbaraju Budharaju, MD, MS, Ohio

Steven Bumb, MD, Ohio

Ahmed Eltelbany, MD, Ohio

Tracey Hardin, MS, Ohio

Patricia Hardman, APRN, Ohio

Michael Lewis, MD, Ohio

Volodymyr Manko, Ohio

Rebecca Stone, Ohio

Chaitanya Valluri, Ohio

Holly Wierzbicki, CNP, Ohio

Jamie Yockey, APRN, CNP, Ohio

Mahdi Mussa, MD, Oklahoma

Monica Saemz, DO, Oklahoma

Peter Ganter, MD, Oregon

Bethany Roy, MD, Oregon

Mary Clare Bohnett, Oregon

Molly Rabinowitz, Oregon

Abdullateef Abdulkareem, MD, MPH, Pennsylvania

David Ahamba, MD, MPH, Pennsylvania

David Chin, MD, Pennsylvania

Thomas Conlon, Pennsylvania

Dan Giesler, MD, Pennsylvania

Umair Randhawa, MD, Pennsylvania

Syed Yusuf, MBBS, Pennsylvania

Michael Rigatti, Pennsylvania

Thaylon Barreto, Rhode Island

Jessica Cook, MD, South Carolina

Robin Malik, MD, South Carolina

John Busigin, Tennessee

Shefali Paranjape, MD, Tennessee

Thai Dang, MD, Texas

Matthew Glover, MD, Texas

Snigdha Jain, MD, Texas

David Kellenberger, Texas

Sumeet Kumar, Texas

Kyle McClendon, PA-C, Texas

Sowjanya Mohan, Texas

Akhil D. Vats, MD, Texas

Samatha Vellanki, Texas

Lee-Anna Burgess, MD, Vermont

Rick Hildebrant, MD, Vermont

Matthew Backens, MD, Virginia

Megan Coe, Virginia

Kevin Dehaan, Virginia

Stephen Fox, Virginia

Amber Inofuentes, MD, Virginia

Jessica Keiser, MD, Virginia

Joseph Perez, MD, FAAFP, MBA, Virginia

Kanwapreet S. Saini, MD, Virginia

Erin Vipler, MD, Virginia

Naveen Voore, MBBS, Virginia

Abhishek Agarwal, MD, MBBS, Washington

Robert Cooney, MD, Washington

Cynthia Horton, MD, Washington

Rich A. Kukreja, MD, Washington

Ji Young Nam, MD, Washington

Kai Wilhelm, MD, Washington

In Kyu Yoo, Washington

Temu Brown, Wisconsin

Pablo Colon Nieves, Wisconsin

Christina Evans, PAC, Wisconsin

Swetha Karturi, MBBS, Wisconsin

Mark Babcock, DO, Wyoming

Ahmad Von Schlegell, Canada

Anand Kartha, Japan

Mohamed Sadek, Qatar

Amine Rakab, MD, Qatar

Abazar Saeed, Qatar

Joao Guerra, MD

Clinical question: What are the most common errors in inhaler use over the past 40 years?

Background: One of the reasons for poor asthma and COPD control is incorrect inhaler use. Problems with technique have been recognized since the launch of the metered-dose inhaler (MDI) in the 1960s. Multiple initiatives have been implemented, including the design of the dry powder inhaler (DPI); however, problems persist despite all corrective measures.

Study design: Meta-analysis.

The overall prevalence of correct technique was the same as poor technique (31%). There was no difference in the rates of incorrect inhaler use between the first and second 20-year periods of investigation.

Bottom line: Incorrect inhaler use in patients with asthma and COPD persists over time despite multiple implemented strategies.

Citation: Sanchis J, Gich I, Pedersen S, Aerosol Drug Management Improvement Team. Systematic review of errors in inhaler use: has the patient technique improved over time? Chest. 2016;150(2):394-406.

Dr. Florindez is an assistant professor at the University of Miami Miller School of Medicine and a hospitalist at University of Miami Hospital and Jackson Memorial Hospital.

Clinical question: What are the most common errors in inhaler use over the past 40 years?

Background: One of the reasons for poor asthma and COPD control is incorrect inhaler use. Problems with technique have been recognized since the launch of the metered-dose inhaler (MDI) in the 1960s. Multiple initiatives have been implemented, including the design of the dry powder inhaler (DPI); however, problems persist despite all corrective measures.

Study design: Meta-analysis.

The overall prevalence of correct technique was the same as poor technique (31%). There was no difference in the rates of incorrect inhaler use between the first and second 20-year periods of investigation.

Bottom line: Incorrect inhaler use in patients with asthma and COPD persists over time despite multiple implemented strategies.

Citation: Sanchis J, Gich I, Pedersen S, Aerosol Drug Management Improvement Team. Systematic review of errors in inhaler use: has the patient technique improved over time? Chest. 2016;150(2):394-406.

Dr. Florindez is an assistant professor at the University of Miami Miller School of Medicine and a hospitalist at University of Miami Hospital and Jackson Memorial Hospital.

Clinical question: What are the most common errors in inhaler use over the past 40 years?

Background: One of the reasons for poor asthma and COPD control is incorrect inhaler use. Problems with technique have been recognized since the launch of the metered-dose inhaler (MDI) in the 1960s. Multiple initiatives have been implemented, including the design of the dry powder inhaler (DPI); however, problems persist despite all corrective measures.

Study design: Meta-analysis.

The overall prevalence of correct technique was the same as poor technique (31%). There was no difference in the rates of incorrect inhaler use between the first and second 20-year periods of investigation.

Bottom line: Incorrect inhaler use in patients with asthma and COPD persists over time despite multiple implemented strategies.

Citation: Sanchis J, Gich I, Pedersen S, Aerosol Drug Management Improvement Team. Systematic review of errors in inhaler use: has the patient technique improved over time? Chest. 2016;150(2):394-406.

Dr. Florindez is an assistant professor at the University of Miami Miller School of Medicine and a hospitalist at University of Miami Hospital and Jackson Memorial Hospital.

Clinical question: Does anticoagulation prevent thromboembolic events in patients undergoing bioprosthetic valve implantation?

Background: The main advantage of bioprosthetic valves, compared with mechanical valves, is the avoidance of long-term anticoagulation. Current guidelines recommend the use of vitamin K antagonist (VKA) during the first 3 months after surgery, which remains controversial. Two randomized controlled trials (RCTs) showed no benefit of using VKA in the first 3 months; however, other studies have reported conflicting results.

Study design: Meta-analysis and systematic review.

Setting: Multicenter.

Synopsis: This meta-analysis included two RCTs and 12 observational studies that compared the outcomes in group I (VKA) versus group II (antiplatelet therapy/no treatment). There was no difference in thromboembolic events between group I (1%) and group II (1.5%), but there were more bleeding events in group I (2.6%) versus group II (1.1%). In addition, no differences in all-cause of mortality rate and need for redo surgery were found between the two groups.

Bottom line: The use of VKA in the first 3 months after a bioprosthetic valve implantation does not decrease the rate of thromboembolic events or mortality, but it is associated with increased risk of major bleeding.

Citation: Masri A, Gillinov M, Johnston DM, et al. Anticoagulation versus antiplatelet or no therapy in patients undergoing bioprosthetic valve implantation: a systematic review and meta-analysis [published online ahead of print Aug. 3, 2016]. Heart. doi: 10.1136/heartjnl-2016-309630

Dr. Florindez is an assistant professor at the University of Miami Miller School of Medicine and a hospitalist at University of Miami Hospital and Jackson Memorial Hospital.

Clinical question: Does anticoagulation prevent thromboembolic events in patients undergoing bioprosthetic valve implantation?

Background: The main advantage of bioprosthetic valves, compared with mechanical valves, is the avoidance of long-term anticoagulation. Current guidelines recommend the use of vitamin K antagonist (VKA) during the first 3 months after surgery, which remains controversial. Two randomized controlled trials (RCTs) showed no benefit of using VKA in the first 3 months; however, other studies have reported conflicting results.

Study design: Meta-analysis and systematic review.

Setting: Multicenter.

Synopsis: This meta-analysis included two RCTs and 12 observational studies that compared the outcomes in group I (VKA) versus group II (antiplatelet therapy/no treatment). There was no difference in thromboembolic events between group I (1%) and group II (1.5%), but there were more bleeding events in group I (2.6%) versus group II (1.1%). In addition, no differences in all-cause of mortality rate and need for redo surgery were found between the two groups.

Bottom line: The use of VKA in the first 3 months after a bioprosthetic valve implantation does not decrease the rate of thromboembolic events or mortality, but it is associated with increased risk of major bleeding.

Citation: Masri A, Gillinov M, Johnston DM, et al. Anticoagulation versus antiplatelet or no therapy in patients undergoing bioprosthetic valve implantation: a systematic review and meta-analysis [published online ahead of print Aug. 3, 2016]. Heart. doi: 10.1136/heartjnl-2016-309630

Dr. Florindez is an assistant professor at the University of Miami Miller School of Medicine and a hospitalist at University of Miami Hospital and Jackson Memorial Hospital.

Clinical question: Does anticoagulation prevent thromboembolic events in patients undergoing bioprosthetic valve implantation?

Background: The main advantage of bioprosthetic valves, compared with mechanical valves, is the avoidance of long-term anticoagulation. Current guidelines recommend the use of vitamin K antagonist (VKA) during the first 3 months after surgery, which remains controversial. Two randomized controlled trials (RCTs) showed no benefit of using VKA in the first 3 months; however, other studies have reported conflicting results.

Study design: Meta-analysis and systematic review.

Setting: Multicenter.

Synopsis: This meta-analysis included two RCTs and 12 observational studies that compared the outcomes in group I (VKA) versus group II (antiplatelet therapy/no treatment). There was no difference in thromboembolic events between group I (1%) and group II (1.5%), but there were more bleeding events in group I (2.6%) versus group II (1.1%). In addition, no differences in all-cause of mortality rate and need for redo surgery were found between the two groups.

Bottom line: The use of VKA in the first 3 months after a bioprosthetic valve implantation does not decrease the rate of thromboembolic events or mortality, but it is associated with increased risk of major bleeding.

Citation: Masri A, Gillinov M, Johnston DM, et al. Anticoagulation versus antiplatelet or no therapy in patients undergoing bioprosthetic valve implantation: a systematic review and meta-analysis [published online ahead of print Aug. 3, 2016]. Heart. doi: 10.1136/heartjnl-2016-309630

Dr. Florindez is an assistant professor at the University of Miami Miller School of Medicine and a hospitalist at University of Miami Hospital and Jackson Memorial Hospital.

Clinical question: Does an initial stable international normalized ratio (INR) predict long-term stability?

Background: Warfarin decreases stroke risk among patients with atrial fibrillation; however, it interacts with food and drugs and requires monitoring to achieve a therapeutic INR. It is unclear if patients on warfarin with an initial stable INR value remain stable over time. Additionally, it is controversial whether patients on warfarin with previously stable INRs should benefit from switching to a non–vitamin K oral anticoagulant.

Study design: Retrospective study.

Setting: Outpatient clinics.

Only 26% of patients taking warfarin had a stable INR during the first 6 months, and only 34% continued to have a stable INR in the subsequent year.

Bottom line: Initial stable INR within the first 6 months among patients taking warfarin does not predict long-term INR stability in the subsequent year.

Citation: Pokorney SD, Simon DN, Thomas L, et al. Stability of international normalized ratios in patients taking long-term warfarin therapy. JAMA.2016;316(6):661-663

Dr. Florindez is an assistant professor at the University of Miami Miller School of Medicine and a hospitalist at University of Miami Hospital and Jackson Memorial Hospital.

Clinical question: Does an initial stable international normalized ratio (INR) predict long-term stability?

Background: Warfarin decreases stroke risk among patients with atrial fibrillation; however, it interacts with food and drugs and requires monitoring to achieve a therapeutic INR. It is unclear if patients on warfarin with an initial stable INR value remain stable over time. Additionally, it is controversial whether patients on warfarin with previously stable INRs should benefit from switching to a non–vitamin K oral anticoagulant.

Study design: Retrospective study.

Setting: Outpatient clinics.

Only 26% of patients taking warfarin had a stable INR during the first 6 months, and only 34% continued to have a stable INR in the subsequent year.

Bottom line: Initial stable INR within the first 6 months among patients taking warfarin does not predict long-term INR stability in the subsequent year.

Citation: Pokorney SD, Simon DN, Thomas L, et al. Stability of international normalized ratios in patients taking long-term warfarin therapy. JAMA.2016;316(6):661-663

Dr. Florindez is an assistant professor at the University of Miami Miller School of Medicine and a hospitalist at University of Miami Hospital and Jackson Memorial Hospital.

Clinical question: Does an initial stable international normalized ratio (INR) predict long-term stability?

Background: Warfarin decreases stroke risk among patients with atrial fibrillation; however, it interacts with food and drugs and requires monitoring to achieve a therapeutic INR. It is unclear if patients on warfarin with an initial stable INR value remain stable over time. Additionally, it is controversial whether patients on warfarin with previously stable INRs should benefit from switching to a non–vitamin K oral anticoagulant.

Study design: Retrospective study.

Setting: Outpatient clinics.

Only 26% of patients taking warfarin had a stable INR during the first 6 months, and only 34% continued to have a stable INR in the subsequent year.

Bottom line: Initial stable INR within the first 6 months among patients taking warfarin does not predict long-term INR stability in the subsequent year.

Citation: Pokorney SD, Simon DN, Thomas L, et al. Stability of international normalized ratios in patients taking long-term warfarin therapy. JAMA.2016;316(6):661-663

Dr. Florindez is an assistant professor at the University of Miami Miller School of Medicine and a hospitalist at University of Miami Hospital and Jackson Memorial Hospital.

Clinical question: How has inpatient antibiotic use changed in the United States in recent years?

Limitations of the study include underrepresentation of pediatric hospitals and certain geographic regions.

Bottom line: Antibiotic-use rates have not changed during 2006-2012. However, broad-spectrum antibiotic use has increased significantly.

Citation: Baggs J, Fridkin SK, Pollack LA, Srinivasan A, Jernigan JA. Estimating national trends in inpatient antibiotic use among US hospitals from 2006 to 2012. JAMA Intern Med. 2016;176(11):1639-1648.

Dr. Menon is an assistant professor at the University of Miami Miller School of Medicine and a hospitalist at University of Miami Hospital and Jackson Memorial Hospital.

Clinical question: How has inpatient antibiotic use changed in the United States in recent years?

Limitations of the study include underrepresentation of pediatric hospitals and certain geographic regions.

Bottom line: Antibiotic-use rates have not changed during 2006-2012. However, broad-spectrum antibiotic use has increased significantly.

Citation: Baggs J, Fridkin SK, Pollack LA, Srinivasan A, Jernigan JA. Estimating national trends in inpatient antibiotic use among US hospitals from 2006 to 2012. JAMA Intern Med. 2016;176(11):1639-1648.

Dr. Menon is an assistant professor at the University of Miami Miller School of Medicine and a hospitalist at University of Miami Hospital and Jackson Memorial Hospital.

Clinical question: How has inpatient antibiotic use changed in the United States in recent years?

Limitations of the study include underrepresentation of pediatric hospitals and certain geographic regions.

Bottom line: Antibiotic-use rates have not changed during 2006-2012. However, broad-spectrum antibiotic use has increased significantly.

Citation: Baggs J, Fridkin SK, Pollack LA, Srinivasan A, Jernigan JA. Estimating national trends in inpatient antibiotic use among US hospitals from 2006 to 2012. JAMA Intern Med. 2016;176(11):1639-1648.

Dr. Menon is an assistant professor at the University of Miami Miller School of Medicine and a hospitalist at University of Miami Hospital and Jackson Memorial Hospital.

Clinical question: How frequent is pulmonary embolism (PE) in patients with unexplained acute chronic obstructive pulmonary disease (COPD) exacerbation?

Signs of cardiac failure, hypotension, and syncope were more frequently found in patients with COPD exacerbation and PE, compared with patients with COPD exacerbation without PE.

Bottom line: PE is a common occurrence in patients with unexplained COPD exacerbations; two-thirds of those emboli involved segmental circulation and therefore were clinically relevant.

Citation: Aleva FE, Voets LW, Simons SO, de Mast Q, van der Ven A, Heijdra YF. Prevalence and localization of pulmonary embolism in unexplained acute exacerbations of COPD: a systematic review and meta-analysis [published online ahead of print Aug. 11, 2016]. Chest. doi: 10.1016/j.chest.2016.07.034.

Clinical question: How frequent is pulmonary embolism (PE) in patients with unexplained acute chronic obstructive pulmonary disease (COPD) exacerbation?

Signs of cardiac failure, hypotension, and syncope were more frequently found in patients with COPD exacerbation and PE, compared with patients with COPD exacerbation without PE.

Bottom line: PE is a common occurrence in patients with unexplained COPD exacerbations; two-thirds of those emboli involved segmental circulation and therefore were clinically relevant.

Citation: Aleva FE, Voets LW, Simons SO, de Mast Q, van der Ven A, Heijdra YF. Prevalence and localization of pulmonary embolism in unexplained acute exacerbations of COPD: a systematic review and meta-analysis [published online ahead of print Aug. 11, 2016]. Chest. doi: 10.1016/j.chest.2016.07.034.

Clinical question: How frequent is pulmonary embolism (PE) in patients with unexplained acute chronic obstructive pulmonary disease (COPD) exacerbation?

Signs of cardiac failure, hypotension, and syncope were more frequently found in patients with COPD exacerbation and PE, compared with patients with COPD exacerbation without PE.

Bottom line: PE is a common occurrence in patients with unexplained COPD exacerbations; two-thirds of those emboli involved segmental circulation and therefore were clinically relevant.

Citation: Aleva FE, Voets LW, Simons SO, de Mast Q, van der Ven A, Heijdra YF. Prevalence and localization of pulmonary embolism in unexplained acute exacerbations of COPD: a systematic review and meta-analysis [published online ahead of print Aug. 11, 2016]. Chest. doi: 10.1016/j.chest.2016.07.034.

The online rating business is proliferating in the medical industry. This should really come as no surprise as health care is a service industry and online ratings have long been a staple in most other service industries. It has become routine practice for most of us to search such online reviews when seeking a pair of shoes, a toaster, or a restaurant; we almost can’t help but scour these sites to help us make the best decision possible.

• Anticipated cost (is the physician or practice in or out of network?).
• Availability or access to the service (location of the practice and how long it will take to be seen).
• How good the services and care will be when they get there.

• They felt it was “tacky” and that the profession of medicine should not be relegated to oversimplified service ratings. They worried that they would feel pressured to please the patient rather than “do the right thing” for the patient. For example, they would be less likely to give difficult advice (such as lose weight or stop smoking) or to resist prescribing medications that they deemed unnecessary or frankly dangerous (for example, antibiotics or narcotics).

Although these are valid concerns, it is hard to ignore the proliferation and traffic of these online websites. For you and your team, I would recommend taking a look at what is online about the members of your group and thinking about online strategies to take control of the conversation.

I don’t think the controversy over online physician ratings will wane anytime soon, but there is no doubt that they are profitable for companies and are therefore highly likely to continue to multiply.

References

1.Hanauer DA, Zheng K, Singer DC, Gebremariam A, Davis MM. Public awareness, perception, and use of online physician rating sites. JAMA. 2014;311(7):734-735. 2. A to Z provider listing: find a U of U Health Care physician by last name. University of Utah website. Available at http://healthcare.utah.edu/fad. Accessed Nov. 16, 2016.

Danielle Scheurer, MD, MSc, SFHM, is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at [email protected].

The online rating business is proliferating in the medical industry. This should really come as no surprise as health care is a service industry and online ratings have long been a staple in most other service industries. It has become routine practice for most of us to search such online reviews when seeking a pair of shoes, a toaster, or a restaurant; we almost can’t help but scour these sites to help us make the best decision possible.

• Anticipated cost (is the physician or practice in or out of network?).
• Availability or access to the service (location of the practice and how long it will take to be seen).
• How good the services and care will be when they get there.

• They felt it was “tacky” and that the profession of medicine should not be relegated to oversimplified service ratings. They worried that they would feel pressured to please the patient rather than “do the right thing” for the patient. For example, they would be less likely to give difficult advice (such as lose weight or stop smoking) or to resist prescribing medications that they deemed unnecessary or frankly dangerous (for example, antibiotics or narcotics).

Although these are valid concerns, it is hard to ignore the proliferation and traffic of these online websites. For you and your team, I would recommend taking a look at what is online about the members of your group and thinking about online strategies to take control of the conversation.

I don’t think the controversy over online physician ratings will wane anytime soon, but there is no doubt that they are profitable for companies and are therefore highly likely to continue to multiply.

References

1.Hanauer DA, Zheng K, Singer DC, Gebremariam A, Davis MM. Public awareness, perception, and use of online physician rating sites. JAMA. 2014;311(7):734-735. 2. A to Z provider listing: find a U of U Health Care physician by last name. University of Utah website. Available at http://healthcare.utah.edu/fad. Accessed Nov. 16, 2016.

Danielle Scheurer, MD, MSc, SFHM, is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at [email protected].

The online rating business is proliferating in the medical industry. This should really come as no surprise as health care is a service industry and online ratings have long been a staple in most other service industries. It has become routine practice for most of us to search such online reviews when seeking a pair of shoes, a toaster, or a restaurant; we almost can’t help but scour these sites to help us make the best decision possible.

• Anticipated cost (is the physician or practice in or out of network?).
• Availability or access to the service (location of the practice and how long it will take to be seen).
• How good the services and care will be when they get there.

• They felt it was “tacky” and that the profession of medicine should not be relegated to oversimplified service ratings. They worried that they would feel pressured to please the patient rather than “do the right thing” for the patient. For example, they would be less likely to give difficult advice (such as lose weight or stop smoking) or to resist prescribing medications that they deemed unnecessary or frankly dangerous (for example, antibiotics or narcotics).

Although these are valid concerns, it is hard to ignore the proliferation and traffic of these online websites. For you and your team, I would recommend taking a look at what is online about the members of your group and thinking about online strategies to take control of the conversation.

I don’t think the controversy over online physician ratings will wane anytime soon, but there is no doubt that they are profitable for companies and are therefore highly likely to continue to multiply.

References

1.Hanauer DA, Zheng K, Singer DC, Gebremariam A, Davis MM. Public awareness, perception, and use of online physician rating sites. JAMA. 2014;311(7):734-735. 2. A to Z provider listing: find a U of U Health Care physician by last name. University of Utah website. Available at http://healthcare.utah.edu/fad. Accessed Nov. 16, 2016.

Danielle Scheurer, MD, MSc, SFHM, is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at [email protected].

The New Year brings new leadership in the United States, with President-elect Donald Trump taking office later this month. With a Republican-controlled Congress, party leaders have the opportunity to shape the nation’s policies around conservative ideals. This includes health care.

Since the Affordable Care Act (ACA) was passed in 2010, Republicans have vowed to repeal and replace it. This could be their opportunity.

However, “there is no clear coalescence around specific policy reforms that would replace the Affordable Care Act,” says Christine Eibner, PhD, a senior economist at Rand and a professor at the Pardee Rand Graduate School.

As a candidate, Trump did little to advance policy ideas around health care. Meanwhile, House Speaker Paul Ryan (R-Wis.) and others have, over the years, proposed reforms with which Trump may or may not agree.

Where we stand January 2017

Whether the Republicans can or will repeal the ACA in its entirety and improve it remains unknown. But, the experts say, the landmark law has left its mark on the American health care system.

“Everyone is complaining about the uncertainty created by the election, but we have been dealing with a highly uncertain environment for many years,” says Ron Greeno, MD, FCCP, MHM, senior advisor for medical affairs at TeamHealth, chair of the SHM Public Policy Committee, and SHM president-elect. “There will be changes, but things were going to change no matter the outcome of the election. It continues to require tolerance for change and tolerance for uncertainty.”

In an analysis for the Commonwealth Fund, Dr. Eibner investigated the economic implications of aspects of Trump’s plans as a candidate. Using a computer model that incorporates economic theory and data to simulate the effects of health policy changes, Dr. Eibner found that Trump’s plans (full repeal alone or repeal with tax deductions for health care premiums, Medicaid block grants, or selling health insurance across state lines) would increase the number of uninsured people by 16 million to 25 million, disproportionately impact low-income and sicker patients, expose individual market enrollees to higher out-of-pocket costs, and increase the federal deficit by $0.5 billion to $41 billion.¹ The Congressional Budget Office (CBO) estimates full repeal could increase the federal deficit by $137 billion to $353 billion by 2025.² Rep. Ryan’s plan, A Better Way, proposes providing people more control over their health care, giving tax credits instead of subsidies for premiums, capping the employer-sponsored health insurance tax exclusion, and expanding use of health savings accounts.³ However, Rep. Ryan’s plan “doesn’t reduce the cost of health care. It puts more onus on individuals, and their costs go up,” Ms. Hoffman says. “The weight of that will be more on people who have preexisting conditions.”

Key provisions: A delicate balance

Many people equate the ACA with the individual mandate, which requires nearly all Americans to purchase health insurance or pay a fine. The federal government provides subsidies to enrollees between 138% and 400% of the federal poverty level so their out-of-pocket costs never exceed a defined threshold even if premiums go up. These could be on the chopping block.

“The last bill Congress passed to repeal the Affordable Care Act, which Obama vetoed, repealed the individual mandate and subsidies for people to buy insurance,” Ms. Hoffman says. “If they do repeal it, private insurance through the exchanges will crumble.”

Mr. Trump’s tax deductions to offset premium costs are based on income, making them more generous for higher-income earners than low-income ones, Hoffman adds.

And … Medicare

The other entitlement program facing abrupt change is Medicare, typically considered the third rail of American politics.

“This is the hot political moment,” Ms. Hoffman says. “This is the point where the Republicans think they can tick off their wish list. For many Republicans, this kind of entitlement program is the opposite of what they believe in.”

Though Mr. Trump has said before he would not alter Medicare, he remained quiet on this point in the aftermath of the election. Repealing the ACA would affect Medicare by potentially reopening the Part D prescription drug doughnut hole and eliminating some of the savings provisions in the law. In fact, the CBO estimates Medicare’s direct spending would increase $802 billion between 2016 and 2025.¹ Rep. Ryan has talked about privatizing Medicare by offering seniors who rely on it vouchers to apply toward private insurance.

“At the highest level, it’s moving Medicare from a defined benefit to a defined contribution program,” Ms. Hoffman says. “It shifts financial risk from the federal government onto beneficiaries. If Medicare spending continues to grow faster than the rest of the economy, Medicare beneficiaries will pay more and more.”

Seniors may also find themselves rationing or skimping on care.

Despite Rep. Ryan’s statements to the contrary, Medicare is not broken because of the ACA, Ms. Hoffman says. Its solvency has been prolonged, and though the reasons are not clear, Medicare spending has slowed since the passage of the ACA.⁶

MACRA launch

Another key factor in the health care policy landscape is MACRA, the Medicare Access and CHIP Reauthorization Act, which fundamentally shifts the way the government administrates and reimburses physicians for health care. MACRA begins in 2017. Dr. Greeno is concerned that changes to the ACA will impact the testing of payment models CMS is testing.

“There are hundreds of hospitals and thousands of physicians already invested in different models, so I don’t expect anybody has any desire to pull the rug from under physicians who are testing alternative payment models [APMs],” he says. “MACRA was passed on a strong bipartisan vote, and it created an APM track. Obviously, Congress intended APM models to continue to expand.”

Dr. Greeno says hospitalists are helping “shape these models,” working with the CMS and the Physician-Focused Payment Model Technical Advisory Committee (PTAC) “to ensure physicians participate in APMs and feel engaged rather than being a worker in a model someone else controls.”

On the campaign trail, Mr. Trump spoke of importing pharmaceuticals from overseas in an effort to control high prices. This policy is no longer part of his online plan. He also proposes allowing the sale of health insurance across state lines.

“It would be giving enrollees in states with stricter regulations the opportunity to circumvent to a looser state, which undermines the state with the stricter regulations,” Dr. Eibner says. “That would really create winners and losers. People who are healthy can buy a policy in a state with looser regulations, and their costs would likely fall. But someone sicker and older, it would be harder.”

Ms. Hoffman defines such a plan as a “race to the bottom.” Without well-established networks of physicians and hospitals, startup costs in new states are prohibitive, and many insurers may not wish to compete across state lines, she adds.

Repeal of the ACA could also limit some of the health benefits it required of plans on the individual market. For example, policymakers might be allowed to strip the contraceptive coverage regulation, which provides for free birth control.

“The reality is a lot of things changing in health care now were changing before the Affordable Care Act passed – PQRS, value-based purchasing, hospital-acquired infections,” Dr. Greeno says. “MACRA will continue the journey away from fee-for-service toward outcome-based models.”

At such a pivotal time, he strongly encourages hospitalists to join SHM if they are not already members and to get involved in SHM’s Grassroots Network.

“For a society of our age – young – and size, we’ve been tremendously impactful in helping with delivery system reform,” Dr. Greeno says. “I think it’s because we’re supporting change, not trying to stop it. We just want it to be intelligent change.”

He also is “convinced” hospitalists will be “critical to the redesign of the health care system. Since we are going to be taking care of the majority of hospitalized adult patients in hospitals, hospitalists want to have our say.” 

Kelly April Tyrrell is a freelance writer in Madison, Wis.

References

1. Eibner C. Donald Trump’s health care reform proposals: Anticipated effects on insurance coverage, out-of-pocket costs, and the federal deficit. The Commonweath Fund website. Available at: http://www.commonwealthfund.org/publications/issue-briefs/2016/sep/trump-presidential-health-care-proposal. Accessed Nov. 17, 2016.

2. Budgetary and economic effects of repealing the Affordable Care Act. Congressional Budget Office website. Available at: https://www.cbo.gov/sites/default/files/114th-congress-2015-2016/reports/50252-Effects_of_ACA_Repeal.pdf. Accessed Nov. 15, 2016.

3. Our vision for a confident America. A Better Way website. Available at: http://abetterway.speaker.gov. Accessed Nov. 17, 2016.

4. Pollitz K. High-risk pools for uninsurable individuals. Kaiser Family Foundation website. Available at: http://kff.org/health-reform/issue-brief/high-risk-pools-for-uninsurable-individuals/. Accessed Nov. 17, 2016.

5. How accessible is individual health insurance for consumers in less-than-ideal health? Kaiser Family Foundation website. Available at: https://kaiserfamilyfoundation.files.wordpress.com/2013/01/how-accessible-is-individual-health-insurance-for-consumer-in-less-than-perfect-health-report.pdf. Accessed Nov. 17, 2016.

6. The Affordable Care Act and Medicare. The Commonwealth Fund website. Available at: http://www.commonwealthfund.org/publications/fund-reports/2015/jun/medicare-affordable-care-act Accessed Nov. 17, 2016.

The New Year brings new leadership in the United States, with President-elect Donald Trump taking office later this month. With a Republican-controlled Congress, party leaders have the opportunity to shape the nation’s policies around conservative ideals. This includes health care.

Since the Affordable Care Act (ACA) was passed in 2010, Republicans have vowed to repeal and replace it. This could be their opportunity.

However, “there is no clear coalescence around specific policy reforms that would replace the Affordable Care Act,” says Christine Eibner, PhD, a senior economist at Rand and a professor at the Pardee Rand Graduate School.

As a candidate, Trump did little to advance policy ideas around health care. Meanwhile, House Speaker Paul Ryan (R-Wis.) and others have, over the years, proposed reforms with which Trump may or may not agree.

Where we stand January 2017

Whether the Republicans can or will repeal the ACA in its entirety and improve it remains unknown. But, the experts say, the landmark law has left its mark on the American health care system.

“Everyone is complaining about the uncertainty created by the election, but we have been dealing with a highly uncertain environment for many years,” says Ron Greeno, MD, FCCP, MHM, senior advisor for medical affairs at TeamHealth, chair of the SHM Public Policy Committee, and SHM president-elect. “There will be changes, but things were going to change no matter the outcome of the election. It continues to require tolerance for change and tolerance for uncertainty.”

In an analysis for the Commonwealth Fund, Dr. Eibner investigated the economic implications of aspects of Trump’s plans as a candidate. Using a computer model that incorporates economic theory and data to simulate the effects of health policy changes, Dr. Eibner found that Trump’s plans (full repeal alone or repeal with tax deductions for health care premiums, Medicaid block grants, or selling health insurance across state lines) would increase the number of uninsured people by 16 million to 25 million, disproportionately impact low-income and sicker patients, expose individual market enrollees to higher out-of-pocket costs, and increase the federal deficit by $0.5 billion to $41 billion.¹ The Congressional Budget Office (CBO) estimates full repeal could increase the federal deficit by $137 billion to $353 billion by 2025.² Rep. Ryan’s plan, A Better Way, proposes providing people more control over their health care, giving tax credits instead of subsidies for premiums, capping the employer-sponsored health insurance tax exclusion, and expanding use of health savings accounts.³ However, Rep. Ryan’s plan “doesn’t reduce the cost of health care. It puts more onus on individuals, and their costs go up,” Ms. Hoffman says. “The weight of that will be more on people who have preexisting conditions.”

Key provisions: A delicate balance

Many people equate the ACA with the individual mandate, which requires nearly all Americans to purchase health insurance or pay a fine. The federal government provides subsidies to enrollees between 138% and 400% of the federal poverty level so their out-of-pocket costs never exceed a defined threshold even if premiums go up. These could be on the chopping block.

“The last bill Congress passed to repeal the Affordable Care Act, which Obama vetoed, repealed the individual mandate and subsidies for people to buy insurance,” Ms. Hoffman says. “If they do repeal it, private insurance through the exchanges will crumble.”

Mr. Trump’s tax deductions to offset premium costs are based on income, making them more generous for higher-income earners than low-income ones, Hoffman adds.

And … Medicare

The other entitlement program facing abrupt change is Medicare, typically considered the third rail of American politics.

“This is the hot political moment,” Ms. Hoffman says. “This is the point where the Republicans think they can tick off their wish list. For many Republicans, this kind of entitlement program is the opposite of what they believe in.”

Though Mr. Trump has said before he would not alter Medicare, he remained quiet on this point in the aftermath of the election. Repealing the ACA would affect Medicare by potentially reopening the Part D prescription drug doughnut hole and eliminating some of the savings provisions in the law. In fact, the CBO estimates Medicare’s direct spending would increase $802 billion between 2016 and 2025.¹ Rep. Ryan has talked about privatizing Medicare by offering seniors who rely on it vouchers to apply toward private insurance.

“At the highest level, it’s moving Medicare from a defined benefit to a defined contribution program,” Ms. Hoffman says. “It shifts financial risk from the federal government onto beneficiaries. If Medicare spending continues to grow faster than the rest of the economy, Medicare beneficiaries will pay more and more.”

Seniors may also find themselves rationing or skimping on care.

Despite Rep. Ryan’s statements to the contrary, Medicare is not broken because of the ACA, Ms. Hoffman says. Its solvency has been prolonged, and though the reasons are not clear, Medicare spending has slowed since the passage of the ACA.⁶

MACRA launch

Another key factor in the health care policy landscape is MACRA, the Medicare Access and CHIP Reauthorization Act, which fundamentally shifts the way the government administrates and reimburses physicians for health care. MACRA begins in 2017. Dr. Greeno is concerned that changes to the ACA will impact the testing of payment models CMS is testing.

“There are hundreds of hospitals and thousands of physicians already invested in different models, so I don’t expect anybody has any desire to pull the rug from under physicians who are testing alternative payment models [APMs],” he says. “MACRA was passed on a strong bipartisan vote, and it created an APM track. Obviously, Congress intended APM models to continue to expand.”

Dr. Greeno says hospitalists are helping “shape these models,” working with the CMS and the Physician-Focused Payment Model Technical Advisory Committee (PTAC) “to ensure physicians participate in APMs and feel engaged rather than being a worker in a model someone else controls.”

On the campaign trail, Mr. Trump spoke of importing pharmaceuticals from overseas in an effort to control high prices. This policy is no longer part of his online plan. He also proposes allowing the sale of health insurance across state lines.

“It would be giving enrollees in states with stricter regulations the opportunity to circumvent to a looser state, which undermines the state with the stricter regulations,” Dr. Eibner says. “That would really create winners and losers. People who are healthy can buy a policy in a state with looser regulations, and their costs would likely fall. But someone sicker and older, it would be harder.”

Ms. Hoffman defines such a plan as a “race to the bottom.” Without well-established networks of physicians and hospitals, startup costs in new states are prohibitive, and many insurers may not wish to compete across state lines, she adds.

Repeal of the ACA could also limit some of the health benefits it required of plans on the individual market. For example, policymakers might be allowed to strip the contraceptive coverage regulation, which provides for free birth control.

“The reality is a lot of things changing in health care now were changing before the Affordable Care Act passed – PQRS, value-based purchasing, hospital-acquired infections,” Dr. Greeno says. “MACRA will continue the journey away from fee-for-service toward outcome-based models.”

At such a pivotal time, he strongly encourages hospitalists to join SHM if they are not already members and to get involved in SHM’s Grassroots Network.

“For a society of our age – young – and size, we’ve been tremendously impactful in helping with delivery system reform,” Dr. Greeno says. “I think it’s because we’re supporting change, not trying to stop it. We just want it to be intelligent change.”

He also is “convinced” hospitalists will be “critical to the redesign of the health care system. Since we are going to be taking care of the majority of hospitalized adult patients in hospitals, hospitalists want to have our say.” 

Kelly April Tyrrell is a freelance writer in Madison, Wis.

References

1. Eibner C. Donald Trump’s health care reform proposals: Anticipated effects on insurance coverage, out-of-pocket costs, and the federal deficit. The Commonweath Fund website. Available at: http://www.commonwealthfund.org/publications/issue-briefs/2016/sep/trump-presidential-health-care-proposal. Accessed Nov. 17, 2016.

2. Budgetary and economic effects of repealing the Affordable Care Act. Congressional Budget Office website. Available at: https://www.cbo.gov/sites/default/files/114th-congress-2015-2016/reports/50252-Effects_of_ACA_Repeal.pdf. Accessed Nov. 15, 2016.

3. Our vision for a confident America. A Better Way website. Available at: http://abetterway.speaker.gov. Accessed Nov. 17, 2016.

4. Pollitz K. High-risk pools for uninsurable individuals. Kaiser Family Foundation website. Available at: http://kff.org/health-reform/issue-brief/high-risk-pools-for-uninsurable-individuals/. Accessed Nov. 17, 2016.

5. How accessible is individual health insurance for consumers in less-than-ideal health? Kaiser Family Foundation website. Available at: https://kaiserfamilyfoundation.files.wordpress.com/2013/01/how-accessible-is-individual-health-insurance-for-consumer-in-less-than-perfect-health-report.pdf. Accessed Nov. 17, 2016.

6. The Affordable Care Act and Medicare. The Commonwealth Fund website. Available at: http://www.commonwealthfund.org/publications/fund-reports/2015/jun/medicare-affordable-care-act Accessed Nov. 17, 2016.

The New Year brings new leadership in the United States, with President-elect Donald Trump taking office later this month. With a Republican-controlled Congress, party leaders have the opportunity to shape the nation’s policies around conservative ideals. This includes health care.

Since the Affordable Care Act (ACA) was passed in 2010, Republicans have vowed to repeal and replace it. This could be their opportunity.

However, “there is no clear coalescence around specific policy reforms that would replace the Affordable Care Act,” says Christine Eibner, PhD, a senior economist at Rand and a professor at the Pardee Rand Graduate School.

As a candidate, Trump did little to advance policy ideas around health care. Meanwhile, House Speaker Paul Ryan (R-Wis.) and others have, over the years, proposed reforms with which Trump may or may not agree.

Where we stand January 2017

Whether the Republicans can or will repeal the ACA in its entirety and improve it remains unknown. But, the experts say, the landmark law has left its mark on the American health care system.

“Everyone is complaining about the uncertainty created by the election, but we have been dealing with a highly uncertain environment for many years,” says Ron Greeno, MD, FCCP, MHM, senior advisor for medical affairs at TeamHealth, chair of the SHM Public Policy Committee, and SHM president-elect. “There will be changes, but things were going to change no matter the outcome of the election. It continues to require tolerance for change and tolerance for uncertainty.”

In an analysis for the Commonwealth Fund, Dr. Eibner investigated the economic implications of aspects of Trump’s plans as a candidate. Using a computer model that incorporates economic theory and data to simulate the effects of health policy changes, Dr. Eibner found that Trump’s plans (full repeal alone or repeal with tax deductions for health care premiums, Medicaid block grants, or selling health insurance across state lines) would increase the number of uninsured people by 16 million to 25 million, disproportionately impact low-income and sicker patients, expose individual market enrollees to higher out-of-pocket costs, and increase the federal deficit by $0.5 billion to $41 billion.¹ The Congressional Budget Office (CBO) estimates full repeal could increase the federal deficit by $137 billion to $353 billion by 2025.² Rep. Ryan’s plan, A Better Way, proposes providing people more control over their health care, giving tax credits instead of subsidies for premiums, capping the employer-sponsored health insurance tax exclusion, and expanding use of health savings accounts.³ However, Rep. Ryan’s plan “doesn’t reduce the cost of health care. It puts more onus on individuals, and their costs go up,” Ms. Hoffman says. “The weight of that will be more on people who have preexisting conditions.”

Key provisions: A delicate balance

Many people equate the ACA with the individual mandate, which requires nearly all Americans to purchase health insurance or pay a fine. The federal government provides subsidies to enrollees between 138% and 400% of the federal poverty level so their out-of-pocket costs never exceed a defined threshold even if premiums go up. These could be on the chopping block.

“The last bill Congress passed to repeal the Affordable Care Act, which Obama vetoed, repealed the individual mandate and subsidies for people to buy insurance,” Ms. Hoffman says. “If they do repeal it, private insurance through the exchanges will crumble.”

Mr. Trump’s tax deductions to offset premium costs are based on income, making them more generous for higher-income earners than low-income ones, Hoffman adds.

And … Medicare

The other entitlement program facing abrupt change is Medicare, typically considered the third rail of American politics.

“This is the hot political moment,” Ms. Hoffman says. “This is the point where the Republicans think they can tick off their wish list. For many Republicans, this kind of entitlement program is the opposite of what they believe in.”

Though Mr. Trump has said before he would not alter Medicare, he remained quiet on this point in the aftermath of the election. Repealing the ACA would affect Medicare by potentially reopening the Part D prescription drug doughnut hole and eliminating some of the savings provisions in the law. In fact, the CBO estimates Medicare’s direct spending would increase $802 billion between 2016 and 2025.¹ Rep. Ryan has talked about privatizing Medicare by offering seniors who rely on it vouchers to apply toward private insurance.

“At the highest level, it’s moving Medicare from a defined benefit to a defined contribution program,” Ms. Hoffman says. “It shifts financial risk from the federal government onto beneficiaries. If Medicare spending continues to grow faster than the rest of the economy, Medicare beneficiaries will pay more and more.”

Seniors may also find themselves rationing or skimping on care.

Despite Rep. Ryan’s statements to the contrary, Medicare is not broken because of the ACA, Ms. Hoffman says. Its solvency has been prolonged, and though the reasons are not clear, Medicare spending has slowed since the passage of the ACA.⁶

MACRA launch

Another key factor in the health care policy landscape is MACRA, the Medicare Access and CHIP Reauthorization Act, which fundamentally shifts the way the government administrates and reimburses physicians for health care. MACRA begins in 2017. Dr. Greeno is concerned that changes to the ACA will impact the testing of payment models CMS is testing.

“There are hundreds of hospitals and thousands of physicians already invested in different models, so I don’t expect anybody has any desire to pull the rug from under physicians who are testing alternative payment models [APMs],” he says. “MACRA was passed on a strong bipartisan vote, and it created an APM track. Obviously, Congress intended APM models to continue to expand.”

Dr. Greeno says hospitalists are helping “shape these models,” working with the CMS and the Physician-Focused Payment Model Technical Advisory Committee (PTAC) “to ensure physicians participate in APMs and feel engaged rather than being a worker in a model someone else controls.”

On the campaign trail, Mr. Trump spoke of importing pharmaceuticals from overseas in an effort to control high prices. This policy is no longer part of his online plan. He also proposes allowing the sale of health insurance across state lines.

“It would be giving enrollees in states with stricter regulations the opportunity to circumvent to a looser state, which undermines the state with the stricter regulations,” Dr. Eibner says. “That would really create winners and losers. People who are healthy can buy a policy in a state with looser regulations, and their costs would likely fall. But someone sicker and older, it would be harder.”

Ms. Hoffman defines such a plan as a “race to the bottom.” Without well-established networks of physicians and hospitals, startup costs in new states are prohibitive, and many insurers may not wish to compete across state lines, she adds.

Repeal of the ACA could also limit some of the health benefits it required of plans on the individual market. For example, policymakers might be allowed to strip the contraceptive coverage regulation, which provides for free birth control.

“The reality is a lot of things changing in health care now were changing before the Affordable Care Act passed – PQRS, value-based purchasing, hospital-acquired infections,” Dr. Greeno says. “MACRA will continue the journey away from fee-for-service toward outcome-based models.”

At such a pivotal time, he strongly encourages hospitalists to join SHM if they are not already members and to get involved in SHM’s Grassroots Network.

“For a society of our age – young – and size, we’ve been tremendously impactful in helping with delivery system reform,” Dr. Greeno says. “I think it’s because we’re supporting change, not trying to stop it. We just want it to be intelligent change.”

He also is “convinced” hospitalists will be “critical to the redesign of the health care system. Since we are going to be taking care of the majority of hospitalized adult patients in hospitals, hospitalists want to have our say.” 

Kelly April Tyrrell is a freelance writer in Madison, Wis.

References

1. Eibner C. Donald Trump’s health care reform proposals: Anticipated effects on insurance coverage, out-of-pocket costs, and the federal deficit. The Commonweath Fund website. Available at: http://www.commonwealthfund.org/publications/issue-briefs/2016/sep/trump-presidential-health-care-proposal. Accessed Nov. 17, 2016.

2. Budgetary and economic effects of repealing the Affordable Care Act. Congressional Budget Office website. Available at: https://www.cbo.gov/sites/default/files/114th-congress-2015-2016/reports/50252-Effects_of_ACA_Repeal.pdf. Accessed Nov. 15, 2016.

3. Our vision for a confident America. A Better Way website. Available at: http://abetterway.speaker.gov. Accessed Nov. 17, 2016.

4. Pollitz K. High-risk pools for uninsurable individuals. Kaiser Family Foundation website. Available at: http://kff.org/health-reform/issue-brief/high-risk-pools-for-uninsurable-individuals/. Accessed Nov. 17, 2016.

5. How accessible is individual health insurance for consumers in less-than-ideal health? Kaiser Family Foundation website. Available at: https://kaiserfamilyfoundation.files.wordpress.com/2013/01/how-accessible-is-individual-health-insurance-for-consumer-in-less-than-perfect-health-report.pdf. Accessed Nov. 17, 2016.

6. The Affordable Care Act and Medicare. The Commonwealth Fund website. Available at: http://www.commonwealthfund.org/publications/fund-reports/2015/jun/medicare-affordable-care-act Accessed Nov. 17, 2016.