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Doctor’s Dispatch: Three Unusual Aspects Of This Year’s Early Flu

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The flu is hitting early and hard this year in Massachusetts and elsewhere.

We share the official data as it comes out. (See that rocketing red 2013 line in the CDC chart above.) But now for a fresh dispatch from the medical trenches — that is to say, in this case, the infectious diseases division of Mount Auburn Hospital. Dr. Robin Colgrove, a virologist by training, underscores that he’s passing along purely anecdotal reports — but they may provide early warning for both doctors and patients. We spoke today; his observations, lightly edited:

Clearly we’re seeing a lot more flu a lot earlier than we usually do. A few other things are unusual this year.

1. Despite the vaccine

It seems to us that we’re seeing more confirmed cases of influenza, using the rapid antigen test, in people who’ve been vaccinated than we would normally see. I was speaking about this at grand rounds the other day and among the primary care doctors in the audience, a number were saying the same thing.

Dr. Robin Colgrove

Dr. Robin Colgrove

Those cases have been mostly mild cases and it may be they have partial protection from the vaccine. (Flu vaccine efficacy has been controversial among researchers for quite some time. In ideal conditions with young healthy people, it may be 80-90 percent effective, but when epidemiologists look at the real world, the numbers have been much lower, maybe 50-60 percent efficacy.) Even in the best years, some people who get vaccinated also get influenza, but they are probably less likely to have severe and prolonged illness.

2. Atypical symptoms

A related point: There seem to be more people this year with atypical symptoms. Clinicians tend to be good at identifying flu: an abrupt high fever and severe malaise, and upper and lower respiratory symptoms. That pattern in the middle of a flu outbreak is almost always flu. Now we’re seeing people [who test positive for flu] with no high fever, maybe scratchy throats, possible gastro-intestinal symptoms. Continue reading

What Boston’s Pioneer ACOs Will Mean For Patients


As we reported last week, five Boston area hospitals and physician groups will have a dominant role in a federal experiment that could transform Medicare. All Medicare patients who see doctors through Atrius Health, Partners HealthCare, Beth Israel Deaconess Medical Center, Mount Auburn Hospital or any of the Steward Health hospitals will be affected.  The question is how?

The Centers for Medicare and Medicaid Services (CMS) today announced 32 organizations that will “Pioneer” the move to accountable care organizations (ACOs). Greater Boston, with five of the 32, will have a large concentration of doctors and patients testing ways to coordinate care and reduce costs.

Medicare rules become the standard for payments and care at most hospitals.  So when these major groups in Boston start doing more preventive care or requiring more interaction among all a Medicare patient’s doctors, the same practices will likely apply — eventually — to patients of all ages.

This pilot will not restrict where patients go for care. Hospitals and doctors will be rewarded for beating their prior spending thresholds and for showing patient care improvements. These groups could lose money if patients need more care than they have in the past or if they get a lot of expensive care that isn’t coordinated.

CMS says this experiment could save $1.1 billion over the next five years.  That’s a lot of money, but keep in mind that the Medicare budget this year is $468 billion.

We asked leaders of each Boston area organization to answer this question: How will joining this pilot project affect the way you care for Medicare patients? Continue reading