This July, 20 students at 10 health care organizations are taking part in a special addiction medicine residency. The program is part of an effort to have addiction medicine treated as a specialty just like pediatrics,  gynecology, etc.

The one-year residencies are offered at Boston University Medical Center, the John A. Burns School of Medicine at the University of Hawaii, Marworth Alcohol and Chemical Dependency Treatment Center (Waverly, Pennsylvania), St. Luke’s-Roosevelt Hospital (New York), the University at Buffalo School of Medicine, the University of Cincinnati College of Medicine, the University of Florida College of Medicine, the University of Maryland Medical System, the University of Minnesota Medical School, and the University of Wisconsin School of Medicine and Public Health.

Some of the organizations have offered similar, but non-accredited programs in addiction medicine for some time. Residents in the program will treat the full range of addictions while studying how genetics, brain chemistry and other factors affect the patient.

The program is a response to the growing idea that addiction should be treated as a chronic disease just like diabetes or asthma is. For starters, doctors can’t expect to see a patient a few times, prescribe a course of treatment and expect a “cure.” Addicted patients generally fare better when their condition is managed on an on-going basis.

That’s according to a recent study published in the New England Journal of Medicine.

Telephone care management generally targets patients with chronic, high-risk health problems, or those needing information on treatment plans. Trained nurses contact the patients individually to help them manage their health and provide additional information or resources.

The study looked at a group of patients expanded to include “chaotic” health care users, such as those who routinely went to the ER for general health care. Researchers found that by expanding the scope of patients to whom telephone-based care management was provided, total health care costs were reduced by 3.6%. Most of the savings came from a 10.1% reduction in hospital admissions.

A new study found that in a significant portion of children with chronic conditions such as asthma, obesity, behavioral/learning problems and other physical conditions, resolved over the course of just six years.

The researchers argue the data indicates that care providers should put more emphasis on prevention and intervention and less on continuing care that might not be needed long-term.

The study was published in the Journal of the American Medical Association.

A variety of studies and programs have shown it works. And improved compliance can keep patients out of the hospital — saving money in the long run. That’s especially true for vital maintenance drugs for chronic conditions like diabetes, or drugs like blood-thinners that can prevent serious conditions from developing.

But the practice isn’t without its potential drawbacks. For starters, there’s the question of how long and how much patients should be paid. Once they’re on a regular schedule, should payments continue? Or is the benefit of the medication (and the momentum of routine) enough to keep them compliant?

Some health care professionals and ethicists question the fairness of paying people who aren’t compliant to take their meds, while the patients who are more responsible and take the medication on their own aren’t “rewarded.”

The survey by the California HealthCare Foundation (CHCF) found that:

• One in 14 Americans had accessed a personal health record (twice as many as the year before)
• 33% of PHR users took specific actions to improve their own health
• PHR use was most valued by patients who have chronic conditions, low income, and/or are less well-educated
• Patients preferred to use PHRs provided by either their physician or their insurer, as opposed to versions from private companies
• 40% of patients who haven’t used PHRs are interested in trying, but
• 68% of patients still have serious concerns about the privacy of their data.

Despite the apparent benefits to patients, PHRs still aren’t used by the majority of Americans. Increased availability of PHRs (in part due to funding through the American Recovery and Reinvestment Act) should make them more available to more people in the next few years.

The survey, conducted by Health Intelligence Network, found 67% of respondents were using telehealth for either clinical or non-clinical purposes. Just under half (49%) use it to remotely monitor patients’ health.

For the most part, providers aren’t using hi-tech solutions: 72% cited the phone as the most used medium for telehealth. Another 39% said they offer broadband connections for telehealth services.

Other highlights from the survey:

• The biggest benefit of using telehealth was health care efficiency, cited by 73% of respondents.
• Just under 20% of respondents said their biggest headache in implementing telehealth was getting reimbursed for it.
• Most of those using telehealth made it available to their entire client base. Only 17% focused its use on the chronically ill; 8% primarily targeted rural patients.
• The condition most commonly tracked via telehealth was heart failure.

A recent story in the L.A. Times highlighted a model-turned-doctor who closed her family practice to focus on a more profitable niche. The practice now exists almost wholly as a place to get marijuana “recommendations,” which are then filled at local dispensaries. The practice also provides some other services, including Botox and a weight loss program (no word on whether it addresses weight gain from the munchies).

Did we mention the Caribbean-trained doctor in question, Sona Patel, bills herself as “Dr. 420” and uses her old modeling photos in her ads?

To be fair, Dr. Patel says she only recommends marijuana for patients with chronic diseases who have not seen improvement in six months or more under conventional treatment. She also claims to turn away two to five patients a day who don’t have a condition suitable for treatment with marijuana.

She concedes that moving from a traditional family practice to her current roster of services is much more profitable. But she says her main motivation was seeing patients with chronic diseases like diabetes get little to no relief from prescription drugs while often suffering serious side effects.

Regardless of motivation, Dr. Patel has plenty of company as a mostly-pot-based practice — there are several hundred in California alone. And there are an increasing number of claims that some of these practitioners don’t take the maximum care to ensure only patients with serious need get access to a controlled substance that has real street value.

Who watches the watchers?

There isn’t much downside to being a liberal dispenser of marijuana prescriptions. Despite the proliferation of pot dispensaries and marijuana-specialty practices, since 1996, there have been only 81 complaints against “pot docs” according to the Medical Board of California. (Then again, patients abusing the system probably feel too good to complain about much.)

Subsequent investigations of those complaints resulted in disciplinary action against only 10 physicians.

That concerns both folks who think it’s a bad idea to allow medical marijuana use as well as more traditional doctors who believe pot has a place in the pharmacy — when properly supervised.

Should medical marijuana use be more tightly controlled? Or does that simply make a useful pharmaceutical harder to get in the hands of patients who need it? And do practices that play up the recreational aspects of marijuana help remove a stigma, or are they just updated Dr. Feelgoods?

Share your thoughts in the comments.

The report, by Thomson Reuters, identified several key factors that lead to various types of waste, fraud and inefficiency. And the biggest causes of waste — as documented by a variety of published research, as well as internal health care data — flies in the face of much conventional wisdom.

Among the leading drivers of waste — and some of their underlying causes:

• Unnecessary care (40% of total waste, up to $325 billion per year) — Unneeded treatments, ranging from overuse of antibiotics to unnecessary diagnostics. These are sometimes prescribed to protect against malpractice, to move the patient to another facility and “churn” more appointments or simply to meet patients’ unrealistic expectations.
• Fraud (19% of waste, up to $175 billlon yearly) — This includes everything from Medicare fraud to kickbacks for unnecessary referrals.
• Administrative inefficiency (17% of waste, up to $150 billion) — This one boils down to time-consuming, often redundant, paperwork.
• Medical errors (12% of waste, up to $100 billion) — Provider mistakes, and the follow-up treatment costs.
• Preventable conditions (6% of waste, up to $50 billion) — Avoidable hospitalizations for chronic conditions like diabetes which are better, and more efficiently, managed with ongoing outpatient care.
• Lack of coordination among care providers (6% of waste, up to $50 billion) — Lack of (or inefficient) communication among care providers leads to duplicate tests, over-prescribing, and other inappropriate treatments.

The good news? Most of these issues can be dealt with, at least in part, at the hospital and practice level. Even small steps to streamline paperwork and patient hand-offs, as well as improving communication among providers, can have a big payoff for everyone.

What are the best steps to take to eliminate some of this waste from health care — and what’s a realistic goal? Share your thoughts in the comments.

EHR systems are also of particular use in improving overall health in poorer communities or in areas with high levels of chronic disease.

Case in point: The Othello, Washington-based Columbia Basin Health Association (CBHA) was an early adopter of EHRs and used the system to monitor roughly 1300 diabetic patients to see if they received recommended exams.

The EHRs also allowed typically overloaded staffers at rural facilities to minimize time spent on administrative tasks so they could focus on co-ordinating patient care, follow-up services, etc.

Within a year, EHRs helped CBHA improve exam rates significantly: The number of patients getting foot exams increased from 31% to 86%; eye exams jumped from 37% to 63%.

In other populations, using data from EHRs allowed CBHA to decrease the number of no-shows for dental appointments, and eventually fill all available appointment times. Bottom line: CBHA was more efficient, and more patients got better care.

North Shore-Long Island Jewish Health System is hoping so.

The first phase of the program will be rolled out to roughly 100 local doctors, then eventually to all the hospital’s 7,000 affiliated doctors. The subsidies, which will be paid over five years, are in addition to federal subsidies of up to $44,000.

North Shore’s goal is to not just get doctors using EHRs to send/receive basic data, but to improve overall patient outcomes.With that in mind, the subsidies are tiered: Physicians can get up to 50% of the total cost of implementing EHRs if they just install systems that can “talk” with the hospitals and labs.

But docs can get as much as 85% of the total cost subsidized if they share (non-personal) data on various patient measures. Of particular interest is data on patients with chronic conditions like diabetes, cardiac post-op outcomes, etc.

It’s expensive, no doubt. But it could have a couple of huge payoffs for North Shore.

When fully rolled out, the program could give North Shore a massive database of patient care information and help health care providers make better decisions on which course of treatment will provide the best outcome.

The program holds promise of another benefit: By creating stronger links — literally –  with local physicians, the hospital will presumably be in a better position to recruit new docs and retain current ones.