Featuring hospital and health care headlines from the media and the Web.
Study: Sioux City hospitals deliver $31 million in benefits
The two hospitals in Sioux City contributed $31 million in economic benefits to the local community, according to a recent study. Mercy Medical Center—Sioux City provided $17.8 million in benefit and UnityPoint Health – St. Luke’s another $13.2 million in community benefit according to the assessment by Iowa Hospital Association (IHA). The IHA report shows that Iowa hospitals provided community benefits in 2013 valued at nearly $1.6 billion. Community benefits include such services and programs as health screenings, support groups, immunizations, nutritional services and transportation programs. (Sioux City Journal)
NewLink could pocket $50 million from Ebola vaccine
Ames-based NewLink Genetics Corp. stands to be paid more than $50 million from a licensing agreement announced Monday to allow pharmaceutical giant Merck to ramp up production of NewLink’s Ebola vaccine. The licensing deal puts NewLink’s vaccine in the hands of the much larger Merck, which a company spokesman said has the size, technology and experience to increase production of the drug and bring it closer to being publicly available. While the vaccine’s effectiveness still needs to be tested, the hope is that it will be able to treat people with Ebola and immunize healthy people, said Merck spokeswoman Pam Eisele. (The Des Moines Register)
County to use Alert Iowa System
Chickasaw County Emergency Management director Kenny Rasing discussed the mass notification system called Alert Iowa that can, and will, be used by Chickasaw County with the group of board heads at Wednesday’s department head meeting. The system is free of charge and available to all counties. Rasing hopes the system will be operational within the next few months.”We are very fortunate to be in on this system,” said Rasing. (New Hampton Chickasaw County Tribune)
Property taxes are down thanks to Obamacare
The property tax burden for counties that subsidize care in health facilities for the uninsured has gone down due to the fact that many more people actually have health insurance now – thanks to the Affordable Care Act. A good example of this is in Cook County, Illinois. Low-income patients are actually able to pay their bills because of expanded Medicaid coverage, which means property taxes and fees will not increase in the county next year. “For the first time in the history of our health care system, we have more insured patients than uninsured,” Cook County Board President Toni Preckwinkle said in her budget address. (MedCity News)
Unreported GPO fees may cause Medicare to overpay hospitals
A government watchdog wants to know if hospitals accurately report revenue they receive from group purchasing organizations, a question that may have broader implications for the federal safe harbor that allows GPOs to earn and distribute such administrative fees. The Government Accountability Office on Monday released a highly anticipated report (PDF) on GPOs that found HHS’ Office of the Inspector General does not routinely assess whether fees from GPOs to hospitals are accounted for on Medicare cost reports, which are used to help set hospital payment rates for Medicare. “To the extent that administrative fee revenue is not reflected on cost reports, Medicare could be overpaying hospitals,” the GAO said. (Modern Healthcare)
When health coverage expansion means longer waits for a doctor
One concern about the Affordable Care Act is that as more Americans get health insurance and start using it, those who already have coverage will have to wait longer for care. Recent research with a focus on Massachusetts suggests this may actually happen, but may not last long. Several years after the coverage expansion in that state, access to care for other, previously covered residents appears to be no worse than before the expansion. (The New York Times)
Marketplaces will automatically renew consumers’ plans but take a look first
So far, the open enrollment period on the federal and state marketplaces—which started Nov. 15 and continues until Feb. 15 for 2015 coverage—is proceeding much more smoothly than last year. But people remain confused about plans, premiums and provider networks. Here are answers to several readers’ questions. (Kaiser Health News)
Health Care M&A leads global deal surge
In a big year for deal making, the health care industry is a standout. Large drugmakers are buying and selling businesses to control costs and deploy surplus cash. A rising stock market, tax strategies and low interest rates are also fueling the mergers and acquisitions. It’s all combining to make 2014 the most active year for health care deals in at least two decades. The industry has announced about $438 billion worth of mergers and acquisitions worldwide so far, about 14 percent of the $3.2 trillion total for all industries, according to data provider Dealogic. Overall, M&A is on track for its best year since 2007, the year before the financial crisis intensified. (ABC News)
Upfront costs of going digital overwhelm some doctors
Dr. Oliver Korshin practices ophthalmology three days a week in the same small office in east Anchorage, Alaska, he’s had for three decades. Many of his patients have aged into their Medicare years right along with him. For his tiny practice, which employs just one part-time nurse, putting all his patients’ medical records in an online database just doesn’t make sense, Korshin says. It would cost too much to install and maintain — especially considering that he expects to retire in just a few years. But starting next year the federal government will penalize Korshin and other doctors for not using electronic health records; Medicare will withhold 1 percent of his payments. (NPR)
Two years ago, Inova Health System recruited a top executive who was not a physician, had never worked in hospital administration and barely knew the difference between Medicare and Medicaid.
What Paul Westbrook specialized in was customer service. His background is in the hotel business – Marriott and The Ritz-Carlton, to be precise.
He is one of dozens of hospital executives around the country with a new charge. Called chief patient experience officers, their focus is on the service side of hospital care: improving communication with patients and making sure staff are attentive to their needs, whether that’s more face time with nurses or quieter hallways so they can sleep.
It’s a dimension of hospital care that has long been neglected, patient advocates say, and it was put high on hospitals’ agendas only when Medicare started tracking patient satisfaction and, in late 2012, shaving payments to hospitals that fell short.
“There is a new recognition that the patient is important,” said Leah Binder, president and chief executive of the Leapfrog Group, an employer-based coalition that advocates for greater health-care quality and safety.
Hospital routines have traditionally been designed to suit employees, not customers, she said. “The patient used to be maybe 10th on the list of a hospital’s priorities.”
The financial penalties introduced by the Affordable Care Act are part of a broader effort to transform health-care delivery and improve quality while reining in costs, increasing transparency and holding hospitals and providers accountable for their work.
The penalties — which for now make up only a fraction of Medicare reimbursements — are based on a hospital’s ranking relative
to other hospitals. One component is how they do on surveys of recently discharged patients. The hospitals are judged on answers to such questions as how well their doctors and nurses communicated with them, how clean and quiet the hospital was, whether they received help when they needed it and how well providers explained the drugs they were given.
Many hospitals commission additional surveys to use for their own purposes, such as marketing and branding.
Chief patient experience officers treat these survey results like sacred texts.
“The one thing I’m not trying to do is to put a mint on the pillow,” said Westbrook, who reports directly to Inova’s president and chief operating officer. “This is a different customer, with very different needs.”
But as patients’ out-of-pocket costs have risen, he said, they have become savvier, more demanding consumers.
“They are going to look on the Internet and on Medicare’s site comparing hospitals, and they are going to read comments,” he said, and increasingly, they will select hospitals based on the reviews. “It’s no different from TripAdvisor.”
Lofty Goals, Practical Implementation
Unlike Westbrook, most chief patient experience officers rise through the ranks of a health system. Like him, though, they speak in lofty terms about teamwork, leadership and developing a philosophy and culture of compassion, service and respect at their institutions.
Westbrook, for instance, talks constantly about the “Inova promise” to “meet the unique needs of each person we are privileged to serve – every time, every touch.”
That phrase had “always hung on a wall,” Westbook said. “Now, we don’t begin a meeting without an Inova promise story.”
On the ground, the focus is doggedly practical. One common innovation is hourly rounds, a system where nurses are expected to check in on each patient regularly, not wait for the person to use the call button. And the interaction is supposed to be meaningful and thorough.
“This doesn’t mean just pausing at the door, saying, ‘Are you okay? Can I get you anything?’ and off you go,” said Susan Eckert, chief nursing executive at MedStar Washington Hospital Center. “We’re telling our nursing staff that you should actually sit down, look at the patient, talk a little bit, and give them several minutes of time during which they are the only thing that exists in the world . . . It’s a very powerful experience.”
Hospitals that have put hourly rounding in place say the practice does not require extra staffing because it is more efficient to prevent problems before they occur. Taking time to reposition a patient prevents bedsores, for example, and helping patients to the bathroom prevents falls.
Another priority is having nurses call patients at home within 48 hours of their discharge, to keep their recoveries on track. (One Medicare question specifically asks patients whether they got good instructions about what to do when they get home. Hospitals can also be penalized if too many patients bounce back to them.)
Hospitals are increasingly taking their cues from patients, both by listening to the advice from new patient and family advisory councils and by using the surveys to identify weak spots.
At Yale-New Haven Hospital, where an executive director of patient relations and a medical director work together to improve the patient experience, officials have made a concerted effort to lower noise so patients can get optimal rest. Hospital staff are told to use “library voices 24/seven” and not to “vent” where patients might hear them. Overhead page calls have been eliminated, beepers are kept on vibrate, doors are closed when staff discuss cases and efforts are made to reduce alarms, pings and beeps at the bedside.
The Cleveland Clinic requires all 3,000 staff physicians to take a day-long relationship and communication class. In 2010, the hospital showed each doctor what patients had said about him or her in surveys. About half the comments were negative — and most of those had to do with how physicians talk to patients.
Doctors were stunned when they saw the results, said James Merlino, a surgeon who is Cleveland Clinic’s chief experience officer.
“Physicians were shocked, dismissive, disbelieving. They said, ‘This isn’t true, the methodology is bad, the sample size is too small,’ ” he said.
Now, he said, “we put physicians through communication training so they learn how to listen better, let the patient set the agenda and organize the encounter better.”
The result is a big increase in physician communication scores since 2008.
At UCLA Health System, parents of pediatric patients created an educational video about central-line catheters that is shown to physicians and nursing staff “to remind them how scary that catheter is for patients and their family members,” said Tony
Padilla, UCLA’s chief patient experience officer, adding that catheter-related infections can be
dangerous and even fatal.
“It drives home the message that during your very busy day as a nurse or physician, please remember: You’re accessing the child’s lifeline.”
Moving The Needle
Moving the needle on Medicare surveys can be a hard slog. Inova Mount Vernon’s composite score went up from 66.6 percent to 68.4 percent from 2010-11 to 2012-13. That means that on average, 68.4 percent of patients gave top marks to the hospital on survey questions in 2012-13. Scores at Inova Fairfax dropped and scores at Inova’s other three hospitals remained about the same.
Hospitals face a balancing act.
“We want to be attentive to a patient’s needs and wants, yet not do things just to please the patient, like overprescribing pain medication,” said Atul Grover, chief public policy officer for the Association of American Medical Colleges, which represents nearly 400 major teaching hospitals and health systems, in addition to U.S. medical schools. “You want to make sure patient satisfaction isn’t driving patient care.”
Some question whether the hospitals that score best on patient surveys are also the ones that provide the best care. Grover, for example, worries that hospitals that don’t offer amenities, such as single rooms, will be dinged in the surveys.
But some research suggests a strong correlation between patient satisfaction and outcomes, said Richard Staelin of Duke University’s Fuqua School of Business.
One of his studies, published in the journal Circulation in 2013, found that the death rate among heart attack patients was lower at hospitals where patient satisfaction scores were high, even when researchers controlled for the quality of care, meaning the care was equivalent.
Another study found higher overall patient satisfaction was associated with lower readmission rates a month after patients were discharged.
Studies have also found that hourly nurse rounds result in more-satisfied patients, with fewer falls and pressure sores.
“Patients co-produce the service,” Staelin said. “What I mean by that is that when someone is sick, the doctors can’t solve the problem without their help. … As a patient, I have to communicate with the doctor or nurse, I have to listen to the
doctor, I have to follow the instructions.”
“There are still lots of doctors who don’t believe it, but gradually the medical profession is coming around,” he added.
Indeed, several patient experience officers said some physicians at their hospitals resisted doing things differently until it was no longer an option.
The financial penalties “are brilliant,” Westbrook said. “That’s what’s driving change.”
Featuring hospital and health care headlines from the media and the Web.
Year after health-care law debut, more Siouxlanders have insurance
Laura Dudley last March was driving from her home in Sioux City to work at Subway in Sioux Center when the right side of her face went numb. By the time the 26-year-old manager arrived at the sandwich shop, she had forgotten the names of the other employees, and soon she couldn’t remember even her own name. She was immediately taken to Mercy Medical Center, where she had an MRI, CAT scan and spinal tap. Dudley was diagnosed with a migraine. She spent the night in the hospital. That migraine cost Dudley, who didn’t have health insurance, $14,000. (Sioux City Journal)
New Iowa health insurance option details released
Three of the state’s largest companies released details on Friday about a new health insurance product. Wellmark Blue Cross and Blue Shield, Hy-Vee and UnityPoint Health announced the Blue Rewards program in June. The plan brings together Wellmark’s insurance options with UnityPoint’s physicians and Hy-Vee’s retail services as part of the companies’ coordination of customer care. (Cedar Rapids Gazette)
African travelers back in Iowa subject to Ebola monitoring
Federal Ebola guidelines that have been developed over the past several weeks now mean that travelers from West Africa are subject to monitoring procedures that continue for 21 days. According to state of Iowa records, 14 such travelers have been monitored. Five are being monitored at a “low-level” risk while one person is considered at “some risk” for the disease. (Quad-City Times)
Stop the spread of Ebola . . . paranoia
These three women in quarantine aren’t sick, although they have good reason to be sick of panicky Americans. Lynnette Bayer and her 14-year-old daughter, Kelsey, returned home Nov. 10 from Uganda with their friend, Pam Lindemann. The trio, all members of East Side Christian Church in Council Bluffs, spent a dozen days overseas on a mission trip. They worked with students at Rock of Ages School in Mbiko, a small suburb of Jinja, the nation’s second-largest city after the capital of Kampala. (Des Moines Register)
Sioux City surgeon uses imaging device to take X-rays outside the office
Before orthopaedic surgeon Russell DeGroote purchased one of the latest tools in diagnostic imaging, injured Sioux City Musketeers had to leave the Tyson Events Center ice and travel across town to UnityPoint Health — St. Luke’s for imaging. Sometimes those X-rays weren’t taken until the next day. Now, the players only have to move several steps from the bench to the locker room, where DeGroote can X-ray their feet and ankles right through their skates. (Sioux City Journal)
How to arrive at the best health policies
Collecting data that can trump a powerful anecdote is the value of the randomized controlled trial, says Amy Finkelstein, an M.I.T. professor and a leader of the Oregon study, which has published a series of papers, most recently on emergency room use. That’s why this type of study — which randomly assigns some people to a new treatment and others to a placebo or an old approach — is the gold standard in evaluating the effectiveness of drugs: It can provide results that are both surprising and persuasive. But despite medical science’s long history with such studies, when it comes to the best way to design health care delivery, the randomized evaluation is still an incredibly rare approach. That may be starting to change. (New York Times)
45 rural hospitals losing critical access status, must reapply
The U.S. Census Bureau and Office of Management and Budget changed their urban and rural classification in several dozen regions around the country. For the critical access health program, that meant reclassifying 105 rural counties as located in an urban area. The 45 affected hospitals in those counties now must prove that they serve largely rural and small town populations. (Healthcare Finance News)
Upfront costs of going digital overwhelm some doctors
Dr. Oliver Korshin practices ophthalmology three days a week in the same small office in east Anchorage he’s had for three decades. Many of his patients have aged into their Medicare years right along with him. For his tiny practice, which employs just one part-time nurse, putting all his patients’ medical records in an online database just doesn’t make sense, Korshin says. It would cost too much to install and maintain — especially considering that he expects to retire in just a few years. (Iowa Public Radio)
Time’s right for a reset on health care
It’s been a bad, bad month for Obamacare. And that may be just what Texas needs. We’ve been at loggerheads with the feds since health reform was enacted four years ago, and the state is paying a price. Texas rejected billions in federal dollars to extend Medicaid coverage to low-income residents. And the governor did little to encourage buying private insurance in the new health exchange. So the state with the most to gain — nearly 1 in 3 working-age Texans have no health insurance — has gained much less than its peers. Why would anything change now? (Dallas Morning News)
Featuring hospital and health care headlines from the media and the Web.
Keokuk Area Hospital officials say financial rebound is underway
It’s a story repeated by several small Tri-State community hospitals; a struggle to keep the doors open because of a lack of Medicare and Medicaid reimbursements. Keokuk Area Hospital has been one of those affected and after years of struggling officials say things are turning around. Shirley Thompson is in good spirits and says she’s feeling better after a health scare brought her back to Keokuk Area Hospital. Thompson says if the hospital was closed she may not be here now. (WGEM)
Churdan man living life normally after heart stops at hospital
When Cecil Hoyle arrived, cardiologist Suzy Feigofsky examined him and told him he needed a temporary pacemaker. She recalled Hoyle asking if that was really necessary. “I said, ‘Not unless you want to go to heaven; then we’ll do nothing,’” Feigofsky recalled. Hoyle joked, “I have one foot in the door now.” “Oh, don’t be silly,” Feigofsky responded. In the next moment, Hoyle flatlined. (Carroll Daily Times Herald)
Family takes first steps in treating baby’s clubfoot
When Tom and Lisa Compart and their newborn, Henry, arrived at University of Iowa Hospitals and Clinics last month for their first appointment, the parents already had a good idea of what lay ahead. After all, the couple had several months to study up on clubfoot, the condition with which Henry had been diagnosed midway through Lisa’s pregnancy. They were ready for the weekly adjustments, the weeks-long casting process and the years of braces in Henry’s future. (Iowa City Press-Citizen)
Flight makes right at Muscatine High School
While Muscatine High School was teaching the three R’s Wednesday, there was a fourth one being taught nearby: Rescuing. The lesson didn’t involve any high-schoolers though, and the “students” who were taught weren’t sitting at a desk with their nose buried in a book. They were sitting in a helicopter that landed in front of the school. The helicopter was part of an emergency drill that the Muscatine Fire Department and University of Iowa’s AirCare Emergency Transport took part in Wednesday morning. (Muscatine Journal)
Hy-Vee should quit selling cigarettes, smoking foes say
Anti-smoking activists are calling on Iowa’s largest grocery chain to quit selling cigarettes and other tobacco products at stores that include pharmacies or health clinics. The move would help Hy-Vee demonstrate its professed interest in customers’ health, the Iowa Tobacco Prevention Alliance says. The group encouraged Hy-Vee to follow the lead of the national CVS drugstore chain, which pulled tobacco products from its stores earlier this year. (Des Moines Register)
Smokeout participant: ‘wish they’d just ban cigarettes’
After Sharon Olvera awoke, she spotted a news item about the event and headed over to the hospital after dropping her grandson off at school. Having been a smoker for 30 years, she has chronic obstructive pulmonary disease. Extreme coughing or hacking as she experienced Thursday is especially a concern for the 65-year-old, who is married with a son and three grandchildren. “I was meant to be here. It was like an act of God,” she said. (Quad-City Times)
The way we pay for health care is broken; a CEO describes how
Across the nation, large employers, health systems, health plans and other purchasers have endeavored to transform health care through innovation. The goal is to increase access, enhance care quality and improve the health of populations while controlling costs and bettering value. However promising, these new care models are unsustainable in the predominantly fee-for-service environment where payment is dictated by volume and not linked to quality or efficiency. This payment model doesn’t realize the potential that investments in prevention can have in improving health and reducing costs over the long-term. (Washington Post)
Health care costs: It’s time for patients to take control
Health analysts agree that it’s time for the patient to start being more of a consumer. Obamacare, controls on Medicare spending, cutting back on malpractice litigation, more preventive care and even healthier lifestyles have all been touted as ways to cut costs in the health-care system. But together they’ve made little more than a dent in the ever-rising cost of health care, which has been outpacing inflation for decades. (MarketWatch)
Former HHS official calls for ‘smarter’ networks that deliver cost-effective care
Many consumers who signed up for health coverage through online insurance exchanges discovered their doctors were not in their plans’ networks. While narrow networks aren’t new, they have emerged as one of insurers’ major levers for keeping costs down under the Affordable Care Act. Consumers have been attracted by lower premiums, but are often distressed at the restrictions. Lawsuits in California allege that some insurers duped customers into thinking their networks were larger by posting inaccurate provider lists. (Kaiser Health News)
AMA pushes lame duck Congress for SGR appeal
The American Medical Association wants the lame duck 113th Congress to permanently repeal the reviled Sustainable Growth Rate funding formula for Medicare before the session adjourns next month. “It’s important that we take advantage of the momentum that was created by all the worked that was done earlier this year to create HR4015 and Senate bill 2000,” AMA President Robert M. Wah, MD, told HealthLeaders Media Tuesday, referring to the ill-fated legislation that failed to repeal the SGR last spring. (HealthLeaders Media)
Per-employee health coverage costs rose 5.4 percent in the Kansas City area this year
Newer-style health insurance plans, with lower premiums but high deductibles, are forcing more Kansas City area employees to think twice about the health care dollars they spend. A survey released Wednesday showed that a lot more area employers are offering the new plans as the latest hope to control health care benefit costs. The annual National Survey of Employer-Sponsored Health Plans, by the Mercer professional services company, also found that those costs rose 5.4 percent this year. (Kansas City Star)
Featuring hospital and health care headlines from the media and the Web.
Even with health insurance, challenges remain
Many Iowa consumers purchasing health insurance through the state’s marketplace are among the sickest and the least prepared to use that insurance effectively, according to a pair of University of Iowa Public Policy Center studies out earlier this month. The studies, funded by a grant from the Commonwealth Fund, also suggest that a high proportion of eligible consumers need post-enrollment help to better understand their new insurance plans, provider availability and billing. (Cedar Rapids Gazette)
However unlikely, Washington hospital preparing for possible Ebola cases
The recent news of confirmed Ebola patients in the United States has heightened the awareness and concern of this infectious disease. While the chance of having a confirmed case of Ebola locally is minimal, Washington County Hospitals and Clinics has actively pursued efforts to ensure preparedness for the Ebola virus. “Though WCHC has plans, protocols, and appropriate supplies and equipment in place to care for patients with infectious diseases, our hospital has taken extra measures to ensure preparedness for Ebola,” stated WCHC CEO Dennis Hunger.
Cresco hospital board checks out construction progress
The Regional Health Services of Howard County Board of Trustees toured the North Wing/Pharmacy areas of the facility’s ongoing construction project at its monthly meeting recently. Following the meeting, Regional Health Services of Howard County CEO Robin Schluter described the areas that were featured on the tour. (Cresco Times Plain Dealer)
Medical marijuana discussion tabled by pharmacy board
Three members of the Iowa Board of Pharmacy recommended Wednesday morning that the state take marijuana out of the strictest classification of drugs, but the full board decided to wait until at least January to discuss the idea. A board subcommittee recommended Wednesday that legislators take marijuana out of Schedule I, a classification that bans almost all uses. But other board members said they wanted to go slow on the proposal. “I think we should take our time here,” said board member James Miller, a Dubuque pharmacist. (Des Moines Register)
Ottumwa students experience medical robotics
High-tech robotic surgical equipment sounds like something you wouldn’t let just anybody play with, but some Ottumwa High School students got to experience the system first-hand. Ottumwa’s robotics club and engineering class took a field trip to Ottumwa Regional Health Center to learn about the “da Vinci Robotics” surgical system. (KTVO)
CHI Health offers Blue Cross plan to achieve $80M in savings, including $10M in price cuts in 2015
CHI Health and Blue Cross Blue Shield of Nebraska are discussing the first proposal offered in weeks by either side in an effort to end their conflict. CHI Health on Monday offered what it called a two-year plan to achieve savings of $80 million — $10 million by cutting prices next year in the Omaha area and $70 million by freezing rates in 2016 and gaining savings through keeping groups of patients healthy. (Omaha World Herald)
CMS: 9.1 million enroll in Medicaid/CHIP over 12 months
More than 9.1 million people enrolled in Medicaid or the Children’s Health Insurance Program between Oct. 1, 2013 and Sept. 30, 2014, increasing total enrollment in the programs by an estimated 15.8 percent, according to a report released by the Centers for Medicare & Medicaid Services. The preliminary estimate is based on 48 states and the District of Columbia reporting both September enrollment data and baseline data from July through September 2013. (Centers for Medicare & Medicaid Services)
How much did health insurance rates go up? It’s complicated
Americans could find the new insurance rates for the Affordable Care Act in online marketplaces last week. Prices of many plans went up. But just how much depends on how you measured them. Shortly after the numbers were released, think tanks, consultants and reporters all crunched the data to produce varying estimates of what’s happening to insurance premiums in the new marketplaces. (New York Times)
Study: American seniors face health care gaps, despite Medicare
Americans older than 65 are more likely to have chronic illnesses and to say they struggle to afford health care – despite qualifying for the federal Medicare program – than are seniors in other industrialized countries, according to a study by the Commonwealth Fund published Wednesday in the journal Health Affairs. (Kaiser Health News)
How medical care is being corrupted
When we are patients, we want our doctors to make recommendations that are in our best interests as individuals. As physicians, we strive to do the same for our patients. But financial forces largely hidden from the public are beginning to corrupt care and undermine the bond of trust between doctors and patients. Insurers, hospital networks and regulatory groups have put in place both rewards and punishments that can powerfully influence your doctor’s decisions. (New York Times)