American College of Physicians: Internal Medicine — Doctors for Adults ®

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From the March 1999 ACP-ASIM Observer, copyright 1999 by the American College of Physicians-American Society of Internal Medicine.

New coalition to strengthen academic internal medicine

Five academic teaching groups have established a new coalition, the Alliance for Academic Internal Medicine, to solidify the presence of internal medicine departments within the medical and political communities.

The founding groups are the Association of Professors of Medicine, the Association of Program Directors in Internal Medicine, the Association of Subspecialty Professors, Clerkship Directors in Internal Medicine and Administrators of Internal Medicine. Since July 1997, the five groups have shared office space and staff members.

Each group will maintain its own identity and jurisdiction, but the alliance will hold joint annual meetings beginning in 2000 and is investigating other collaborative efforts, such as newsletters for group members.

"There's a compelling logic for those organizations to speak with a single voice," said Herbert S. Waxman, FACP, the College's Senior Vice President of Education. He pointed out that the College recently worked with the five groups to focus on problems in residency program accreditation.

The alliance represents the internal medicine departments and residency and fellowship programs of 125 U.S. medical schools and 420 teaching programs.

State legislatures poised to tackle liability, formulary issues

The Blue Cross and Blue Shield Association is predicting that liability and formulary issues will dominate health care proposals in state legislatures this year.

According to a report the association released last month, 28 states are expected to consider liability legislation, with many of those bills seeking to expand patients' rights to sue insurance companies. Thirty states considered—but none passed—such legislation last year. Texas is the only state where patients can sue HMOs in state courts for being denied treatment.

The report also predicted that bills regulating pharmacy benefits will be introduced. Analysts expect 17 states this year—including California and New York-to consider legislation on the use of formularies by health plans. Several proposed bills would force health plans to pay for drugs they have removed from their formularies, while other bills would restrict requirements from health plans that pharmacists substitute generic drugs for brand name products. Still other proposals would allow physicians to challenge health plan formularies, and eight states are expected to consider legislation that would mandate health plan payments for all FDA-approved drugs.

A spokesperson for the association said that drug companies are sponsoring many of the pharmacy-related bills. Pharmaceutical companies are concerned about health plans' tactics to control escalating drug costs, especially as their patents on key drugs expire.

HMOs starting to pay for care during clinical trials

HMOs appear to be warming up to the idea of paying for patient care incurred during clinical trials.

UnitedHealthcare Corporation in Minneapolis rolled out a pilot program last month that will pay for the care of its members who are enrolled in oncological clinical trials. And late last year, the National Institutes of Health signed an agreement with the American Association of Health Plans that is expected to increase HMO involvement in clinical trials for dozens of diseases.

Health insurers and HMOs have traditionally balked at reimbursing clinical trial treatments. In forming its Clinical Trials Pilot Program, UnitedHealthcare becomes the first national health plan to formally pay for such treatments. Its decision is prompting other major insurers and health plans to consider participating in clinical trials.

UnitedHealthcare created the program through an agreement with the Coalition of National Cancer Cooperative Groups Inc., a network of six oncology group foundations sponsored by the National Cancer Institute. Physicians who contract with UnitedHealthcare and are members of one of the six coalition groups can enroll patients in group-sponsored clinical trials. If a physician is not affiliated with the coalition, the HMO will help locate a doctor to whom the patient can be referred. If a physician is a member of the coalition but does not contract with UnitedHealthcare, the HMO will sign limited provider agreements so a patient's care will be covered.

New patient-based research group to hold first meeting

A new group created to get physicians more involved in patient-based research will hold its first annual meeting in Atlantic City next month.

The Association for Patient-Oriented Research (APOR) was formed to examine research that originates from observations made at patients' bedsides, not in laboratories. At its meeting, scheduled for April 30 through May 2, the group will discuss how physicians can incorporate patient-oriented research into their practice.

While APOR members acknowledge the important breakthroughs made by research scientists, they are concerned that physicians are losing their investigative edge, said Jules Hirsch, FACP, the group's secretary-treasurer. "Are we just health care deliverers who take information from other scientists?" Dr. Hirsch asked. "Or can we still generate science on the basis of our own observations?"

For more information about the meeting, contact Dr. Hirsch at 212-327-8426 or the APOR Web site at www.mc.vanderbilt.edu/gcrc/apor/.

Americans worried about medical record privacy

While Americans trust doctors and hospitals with confidential medical information, they don't want their records given to private and government insurers.

According to two surveys conducted for the California HealthCare Foundation, an independent philanthropy, patients are particularly worried that hackers might break into computerized medical records.

Many respondents said they would consider allowing their medical information to be used for research purposes. But almost 60% said they did not want their records given to hospitals designing preventive care programs; employers considering them for jobs; other health plans, even those that might provide better benefits; or drug companies for direct-to-consumer marketing.

Although 60% of the respondents said they had confidence in doctors and other health care professionals, almost 20% said that their medical privacy had already been violated by a provider, health plan or employer. And 15% of respondents claimed to have altered their behavior in order to keep certain details out of their patient records. Respondents reported not seeking care or giving inaccurate information to physicians, asking physicians to not record details of their health problems and paying for their care out-of-pocket to keep details of certain conditions out of their medical records.

Almost half of those surveyed said that fines and punishments should be imposed for violations. They also saw a strong need for encryption technology to protect electronic medical records and for policies requiring personal permission to release medical information.

Teaching hospitals show better survival rates

Elderly patients have a better chance of surviving a heart attack and other conditions at teaching hospitals, according to two reports published in the Jan. 28 issue of the New England Journal of Medicine. Both studies relied upon Medicare data.

One study concluded that while it cost more to treat patients for hip fractures, stroke, heart disease and congestive heart failure in major teaching hospitals in 1994, death rates through the end of 1995 for those patients were 25% lower than in smaller academic facilities or nonteaching hospitals.

Another study found that heart attack patients at teaching hospitals were more likely to receive aspirin and beta-blockers, simple therapies that are known to reduce deaths from heart attacks.

Study: Patients fudge blood-pressure readings

Believing that higher blood-pressure readings may merely reflect temporary stress, patients who monitor their own blood pressure may not report accurate figures to their physicians.

According to a study published in the American Journal of Hypertension, more than half of all patients omitted high readings and entered false ones. Patients were instructed to measure their blood pressure twice a day and mark their readings in a logbook, but they were not told that the measuring device they used was fitted with a memory chip.

Analysts say that such evidence of cheating has serious implications for treating conditions-such as high blood pressure and type II diabetes-that rely upon patient-reported measurements. The report's authors, however, said it's still important to get patients involved in managing their own care. One solution, they suggested, may be to use the blood-pressure devices with memory chips in order to allow doctors to monitor deviations between actual readings and measurements reported by patients.

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