Given a paragraph, generate a claim that is supported by the given paragraph. 1) The claim must contain information from within the paragraph. 2) A sentence within the paragraph can be used as a claim. 3) The claim should not have contradictions within the paragraph. 4) The claim should be at most one sentence long.

Q: - Frustration over limited time spent with patients. - Inordinate amounts of time inputting required data. - Side effects including high levels of stress. The patient? Herself. The remedy? “I did the research and found direct primary care,” said Anderson-Elder of Windsor. And in June she joined Dr. Frank Morgan at Balance Health in Greeley, a direct primary care clinic he founded four years ago in Greeley. Leaving her family practice at UCHealth Medical Clinic in Windsor after seven years wasn’t an easy decision, she said, but it was the right decision for her. Many physicians — from all specialties — share Anderson-Elder’s frustration and levels of stress incurred while working in insurance-based health care systems. In the 2018 Medscape National Physician and Depression Report, 42 percent of family physicians admitted to having burnout or depression, listing “too many bureaucratic tasks (charting, paperwork)” and “too many hours at work” as the leading factors in burnout. Although direct primary care has been around for some time, it is just now gaining a toehold with both physicians contemplating the switch to a different way of providing care and patients willing to give it a shot, so to speak. In 2017, there were more than 600 direct primary care clinics in the U.S., 10 percent of those in Colorado, according to the Colorado Independent. Anderson-Elder said in her research she found 1,000 out of the 80,000 family doctors practicing in the U.S. have gone the direct primary care route. DIRECT PRIMARY CARE What is direct primary care? And why the interest? First and foremost, the major difference is that direct primary care does not accept insurance. Patients instead pay a monthly membership fee that includes unlimited visits, calls and emails, along with many routine services and access to prescriptions and lab work at a reduced cost. For the physician, it means quality time spent with patients and no more time filling out paperwork to satisfy health insurance company regulations. What the monthly fee is varies from clinic to clinic. At Balance Health, it is $99 for adults, $180 for couples and $30 for children. Those who sign up for direct primary care are asked to sign an annual contract but can be released from it with 30 days’ notice, Anderson-Elder said. “We want to be accessible to our patients. We don’t want them to go to urgent care or ER if they don’t have to,” she said. And yes, that includes calls at 3 a.m., but if it can wait till morning, the patient is worked into that day’s schedule. Anderson-Elder typically sees eight to 17 patients per day, depending on whether it’s cold and flu season. And she spends as much time as needed with them. At her previous practice, she was limited to spending 15 to 20 minutes per patient. “People service their cars,” she said. “They should do the same thing with their bodies. You should be looked at and tuned up.” While most people think of going to the doctor only when they don’t feel well or need a physical for work or school, Anderson-Elder said she likes to see patients even when they feel healthy so she can check in on their well-being and talk about proper nutrition. “Oftentimes patients think they’re healthy, but then we do an exam and sometimes find things,” she said. Direct primary care works best when combined with a high-deductible health plan, Anderson-Elder said, for those times when unexpected surgeries are scheduled and for patients who suffer from chronic illnesses. But she said about one-third of her patients have no health insurance at all. She also noted direct primary care should not be confused with concierge medicine, which also provides direct access to providers for a flat fee but still bills insurance companies for services provided. Another key distinction between the two is direct primary care is mentioned in the Affordable Care Act as an acceptable option for receiving medical care without insurance, while concierge medicine is not, according to the American Academy of Family Physicians. And last year, Colorado Gov. John Hickenlooper signed Colorado HB17-1115, which establishes that direct primary health care can operate without regulation of the division of insurance. Windsor Republican Rep. Perry Buck was a primary sponsor of the bill. Patients at Balance Health also can tap into other healthy-living services for additional fees. Dr. Dana Morgan, a family care physician, specializes in bioidentical hormone replacement therapy. Balance Health also has a small fitness gym replete with trainers and classes. Wellness coaching also is offered. Leaving her practice in Windsor, though a hard decision, has been the right prescription for her, she said. “I no longer take paperwork home,” she said. “I’m happier and less stressed.” ___ Information from: The Tribune of Greeley, Co, http://greeleytribune.com

A: Windsor doctor joining direct primary care movement.
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Q: Amid mounting global concern over the public health implications of so-called e-cigarettes, Touraine said they faced the same fate as traditional ones: a ban on smoking in public spaces and sales to minors and a blackout on media advertising. In a country where the pungent waft of Gaulloises and Gitanes once seemed an unassailable part of cafe culture, smokers have long been banished to outdoor terrace seats. The near-odorless electronic alternative - battery-driven devices that allow users inhale odorless nicotine-laced vapor rather than smoke - are gaining ground in no-go zones such as bars, cafes, trains, waiting rooms and offices. A government-commissioned report said this week that around 500,000 people in France had turned to e-cigarettes, which are designed to look like cigarettes although some come in different colors, and recommended a crackdown on public use. Health officials in many countries say the impact of electronic cigarettes on health needs further study. Another worry they cite is that the electronic alternative will increase the general temptation to smoke, including enticing those who have quit to start again, or that smokers may use them alongside rather than instead of regular cigarettes. “This is no ordinary product because it encourages mimicking and could promote taking up smoking,” said Touraine, who announced her plans at a news conference. In the United States, the number of smokers who have tried out e-cigarettes doubled to one in five in 2011 and the number of all adults trying it doubled too, to 6 percent, according to the U.S. Centers for Disease Control and Prevention. In France, a country of 66 million, the government says tobacco smoking kills some 66,000 people a year and another 5,000 are killed through passive exposure to smoke. The expert in charge of the French report advised against an outright ban on e-cigarettes, however, saying they still seemed safer than tar-laden tobacco. Electronic cigarettes, whose invention is widely credited to a Chinese pharmacist a decade ago, usually comprise disposable cartridges of liquid such as propylene glycol that is easily turned to vapor and can contain artificial flavors alongside concentrated liquid nicotine.

A: France to ban electronic cigarettes in public.
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Q: Gov. Tom Wolf thanked both health systems in an announcement on Thursday. Wolf, a Democrat, praised the rival companies for reaching the agreement following their 2014 contract. In-network access to UPMC facilities for Highmark patients was set to expire in 2019. Children’s Hospital of Pittsburgh of UPMC, UPMC Altoona, UPMC Bedford and multiple other hospitals and specialty facilities will remain open to Highmark patients. The locations include centers that specialize in transplant services, cancer treatment and psychiatric health. “This is medical care that simply is not available anywhere else in the region, and denying affordable access to this vital care is just not acceptable,” Wolf said in a release. UPMC executive vice president David Farner praised the agreement. The pact helps preserve community-based care for patients across the state, Highmark president Deborah Rice-Johnson said. The health system agreement doesn’t address a dispute between Williamsport-based PMF Industries Inc. and UPMC, the Pittsburgh Post-Gazette reported. UPMC disagreed on PMF’s use of reimbursement estimates that are based on Medicare rates. Evangelical Community Hospital has sided with UPMC in rejecting its reimbursement system.

A:
New deal between UPMC, Highmark extends in-network access.
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