“The basic economic model of supply and demand is working very much in favor of physicians. Whether entering the job market directly from training or looking for favorable opportunities with years of practice experience, both Primary Care Physicians and Specialists will find increased compensation and employed-model positions available. Expect generous signing bonuses and compensation packages, especially for Primary Care Physicians recruited to underserved areas. For those in practice, higher income is also a function of increased patient volume. With ever-increasing medical education debt loads, robust remuneration for physicians is welcomed unequivocally.”
— Steve Cannon
Physicians have low Medicaid acceptance
An analysis from HealthPocket raises the specter that individuals who obtain health coverage under expanded Medicaid starting in 2014 will have to dig to find a clinician who will treat them.
At the same time that many states are increasing their Medicaid rolls under the Affordable Care Act (ACA), only 43 percent of physicians report that they currently accept Medicaid patients, HealthPocket said last week in a news release.
Additionally, only 20 percent of physician assistants (PAs) and nurse practitioners (NPs), who already are paid lower reimbursement rates by the nature of their training, report that they accept Medicaid. These clinicians have been viewed by many as a potential solution to the shortage of primary care physicians and healthcare capacity. Their Medicaid acceptance may be underreported because some PAs and NPs may work under a Medicaid-accepting physician, the analysis said.
The acceptance rates raise the question of whether Medicaid expansion will insure more Americans, who will then face a significant shortage of practitioners to go to for their care, said Kev Coleman, head of research and data at HealthPocket, which compares and ranks health plans, in the news release.
Historically, Medicaid payments to physicians have been lower than those from both private insurance and Medicare for the same service. On average, Medicaid pays doctors only 66 percent of the amount Medicare pays for the same service, according to a December 2012 study by the Kaiser Family Foundation. The result of this lower reimbursement rate is a smaller pool of physicians who are willing to accept Medicaid, HealthPocket noted in the news release.
The ACA includes provisions to raise the reimbursements rates of Medicaid compared to Medicare and other plans, but those have not fully been established and offer only a temporary two-year increase.
“Ensuring there are sufficient healthcare providers available to the newly insured—even those with private insurance—is a major public health challenge right now,” Coleman said in the release. “But if the current Medicaid acceptance rates hold true for 2014, timely access to care for those relying on Medicaid is likely to become more difficult as enrollees increase for an already inadequate pool of doctors.”
HealthPocket also compared rates in the five cities with the highest average household income to the five cities with the lowest to examine whether an area’s income influenced Medicaid acceptance. HealthPocket found that the richest and poorest cities had similar Medicare acceptance rates on average despite their differences in income. Both groups had one city well below the national average for Medicaid acceptance. Among rich cities, Washington, D.C. was the lowest, with only 31 percent of healthcare providers documented as accepting Medicaid. Among the poorest cities, Detroit was the lowest, having the same acceptance rate as D.C.
Scientists Create World's Smallest Laser
September 09, 2009
Scientists at the University of California, Berkeley have created the world's smallest laser, according to a paper published in the advance online edition of Nature on Aug. 30.
Pressed into a vanishingly small 5-nanometer-wide gap, the tiny beamlet, called a hybrid plasmon laser, is about twice as big as a single string of DNA.
Previously, many physicists thought light could not be made smaller than half its own wavelength.
"This limit was something researchers were trying very hard for the last couple of years to [break]," Volker Sorger, a Ph.D. student at UC Berkeley's Nanoscale and Engineering Sciences lab, and a lead author on the study, tells DOTmed News.
What scientists found was that light could be reduced beyond its conventional limits by binding it to electron fields on the surface of metals.
Imagine the electrons on a metal's surface as "a row of ducks sitting on water," explains Sorger. The scientists then shine a light onto the metal, and the light acts like a stone thrown into the water. "It creates waves," says Sorger. "A wave comes along, and the ducks go up and down. This is what the electrons do" in response to light, says Sorger. "They basically create an oscillating field," known as surface plasmons, he says, which can be crushed into nano-sized spaces.
The tricky part was then keeping the plasmons focused and coherent -- something the UC Berkeley team was able to do by squeezing them into a tiny gap made by having a nanowire almost touch a silver surface. "You don't bring it in absolute close contact," says Sorger. "You leave a little bit of gap. This sucks in the light."
The 50-nanometer-long nanowire, made of cadmium sulfide, a semiconductor, then amplifies this light field, thereby creating the coherent light -- or laser -- in the gap.
Sorger believes this laser will have widespread applications. "You could detect a single molecule, a single nanometer in dimension," Sorger says, which could be used in airport security, for instance, to detect a solitary molecule of TNT coming off someone's luggage. "That is something that people have never been able to do before," says Sorger, "because light was always so much bigger than the true nanoscale."
Other possible uses include extremely fine-tuned biological experiments, as well as high-speed chips that, according to simulations developed by Sorger's team, would run 100,000 times faster than current technology.
"People were saying the 20th century was the century of the electron," Sorger says. Now it's the "era of photons, of light."
Using PET/CT Imaging, Researchers Can Tell if Chemotherapy Is Working
Oncologists often have to wait months before they can determine whether a treatment is working. Now, using a non-invasive method, researchers at UCLA's Jonsson Comprehensive Cancer Center have shown that they can determine after a single cycle of chemotherapy whether the toxic drugs are killing the cancer or not.
Using a combination Positron Emission Tomography (PET) and computed tomography (CT) scanner, researchers monitored 50 patients undergoing treatment for high-grade soft tissue sarcomas. The patients were receiving neoadjuvant chemotherapy treatments to shrink their tumors prior to surgery. The study found that response could be determined about a week after the first dose of chemotherapy drugs. Typically, patients are scanned at about three months into chemotherapy to determine whether the treatment is working.
"The question was, how early could we pick up a response? We wanted to see if we could determine response after a single administration of chemotherapy," said Dr. Fritz Eilber, an assistant professor of surgical oncology, director of the Sarcoma Program at UCLA's Jonsson Cancer Center and senior author of the study. "There's no point in giving a patient a treatment that isn't working. These treatments make patients very sick and have long-term serious side effects. "
The study appears in the April 15 issue of the journal Clinical Cancer Research.
PET scanning shows biochemical functions in real time, acting as a sort of molecular camera. For this study, Eilber and his team monitored the tumor's metabolic function, or how much sugar was being consumed by the cancer cells. Because they're growing out of control, cancer cells use much more sugar than do normal cells, making them light up under PET scanning using a glucose uptake probe called FDG. In order to identify an effective response to treatment, researchers needed to see a 35 percent decrease in the tumor's metabolic activity.
Of the 50 patients in the study, 28 did not respond and Eilber and his team knew within a week of their initial treatment. This allows the treatment course to be discontinued or changed to another more effective treatment, getting the patient to surgery more quickly.
"The significance of this study was that it identified people - more than half of those in the study - who were not going to benefit from the treatment early in the course of their therapy," Eilber said. "This information significantly helps guide patient care. Although this study was performed in patients scheduled for surgery, I think these findings will have an even greater impact on patients with inoperable tumors or metastatic disease as you get a much quicker evaluation of treatment effectiveness and can make decisions that will hugely impact quality of life."
Eilber said he was surprised how soon response to therapy could be determined.
"We had an idea that patients either respond or do not respond to treatment, but we weren't sure how early you could see that," he said. "I really was not sure we would be able to see effectiveness this early."
Eilber and his team will continue to follow the patients and a clinical trial currently is underway based on the results of this study. Eilber believes it will help personalize treatment for each patient and may one day become the standard of care.
Researchers also may use the non-invasive imaging method to gauge response to novel and targeted therapies. Eilber said that they are clinically testing new tracers as well. Instead of measuring glucose uptake, these probes look at cell growth. Response to therapy also may be tested using PET in other cancer types, he said.
The nearly two-year study represented a true multidisciplinary effort, Eilber said. Experts from surgery, medical oncology, molecular and medical pharmacology, radiology, pathology, orthopedics, nuclear medicine and biostatistics comprised the research team.
The study was funded by grants from the UCLA In Vivo Cellular and Molecular Imaging Centers and the Department of Energy.
UCLA's Jonsson Comprehensive Cancer Center has more than 350 researchers and clinicians engaged in disease research, prevention, detection, control, treatment and education. One of the nation's largest comprehensive cancer centers, the Jonsson center is dedicated to promoting research and translating basic science into leading-edge clinical studies. In July 2008, the Jonsson Cancer Center was named among the top 10 cancer centers nationwide by U.S. News & World Report, a ranking it has held for nine consecutive years. For more information on the Jonsson Cancer Center, visit our website at http://www.cancer.ucla.edu.
Vapor Sensor May One Day Whiff Disease
March 18, 2009by Lynn Shapiro, WriterA future sensor may test a patient's breath for breast cancer, lung cancer, diabetes or asthma.
A University of Missouri researcher is developing a device that will analyze breath and urine samples for volatile markers inside the body that indicate disease. These volatile markers, such as alkanes, acetones or nitric oxide, give doctors clues about what is happening inside the body and can be used as a diagnostic tool.
"Little traces of certain gas molecules in the breath or urine tell us if anything unusual is going on in the body," said Xudong "Sherman" Fan, investigator of the study. "Measuring these volatile markers would be a non-invasive way to determine if a disease is present without having to draw blood or perform a biopsy. In addition to the biomarkers already discovered, many more potential volatile markers are still under investigation."
Opto-fluidic Ring Resonator
The sensor device known as the opto-fluidic ring resonator (OFRR), is an optical gas sensor that consists of a polymer-lined glass tube that guides the flow of a gas vapor and a ring resonator that detects the molecules that pass through the glass tube. As the gas vapor enters the device, molecules in the vapor separate and react to the polymer lining. Light makes thousands of loops around the gas or liquid sample. The more the light loops around the sample, the more the light energy interacts with the gas vapor. These repetitive interactions enable the detection of vapor molecules down to a very small quantity.
Optical gas sensors have broad applications in industry, military, environmental science, medical care and homeland security. In addition to OFRR's application in the medical industry, the device also can improve the detection of explosives on the battlefield. Currently, the existing gas vapor sensor technology is very bulky with equipment weighing more than 100 pounds and is difficult to use in the field.
"We hope to design a vapor sensor that has ultra-high sensitivity, specific and rapid response to a certain molecule, as well as the ability of on-the-spot chemical analyses, which usually requires the sensor to be small, portable, reusable and have less power consumption," said Fan, who also is assistant professor of biological engineering in the MU College of Engineering and the MU College of Agriculture, Food and Natural Resources.
"If the gas sensor is portable, military personnel can determine more quickly whether an area is dangerous."
Source: University of Missouri