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October 2013 Briefing - Pain Management

Here are what the editors at HealthDay consider to be the most important developments in Pain Management for October 2013. This roundup includes the latest research news from journal articles, as well as the FDA approvals and regulatory changes that are the most likely to affect clinical practice.

FDA Announces Moves to Avert Drug Shortages

THURSDAY, Oct. 31 (HealthDay News) -- Drug makers would have to promptly notify the federal government of potential drug shortages under a new rule proposed Thursday by the U.S. Food and Drug Administration. The companies would be required to alert the FDA at least six months before a possible interruption in supply, or no later than five days after the interruption has occurred.

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Top 100 EHR Systems Sorted by Company Revenue

THURSDAY, Oct. 31 (HealthDay News) -- The top 100 electronic health record (EHR) systems have been sorted, mainly by company revenue, in an article published Oct. 25 in Medical Economics.

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Sebelius: 'Hold Me Accountable' for Website 'Debacle'

WEDNESDAY, Oct. 30 (HealthDay News) -- U.S. Health and Human Services Secretary Kathleen Sebelius on Wednesday claimed responsibility for the failed rollout of HealthCare.gov and committed to fixing the website's many software and system problems.

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Record High in Medical School Applicants, Enrollment

WEDNESDAY, Oct. 30 (HealthDay News) -- In 2013, a record number of students applied to and enrolled in medical schools, according to a report published by the Association of American Medical Colleges (AAMC).

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2013 Health Care Quality Report Shows Some Improvements

WEDNESDAY, Oct. 30 (HealthDay News) -- Five key quality issues are showing some positive trends, according to the 2013 State of Health Care Quality Report published by the National Committee for Quality Assurance (NCQA).

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Expedited Review Speeds Approval of New Drugs by FDA

WEDNESDAY, Oct. 30 (HealthDay News) -- In 2008, new drugs that received expedited review by the U.S. Food and Drug Administration were approved more rapidly, but many questions about safety remain unresolved, according to research published online Oct. 28 in JAMA Internal Medicine.

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Health Agency Chief Apologizes for Federal Website Woes

TUESDAY, Oct. 29 (HealthDay News) -- The head of the federal agency responsible for HealthCare.gov issued a public apology Tuesday for problems that have plagued the health insurance website since its Oct. 1 launch. "I want to apologize to you that the website has not worked as well as it should," Marilyn Tavenner, administrator of the U.S. Centers for Medicare and Medicaid Services, told members of the House of Representatives' Ways and Means Committee at a hearing on the Affordable Care Act.

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Consultant Offers Tips for Training Staff to Use EHR System

TUESDAY, Oct. 29 (HealthDay News) -- Six tips can help educate staff to use new electronic health record (EHR) systems, according to an article published Oct. 25 in Medical Economics.

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Docs, Lawyers Join Forces to Allow Doctors to Apologize

TUESDAY, Oct. 29 (HealthDay News) -- A new Senate bill allows health care professionals to make benevolent gestures without fear of these statements being used against them, according to a report published by the Pennsylvania Medical Society.

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Survey Assesses Patients' Expectations After Spine Surgery

TUESDAY, Oct. 29 (HealthDay News) -- A new survey has been developed and validated for assessing patients' expectations of lumbar spine surgery, according to a report published in the Oct. 2 issue of The Journal of Bone & Joint Surgery.

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Spine Surgery Patients Meeting Strict Criteria Benefit More

MONDAY, Oct. 28 (HealthDay News) -- Patients meeting strict criteria benefit more from surgery for degenerative spondylolisthesis (DS), compared to non-operative care, although the treatment effect of surgery is modified by specific patient characteristics, according to a study published in the Oct. 1 issue of Spine.

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FDA Approves Extended-Release Hydrocodone Painkiller

FRIDAY, Oct. 25 (HealthDay News) -- Zohydro ER (hydrocodone bitartrate extended-release) has been approved by the U.S. Food and Drug Administration for severe pain that requires round-the-clock long-term treatment, the agency said Friday in a news release.

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Many Interns Don't Practice Etiquette-Based Communication

FRIDAY, Oct. 25 (HealthDay News) -- Internal medicine interns overestimate the extent to which they practice an etiquette-based communication approach, according to a study published online Oct. 12 in the Journal of Hospital Medicine.

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Coexisting Pain Tied to Worse Knee Replacement Outcomes

FRIDAY, Oct. 25 (HealthDay News) -- Musculoskeletal pain in the low back, hips, and the nonoperatively treated knee before total knee replacement is associated with poorer physical function at six months after surgery, according to a study published in the Oct. 16 issue of The Journal of Bone & Joint Surgery.

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Peer Intervention Program Reduces Patient Complaints

FRIDAY, Oct. 25 (HealthDay News) -- A physician peer intervention program is effective in improving unsafe and dissatisfying physician behaviors identified through patient complaints, according to a study published in the October issue of the Joint Commission Journal on Quality and Patient Safety.

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Most Negative Online Posts Aren't Defamation

FRIDAY, Oct. 25 (HealthDay News) -- Few negative online posts about doctors reach the level of defamation, according to an article published Oct. 10 in Medical Economics.

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FDA Urges Tighter Controls on Certain Prescription Painkillers

THURSDAY, Oct. 24 (HealthDay News) -- On Thursday, the U.S. Food and Drug Administration called for tighter controls on prescription painkillers containing the narcotic hydrocodone.

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Physicians Should Motivate and Retain Top Employees

THURSDAY, Oct. 24 (HealthDay News) -- Even in a time of declining reimbursements, smart employers should know how to motivate and retain superstar employees in their practice, according to an article published Oct. 10 in Medical Economics.

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Penalty Delayed As Federal Exchange Comes Under Fire

THURSDAY, Oct. 24 (HealthDay News) -- U.S. consumers who sign up for health insurance by March 31 won't face tax penalties for being uninsured during the first three months of 2014, the Obama administration said Thursday.

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State Parity Laws Increase Access to Substance Use Tx

THURSDAY, Oct. 24 (HealthDay News) -- Implementation of legislation incorporating parity for substance use disorder (SUD) treatment has correlated with improved access to specialty treatment, according to a study published online Oct. 23 in JAMA Psychiatry.

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>5 Percent Readmitted After Total Joint Arthroplasty

THURSDAY, Oct. 24 (HealthDay News) -- More than 5 percent of patients who undergo total hip and knee arthroplasty have unplanned readmission within 90 days, according to a study published in the Oct. 16 issue of The Journal of Bone & Joint Surgery.

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Methylprednisolone Shot-Linked Fungal Infections Investigated

WEDNESDAY, Oct. 23 (HealthDay News) -- For patients who received epidural, paraspinal, or joint infections with contaminated lots of methylprednisolone acetate, infections caused by the outbreak associated pathogen Exserohilum rostratum result in a spectrum of clinical disease, according to a study published in the Oct. 24 issue of the New England Journal of Medicine.

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Intranasal Oxytocin Application Enhances Placebo Effect

TUESDAY, Oct. 22 (HealthDay News) -- Intranasal application of the hormone oxytocin enhances the placebo response, according to a research letter published in the Oct. 23/30 issue of the Journal of the American Medical Association.

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Research Backlog at NIH Due to Shutdown

TUESDAY, Oct. 22 (HealthDay News) -- It will take some time before research programs return to normal at the U.S. National Institutes of Health after the end of the federal government shutdown, officials say.

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Scribes Can Be Beneficial in Medical Practices

TUESDAY, Oct. 22 (HealthDay News) -- Medical scribes can accurately document physician or independent practitioner dictation and activities, allowing providers to spend more time with patients, according to an article published Oct. 10 in Medical Economics.

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Study Probes Why Truckers Use Booze, Illicit Drugs

TUESDAY, Oct. 22 (HealthDay News) -- The use of psychoactive substances, including alcohol, amphetamines, and marijuana, appears common in truck drivers, particularly when working conditions are poor, according to research published online Oct. 21 in Occupational & Environmental Medicine.

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Rocker Sole Shoes Show No Benefit for Low Back Pain

TUESDAY, Oct. 22 (HealthDay News) -- Rocker sole shoes seem no more beneficial than flat sole shoes for people with low back pain (LBP), according to a study published in the Oct. 15 issue of Spine.

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Obama: 'No Excuse' for Troubled HealthCare.gov Website

MONDAY, Oct. 21 (HealthDay News) -- Saying he's confident the problems will get fixed, President Barack Obama admitted today that there is "no excuse" for the troubles plaguing the beleaguered HealthCare.gov website. "There's no sugar-coating it. The website has been too slow, people have been getting stuck during the application process, and I think it's fair to say that nobody's more frustrated by that than I am," he said during the nearly 30-minute-long address in the White House Rose Garden.

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Seniors Rarely Consider Switching Medicare Plan, Provider

MONDAY, Oct. 21 (HealthDay News) -- Most seniors report being satisfied with Medicare coverage and most would not consider switching plan or provider even though the Medicare annual open enrollment period, which lasts from Oct. 15 to Dec. 7, allows people the opportunity to make changes, according to a report from Allsup.

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Small Businesses Weigh Health Insurance Options

MONDAY, Oct. 21 (HealthDay News) -- Small businesses rated most features of the Small Business Health Options (SHOP) exchanges favorably, but reasonable prices for premiums are especially important to them, according to research published online Oct. 16 in Health Affairs.

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Eye Contact Affects Patients' Perception of Clinician Empathy

FRIDAY, Oct. 18 (HealthDay News) -- Physicians who make direct eye contact and engage in a moderate amount of social touch are perceived by patients as being more empathetic, according to research published online Aug. 14 in the Journal of Participatory Medicine.

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In Buying Exchange Insurance, It Helps to Have Help

FRIDAY, Oct. 18 (HealthDay News) -- You have to wade through a lot of insurance jargon and be a skilled number-cruncher to choose the right health insurance plan on the new health exchanges, health literacy and consumer decision-making experts say.

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Sebelius: Exchange Launch 'Rockier Than We Would Have Liked'

THURSDAY, Oct. 17 (HealthDay News) -- U.S. Health and Human Services Secretary Kathleen Sebelius admitted Wednesday that the troubled launch of the federal government's new health insurance exchange hasn't gone as planned. However, she said technicians were working to fix the glitches that have plagued the HealthCare.gov website, and improvements should be evident shortly to consumers, the Cincinnati Enquirer reported Wednesday.

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Risk Factors for VTE Post-Spine Surgery Identified

THURSDAY, Oct. 17 (HealthDay News) -- There are multiple independent risk factors for the development of deep venous thrombosis (DVT) and/or pulmonary embolism (PE) after spine surgery, according to a study published in the Oct. 1 issue of Spine.

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'Coverage Gap' Likely to Affect 5.2 Million Uninsured Adults

THURSDAY, Oct. 17 (HealthDay News) -- About 5.2 million uninsured adults are expected to fall into the Affordable Care Act (ACA) 'coverage gap,' with incomes too high to qualify for Medicaid programs but below the level eligible for federal subsidies to purchase private insurance, according to a report issued by the Henry J. Kaiser Family Foundation.

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Docs Should Discuss Out-of-Pocket Costs With Patients

THURSDAY, Oct. 17 (HealthDay News) -- Given the high out-of-pocket costs associated with health care and their implications for patients, physicians should discuss these costs with patients during the clinical decision-making process, according to a perspective piece published in the Oct. 17 issue of the New England Journal of Medicine.

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Steps Given to Minimize Burden of Prior Authorizations

THURSDAY, Oct. 17 (HealthDay News) -- Prior authorizations are a time-consuming part of work, but the process can be simplified, according to an article published online Oct. 10 in Medical Economics.

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Med Students Value 'Enjoying Work' in Specialty Selection

THURSDAY, Oct. 17 (HealthDay News) -- For first year medical students, enjoying work is the most important lifestyle domain in choosing a specialty, according to a study published in the October issue of Academic Medicine.

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Medicare, Medicaid Will Be Affected by Federal Debt Default

WEDNESDAY, Oct. 16 (HealthDay News) -- Failure to raise the debt ceiling by Oct. 17 will have a substantial effect on health care programs, including Medicare and Medicaid, according to a report published by the American Association of Family Physicians (AAFP).

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Nonprofit U.S. Hospital CEO Compensation Varies Widely

TUESDAY, Oct. 15 (HealthDay News) Nonprofit hospital chief executive officer (CEO) compensation is associated with technology and patient satisfaction, but not with processes of care, patient outcomes, or community benefit, according to a study published online Oct. 14 in JAMA Internal Medicine.

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Most Docs Monitor Online Reviews About Themselves

TUESDAY, Oct. 15 (HealthDay News) -- Most health care providers monitor online reviews about themselves and find the reviews fair, according to the results of a survey published by ZocDoc.

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CBT Equal to Intensive Medical Care for Peds Abdominal Pain

MONDAY, Oct. 14 (HealthDay News) -- Cognitive behavioral therapy (CBT) is as effective as intensive medical care (IMC) for the treatment of pediatric functional abdominal pain (FAP), according to a study published online Oct. 14 in Pediatrics.

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Alternative Medicine Often Used by Youth With Headache

MONDAY, Oct. 14 (HealthDay News) -- Youth with headache frequently use complementary and alternative medicine (CAM), according to a study published online Oct. 14 in Pediatrics.

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Study Discusses How to Create Value in Insurance Marketplaces

MONDAY, Oct. 14 (HealthDay News) -- Based on experience from other markets, health insurance exchange marketplaces can create greater value for consumers, according to research published in the September issue of Health Management, Policy and Innovation.

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Hospital Care Quality Varies by Insurance Coverage

MONDAY, Oct. 14 (HealthDay News) -- Examining hospital quality differences by various patient insurance groups would help reduce care disparities, according to a study published in the October issue of Health Affairs.

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'Cyberchondria' Worse in Those Troubled by Uncertainty

FRIDAY, Oct. 11 (HealthDay News) -- In a vicious cycle, those who have trouble handling uncertainty turn to the Internet to search for medical information which in turn leads to greater health anxiety ("cyberchondria"), according to a study published online Aug. 31 in Cyberpsychology, Behavior, and Social Networking.

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Regional Variation Seen in Medicare ACO Formation

FRIDAY, Oct. 11 (HealthDay News) -- Underlying provider integration in a given geographic region may drive the formation of Medicare accountable care organizations (ACOs), according to a study published in the October issue of Health Affairs.

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Consumers Frustrated With First Days of ACA Exchanges

FRIDAY, Oct. 11 (HealthDay News) -- A new poll of consumer satisfaction with the Affordable Care Act's health insurance exchanges confirms what headlines having been saying since the online marketplaces' launch: things have not gone smoothly.

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Addicted Physicians Say Rx Misuse Is for 'Self-Medication'

FRIDAY, Oct. 11 (HealthDay News) -- Physicians who misuse prescription drugs report self-medication as a leading reason, according to research published in the September/October issue of the Journal of Addiction Medicine.

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Unexplained Post-Op Pain in 7 Percent of Teen Scoliosis Cases

FRIDAY, Oct. 11 (HealthDay News) -- Unexplained pain after the six-month postoperative period occurs in 7 percent of patients undergoing surgery for adolescent idiopathic scoliosis (AIS), according to a study published in the Oct. 1 issue of Spine.

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State-Run Health Exchanges Off to Smoother Start

WEDNESDAY, Oct. 9 (HealthDay News) -- Unlike the highly publicized problems that have plagued the federal health exchange website created to help Americans register for insurance coverage, many state-run exchanges are operating well, according to published reports.

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Patient Satisfaction a Poor Proxy After Spine Surgery

THURSDAY, Oct. 10 (HealthDay News) -- In a group of patients undergoing elective spine surgery to treat degenerative conditions, patient satisfaction with care received was a poor proxy and correlated poorly with outcomes, complications, and quality of life following surgery, according to research published in the September issue of The Spine Journal.

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Triathletes Tolerate Pain Better Than Non-Athletes

THURSDAY, Oct. 10 (HealthDay News) -- Triathletes have less fear of pain and are better able to tolerate pain compared with non-athletes, according to a study published online in Pain.

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Greater Potential for Health Gains From Delayed Aging

WEDNESDAY, Oct. 9 (HealthDay News) -- The most effective way to stall disease, extend years of life in good health, and enhance public health would be to delay aging, according to research published in the October issue of Health Affairs.

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Provision of High-Quality Care Linked to Doc Job Satisfaction

WEDNESDAY, Oct. 9 (HealthDay News) -- For physicians, being able to provide high-quality health care is a driver of professional satisfaction, according to a study published online Oct. 9 by the RAND Corporation.

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AAFP Urges Congress to End Federal Government Shutdown

WEDNESDAY, Oct. 9 (HealthDay News) -- The American Association of Family Physicians (AAFP) is urging Congress to end the federal shutdown, according to a statement from the association.

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Use of Single-Fraction Radiation for Pain Found Rare in Elderly

TUESDAY, Oct. 8 (HealthDay News) -- Although single-fraction radiotherapy has been shown to be effective for pain relief of bone metastases in patients with prostate cancer, only about 3 percent of elderly patients receive single-fraction compared with multiple-fraction radiotherapy, according to a research letter published in the Oct. 9 issue of the Journal of the American Medical Association.

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Lifetime Societal Net Benefit From Total Knee Arthroplasty

TUESDAY, Oct. 8 (HealthDay News) -- For patients with end-stage osteoarthritis of the knee, total knee arthroplasty is associated with a lifetime societal net benefit, according to a study published in the Aug. 21 issue of The Journal of Bone & Joint Surgery.

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Confusion Still Surrounds ACA Health Insurance Exchanges

TUESDAY, Oct. 8 (HealthDay News) -- Much confusion still exists surrounding the Affordable Care Act (ACA) health care insurance exchanges, which opened on Oct. 1, according to an article published online Sept. 30 in Medical Economics.

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Patterns of Health Insurance Coverage Vary by State

TUESDAY, Oct. 8 (HealthDay News) -- Patterns of health insurance coverage among adults vary by state, and these differences may be used to guide efforts to expand coverage under the Affordable Care Act (ACA), according to research published online Sept. 25 in Health Affairs.

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Patient Satisfaction Is Poor Measure of Hospital Quality

TUESDAY, Oct. 8 (HealthDay News) -- The Pridit approach can be used to predict hospital quality and health outcomes, according to a study published online Sept. 30 in the Risk Management and Insurance Review.

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Both Patients and Doctors Tend to Be Creatures of Habit

MONDAY, Oct. 7 (HealthDay News) -- Doctors often struggle with their patients' reluctance or inability to modify behaviors for the sake of their health, but physicians themselves are prone to stay the path they're on even if it isn't working or recommended, according to an opinion piece published Oct. 5 in The New York Times.

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Design and Software Problems Plague Health Exchanges

MONDAY, Oct. 7 (HealthDay News) -- Problems signing up for health insurance through HealthCare.gov, the federal website serving health exchanges in 36 states, are the result of design and software problems, The Wall Street Journal reported.

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U.S. Health Exchange Website Faced Intermittent Shutdowns

MONDAY, Oct. 7 (HealthDay News) -- The U.S. Health and Human Services Department announced late Friday that the healthcare.gov site -- a key to the launch of the new health care insurance exchanges -- would be unavailable during "off-peak" hours over the weekend for repairs.

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Senators Request Delay in Transition to Meaningful Use 2

MONDAY, Oct. 7 (HealthDay News) -- A group of U.S. senators has requested that the transition to meaningful use 2 be delayed by one year, according to an article published Sept. 30 in Medical Economics.

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Majority of Physicians Concerned About Future of Medicine

FRIDAY, Oct. 4 (HealthDay News) -- Although physicians are concerned about the future of medicine, the majority are satisfied with practicing medicine and feel financial incentives could provide a way to motivate patients to change behavior, according to a survey conducted by the Deloitte Center for Health Solutions.

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High-Dose rhBMP Linked to Increased Incidence of Cancer

FRIDAY, Oct. 4 (HealthDay News) -- Patients receiving high-dose recombinant human bone morphogenetic protein-2 (rhBMP-2) as part of spine surgery have an increased risk of cancer and may be at risk for major complications, according to two studies published in the Sept. 4 issue of The Journal of Bone & Joint Surgery.

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Patient Portal Market Earned $279.8 Million in 2012

FRIDAY, Oct. 4 (HealthDay News) -- The total U.S. patient portal market for hospitals and physicians earned $279.8 million in 2012, and this is expected to increase in the coming years, mainly due to stage 2 meaningful use requirements, according to a report published by consulting firm Frost & Sullivan.

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Number of EMR Functions Linked to Physician Stress

FRIDAY, Oct. 4 (HealthDay News) -- For primary care physicians, the number of electronic medical record (EMR) functions is associated with stress and satisfaction, according to a study published online Sept. 4 in the Journal of the American Medical Informatics Association.

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Glitches Still Dog Online Health Exchanges

THURSDAY, Oct. 3 (HealthDay News) -- Problems navigating the new federal and state computer-based health insurance exchanges spilled into a third day Thursday.

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Impact of Shutdown on Docs, Patients Discussed

THURSDAY, Oct. 3 (HealthDay News) -- The shutdown of non-essential government services as of midnight Oct. 1 has led to questions about what the shutdown means for primary care physicians and their patients; answers have been issued in an article published Oct. 1 in Medical Economics.

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Expanding Scope of Nurse Practitioners Practice Discussed

THURSDAY, Oct. 3 (HealthDay News) -- Non-physician practitioners could ease the anticipated increased demand for physicians, but broadening their scope of practice is controversial, according to an article published Sept. 10 in Medical Economics.

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Government Shutdown Impacting Health Care Agencies

THURSDAY, Oct. 3 (HealthDay News) -- The government shutdown is having a serious impact on health care agencies, according to an article published Oct. 1 in Medical Economics.

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Fallout From Increase in High-Deductible Plans Examined

THURSDAY, Oct. 3 (HealthDay News) -- The expected increase in high-deductible health plan (HDHP) enrollment due to implementation of the Affordable Care Act (ACA) highlights the need for more research into the health impact of HDHPs, according to a perspective piece published online Oct. 2 in the New England Journal of Medicine.

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Demand for Doctors Remained High in 2012

THURSDAY, Oct. 3 (HealthDay News) -- Demand for physicians, particularly primary care physicians remains high, according to a report published by the Association of Staff Physician Recruiters (ASPR).

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Technical Problems Still Vex Day 2 of ACA Exchange Rollout

WEDNESDAY, Oct. 2 (HealthDay News) -- Computer troubles continued to plague the launch of the Affordable Care Act's health insurance exchanges on Wednesday. But Obama administration officials said Wednesday that the computer glitches were a reflection of heavy consumer interest in the exchanges, not flaws with the online registration system.

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Technical Glitches Mar Affordable Care Act Exchange Debut

WEDNESDAY, Oct. 2 (HealthDay News) -- The Affordable Care Act health insurance exchanges rollout did not run smoothly on Tuesday as many consumers were frustrated by long delays and computer system failures.

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AMA: More Than Half of Doctors Self-Employed in 2012

WEDNESDAY, Oct. 2 (HealthDay News) -- More than half of physicians are self-employed, and 60 percent work in practices that are fully owned by physicians, according to the results of the 2012 Physician Practice Benchmark Survey.

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Technological Advances in Health Care for Google, Apple

WEDNESDAY, Oct. 2 (HealthDay News) -- Google and Apple have launched developments in health care technology, according to a report published Sept. 20 in Medical Economics.

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Opioid Use Often Continues After Bariatric Surgery

TUESDAY, Oct. 1 (HealthDay News) -- Among chronic opioid users who undergo bariatric surgery, about three-quarters continue chronic opioid use after surgery, with an increase in opioid dose, according to a study published in the Oct. 2 issue of the Journal of the American Medical Association.

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Poor Performance Triggering EMR Switch for Small Practices

TUESDAY, Oct. 1 (HealthDay News) -- Small physician practices are leaving electronic medical record (EMR) vendors as software systems have failed to meet growing expectations, according to a report from KLAS research.

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In the Doctor's Lounge With Dr. Cindy Haines

TUESDAY, Oct. 1 (HealthDay News) -- Please allow me to introduce myself: I am HealthDay's chief medical officer and the managing editor of Physician's Briefing, HealthDay's news service for health care professionals. This service is intended to provide busy physicians, nurses, and pharmacists with easily accessible, digestible health news that can keep them up-to-date and not missing a beat in their busy days providing care for those in need (and navigating the headaches and heartaches the business of medicine can too often bring). In short, this service is intended to make your professional life flow more smoothly in the way that helpful, useable, relevant, and timely information can.

Exchanges Will Be Cornerstone for Coverage Choices
Young Adults May Be Key to Making It All Work
Expect Pluses, Minuses for Those With Job-Based Coverage
If You're an Uninsured Worker, It's Your Chance to Get Covered
Medicaid Expansion Will Allow More to Get More
Many on Medicare Already Enjoying Benefits
AMA Presents: The National Journal
editors@healthday.com

Many Health Care Professionals Oppose ACA Proposals

TUESDAY, Oct. 1 (HealthDay News) -- The majority of health care professionals are concerned about negative outcomes relating to enactment of the Affordable Care Act (ACA), although they recognize the benefits, according to a survey conducted by Coupa Software.

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Affordable Care Act Exchanges Are Up and Running

TUESDAY, Oct. 1 (HealthDay News) -- Despite the first federal government shutdown in 17 years and a push by Republicans in the House of Representatives to delay further implementation of "Obamacare," the Affordable Care Act's health insurance exchanges opened for business today.

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