ObserverWeekly
2-18-03
Medicare update
- Congress passes bill halting 4.4% cut, raising Medicare pay for physicians 1.6%
ACP-ASIM Journals
- Annals: Higher regional Medicare spending doesn't improve outcomes
Annual Session update
- New half-day pre-Annual Session course to focus on handheld computing
For young physicians
- Free online guide helps researchers present findings
Clinical news in the headlines
- New study adds more controversy to antihypertensive debate
- Ibuprofen found to cancel heart benefits of aspirin
Tools for your practice
- CDC releases guide to smallpox vaccination
- New Web journal to offer lessons on patient safety
Policy news
- ACP-ASIM signs brief supporting use of race to encourage diversity in medical school admissions
Medicare update
Congress passes bill halting 4.4% cut, raising Medicare pay for physicians 1.6%
Congress last week passed legislation canceling a planned 4.4% cut in physician fees, replacing it instead with a 1.6% raise. The bill will add tens of billions of dollars in Medicare payments to doctors over the next 10 years.
The new fees will take effect on March 1. Because of the legislation, physicians will see higher Medicare updates in 2004 and subsequent years. Even with the increased expenditures, however, additional policy changes will likely be needed to assure adequate payments to physicians.
A key part of the bill gives the Center for Medicare and Medicaid Services (CMS) the authority to fix mistakes in how Medicare payments were calculated. Those mistakes have already cost physicians tens of billions of dollars in lost fees, including a 5.5% cut in fees last year.
ACP-ASIM worked as part of a coalition of groups that lobbied Congress to rescind the cuts and restore physicians' fees. Those groups, which included the AMA, specialty societies and state medical societies, met weekly for more than a year.
In a statement on the Web, College officials said that the victory could not have been achieved without the "tireless" efforts of the thousands of College members and leaders who took time to contact their legislators. ACP-ASIM developed a Medicare Crisis Action Kit that resulted in more than 5,500 letters, e-mails and faxes from College members and their patients being sent to legislators.
College officials noted that the hard-won increases may not be enough to assure that physician reimbursement keeps pace with practice expenses, such as the runway costs of medical liability insurance. As a result, ACP-ASIM officials will continue to work with the CMS and Congress to make other necessary changes in Medicare payment policy.
The College's statement is online at http://www.acponline.org/college/misc/imp_medcon.htm.
ACP-ASIM Journals
Annals: Higher regional Medicare spending doesn't improve outcomes
While Medicare patients in some regions of the country receive twice as much care as others, a study in today's Annals of Internal Medicine says that those patients don't enjoy better outcomes or higher survival rates.
Some regions—including areas around Detroit, Mich., and Jacksonville, Fla.—spend as much as 60% more on Medicare patients for more hospitalizations, diagnostic tests and specialist referrals, according to the article.
Researchers studied four groups of patients: people with heart attacks, colorectal cancer and hip fractures, and a representative sampling of elderly patients. They found that increased spending did not translate into lower mortality rates, better health outcomes or higher patient satisfaction.
Researchers also found that patients in regions that spend more tend to receive fewer preventive services, such as flu and pneumococcal immunizations.
The study and accompanying editorials are online at http://www.annals.org.
Annual Session update
New half-day pre-Annual Session course to focus on handheld computing
The College will hold a half-day course before Annual Session on handheld computing.
"Integrating PDAs into Your Medical Practice" will give internists an overview of handheld computers, also known as personal digital assistants (PDAs). Physicians will also learn how to use handheld computers to boost productivity.
The course will run from 1-5 p.m. on Wednesday, April 2, making it ideal for internists who travel to San Diego early. Participants will earn 3.5 category 1 CME credits for the course.
Details about the course are online at http://www.acponline.org/cme/as/2003/presession_courses.htm.
For young physicians
Free online guide helps researchers present findings
ACP-ASIM has created an online guide to help students and residents present their research findings at College and other scientific meetings.
Eight articles offer tips on the scientific communication process, from writing abstracts to presenting posters or delivering oral presentations at any formal scientific session.
The guide is online at http://www.acponline.org/srf/abstracts/guide.htm.
Clinical news in the headlines
New study adds more controversy to antihypertensive debate
A large trial that compared the hypertensive effects of diuretics with angiotensin converting-enzyme (ACE) inhibitors found that in older patients and men, ACE-inhibitors reduced rates of death, heart attack and stroke better than diuretics. Both drugs controlled blood pressure equally well.
Study subjects were randomly assigned to receive either a diuretic or an ACE inhibitor. Overall, patients in the ACE inhibitor group had 11% fewer deaths and cardiovascular events.
Among the men, however, those in the ACE group fared even better: They had 17% fewer deaths and cardiovascular events than those in the diuretic group.
The study's results, published in the Feb. 13 New England Journal of Medicine, conflict with results from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), released last December. The ALLHAT study found that diuretics more effectively reduced cardiovascular events.
The results may conflict because of racial differences between the two groups of study subjects. More than one-third of the ALLHAT subjects were black. In the Australia study, by contrast, 95% of the patents were white. (Age and gender demographics were similar for both studies.)
Previous studies have shown that race can affect results for two reasons. Black patients require higher doses of ACE inhibitors to control their blood pressure. Also, because they tend to be more sensitive to salt, black patients tend to respond better to diuretics.
An abstract of the study is online at http://content.nejm.org/cgi/content/short/348/7/583.
The ALLHAT study results are available at http://jama.ama-assn.org/issues/v288n23/rfull/joc21962.html.
Ibuprofen found to cancel heart benefits of aspirin
New research confirms what physicians know but don't necessarily practice: Combining ibuprofen with aspirin cancels the positive blood-thinning effects of aspirin. Taken together, the two drugs lead to worse outcomes than either drug alone.
A study in the Feb. 15 Lancet found that patients who were prescribed ibuprofen and aspirin died 75% more often from heart disease than those on aspirin alone.
Alternate anti-inflammatory options including other nonsteroidal anti-inflammatory drugs and the painkiller diclofenac did not show a similar negative effect when combined with aspirin.
In a HealthScoutNews article, the study's author cautioned that the findings apply only to patients who regularly take ibuprofen and aspirin together. Those who occasionally take the two drugs together, he explained, shouldn't have any increased risk.
The Lancet study is online at http://www.thelancet.com. (Free registration required.)
The HealthScoutNews article is online at http://news.yahoo.com/news?tmpl=story2&cid=97&
ncid=97&u=/hsn/20030214/hl_hsn/study_warns_of_mixing
_ibuprofen_with_aspirin.
Tools for your practice
CDC releases guide to smallpox vaccination
The CDC has developed a pocket guide on smallpox vaccination that features images of normal and adverse reactions to the vaccine.
The reference guide provides step-by-step instructions and photographs on how to administer the vaccine with a bifurcated needle. It also provides images detailing a successful "take" of the vaccine, as well as images and descriptions of the most important adverse events associated with the vaccine.
Hard copies of the brochure are available to health care professionals who may be involved in the upcoming smallpox vaccination plan or who may be on the front line of diagnosing a potential smallpox outbreak.
Information on how to obtain copies of the guide from your state health department is online at http://www.acponline.org/bioterro/ref_smallpox.htm.
For more information, see the College's Bioterrorism Resource Center.
New Web journal to offer lessons on patient safety
The Agency for Healthcare Research and Quality (AHRQ) last week launched a new monthly, peer-reviewed Web journal that presents actual cases of medical errors. The site is designed to educate health care professionals about patient safety in an anonymous environment.
The site, which is called AHRQ WebM&M (morbidity and mortality), will present five cases of medical errors each month drawn from different medical specialties, including internal medicine.
Each case will be posted with expert commentary and a readers' forum. AHRQ will expand one of the five monthly cases into an interactive learning module with CME credits.
AHRQ WebM&M is online at http://webmm.ahrq.gov.
Policy news
ACP-ASIM signs brief supporting use of race to encourage diversity in medical school admissions
The College has signed onto a brief supporting the University of Michigan's consideration of an applicant's race as one factor in making admissions decisions.
The Association of American Medical Colleges (AAMC) filed an amicus brief in the case of Grutter v. Bolinger, one of two affirmative action cases being considered by the U.S. Supreme Court that challenge the use of race in admissions policies. The case challenges the University of Michigan's use of racial preferences in its law school's admissions policies.
The brief, signed by the AAMC, ACP-ASIM and dozens of medical schools and professional organizations, argues that racial and ethnic preferences are important to the medical profession. Educators must be able to consider race and ethnicity when selecting students in order to graduate a capable, effective physician workforce prepared to meet the needs of a diverse society.
Without race-conscious admissions policies, the brief argues, medical schools would be unable to increase the number of minority physicians necessary to serve America's ever-growing minority population, expand areas of academic research, and raise the general cultural competence of all physicians.
The brief also points out that minority physicians are more willing to practice in underserved areas, that minority patients' trust in the health care system increases when treated by members of their own racial or ethnic group, and that more minorities in medical student populations lead to diversity in medical research.
The AAMC brief is online at http://www.aamc.org/diversity/focuson.htm.
About ACP-ASIM ObserverWeekly
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Copyright 2003 by the American College of Physicians-American Society of Internal Medicine.
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