What can we expect from the "Cadillac tax" in 2018 and beyond?

One controversial aspect of the Patient Protection and Affordable Care Act is the provision to impose a 40% excise tax on insurance benefits above a certain threshold, commonly referred to as the "Cadillac tax." We use the Employer Health Benefits Survey, sponsored by the Kaiser Family Foundation and Health Research and Educational Trust, to examine the number and characteristics of plans that likely will be affected. We estimate that about 16% of plans will incur the tax upon implementation in 2018, while about 75% of plans will incur the tax a decade later due to the indexing of the tax thresholds with the Consumer Price Index. If the Cadillac tax is ultimately implemented as written, we find that it will likely reduce private health care benefits by .7% in 2018 and 3.1% in 2029, and will likely raise about $931 billion in revenue over the ensuing 10-year budget window from 2020 to 2029.     

What can you expect during your onsite survey?

The world of accreditation is in constant change, and as health information management professionals, we should always embrace change. New standards and survey procedures provide us with new goals, outlooks, ways to increase the quality of patient care, and opportunities to mentor the hospital staff including the medical staff and governing board. I encourage you to evaluate, amend, and build on the information contained within this article. Remember that talking to your peers about their experiences and working as though your survey is tomorrow is your best bet for superior survey results. Who knows, you could receive an unannounced survey.     

Talking about breast symmetry in the breast cancer clinic: What can we learn from an examination of clinical interaction?

BackgroundBreast asymmetry is a common post‐operative outcome for women with breast cancer. Quality of cosmetic result is viewed clinically as a critical endpoint of surgery. However, research suggests that aesthetic standards governing breast reconstruction can be unrealistic and may problematically enforce feminine appearance norms. The aim of reconstructive procedures is to help women live well with and beyond breast cancer. Therefore, understanding how patients and clinicians talk about surgical outcomes is important. However, we lack evidence about such discussions.ObjectiveTo examine clinical communication about breast symmetry in real‐time consultations in a breast cancer clinic.DesignSeventy‐three consultations between 16 clinicians and 47 patients were video‐recorded, transcribed and analysed using conversation analysis.ResultsIn most cases, patients do considerable interactional work to persuade clinicians of the validity of their concerns regarding breast asymmetry, and clinicians legitimize these concerns, aligning with patients. In a significant minority of cases, patients appear more accepting of their treatment outcome, but clinicians prioritize symmetry or treat symmetry with the presence of breast tissue as normative, generating misalignment between clinician and patient.ConclusionCurrent clinical communication guidelines and practices may inadvertently reinforce culturally normative assumptions regarding the desirability of full, symmetrical breasts that are not held by all women. Clinicians and medical educators may benefit from detailed engagement with recordings of clinical communication like those analysed here, to reflect on which communicative practices may work best to attend to a patient''s individual stance on breast symmetry, and optimize doctor‐patient alignment.     

What can we expect of clinical teachers? Establishing consensus on applicable skills,attitudes and practices

CONTEXT: Despite myriad advances in medical education, we have not yet established a universally accepted set of attributes we can reasonably expect from our teachers. METHODS: A modified Delphi technique established the skills, attitudes and practices thought to be core for clinical teachers within our region. We identified relevant statements from the literature. Individuals with significant involvement in undergraduate teaching acted as Delphi panelists. Four statement categories emerged: Preparing to Teach, Delivery of Teaching, Teacher Conduct and Supporting Activities. Two iterations of the Delphi round then took place. In the first round, panelists were asked to accept, reject or develop the statements identified from the literature. In the second round, they were asked to accept or reject modified statements. Throughout the exercise panelists were expected to differentiate between what could be expected from both those involved in clinical undergraduate education and those with a specialist educational remit. Agreement of > or = 80% was used to assign statements to basic or advanced categories. RESULTS: A total of 38 regional panelists participated in the Delphi process. After the 2 iterations, 27 statements were accepted at basic level, mostly in Teacher Conduct (11), and least in Supporting Activities (2). Overall, only 4 statements scored > 80% at advanced level. Many statements (25 of 56), were not clearly defined as either basic or advanced and failed to gain acceptance > 80% for either category. DISCUSSION: A useful set of attributes has been developed that can be applied to a majority of clinical teachers. There was less agreement than expected around higher level attributes. Further debate is invited.     

In search of the cancer candidate: can lay epidemiology help?

First published in 1991, the ideas embedded in ‘Lay epidemiology and the prevention paradox’ offered a novel and rational explanation for the lay public’s failure to fully engage with the lifestyle messages offered by health educators. During the course of a large ethnographic study in South Wales, Davison and colleagues described the emergence of what they termed the coronary candidate. Candidacy provides a ‘cultural mechanism’ that facilitates the estimation of risk for coronary heart disease. The model has rarely been applied to other major illnesses. This article presents findings from a study that sought to explore the lay epidemiology model, candidacy and cancer. In a series of in‐depth individual interviews, members of the lay public discussed their ideas about cancer, and what emerged was an explanatory hierarchy to account for cancer events. Yet the random and unpredictable nature of cancer was emphasised as well as a general reluctance to accept the idea of cancer candidacy.