- CMS: Physician pay increases, new drug payments are official
- ACP comments on changes to Medicare fee schedule for 2004
Clinical News in the Headlines
- Highlights from the Jan. 6 Annals of Internal Medicine
- Statins may help prevent recurrences of atrial fibrillation
- FDA moves to outlaw ephedra sales
- New guidelines revise bone density testing recommendations
- HHS now accepting J-1 visa waiver applications
- Last chance to save $75 on Annual Session registration
CMS: Physician pay increases, new drug payments are official
A 1.5% Medicare pay increase for physicians included in last year's Medicare reform legislation went into effect last week, as did new payment rates for many physician-administered drugs.
The new final rule with the payment increase replaces a previously scheduled 4.5% physician fee cut. According to the Dec. 31 Modern Physician, some rural physicians will see additional payment hikes, producing a total increase of 4.8%.
The rule also changes how Medicare will pay for several physician-administered drugs. Payments for injectibles, for example, will be reduced from 95% to 85% of the drugs' average wholesale price (AWP). Medicare plans to offset a portion of that decrease by increasing physician payments for administering those drugs.
The Centers for Medicare and Medicaid Services (CMS) intends to continue paying 95% of the AWP for vaccines for flu, pneumonia and hepatitis B; blood-clotting factors; some drugs associated with renal dialysis; some infusion drugs and some that use a nebulizer; and any drugs or biological agents introduced in 2004. Other drugs, however, will be paid at only 80% of AWP.
Because the new payment rates were posted late last year, the CMS has extended its deadline for physicians to declare whether or not they will participate in Medicare. Physicians now have until Feb. 17 to make that decision. Comments on the final rule can be submitted until March 8.
The Modern Physician article is online at http://www.modernphysician.com/news.cms?newsId=1646.
ACP analyses about the Medicare reform legislation are online at http://www.acponline.org/hpp/presdrug_law.htm.
The College late last year commented on changes to the Medicare physician fee schedule for calendar year 2004.
In a Dec. 18 letter to the Centers for Medicaid and Medicare Services (CMS), ACP discussed changes to four areas: practice expenses, liability insurance, new G codes for renal disease dialysis and tracking codes. Here's an overview of the College's comments.
- Practice expenses. Among other things, ACP supported the CMS decision to delay the implementation of revised practice expense values for E/M codes for several nursing home codes (CPT codes 99301-99303 and 99311-99313) and two home-visit codes (99348 and 99350). The College also expressed concern that practice expense values for venom immunotherapy mean that Medicare payment is less than the actual cost of the venom antigen.
- Liability insurance. ACP supports the CMS decision to have the Relative-value scale Update Committee (RUC) review premium data that were used to establish practice cost indices for liability insurance. The College also encouraged the CMS to forward these data to specialty societies, which can review them as well.
- G codes for dialysis. ACP is concerned that these new codes will threaten access to care for renal patients and create unintended complications for patients seeking dialysis care. Geographic inequities in payments, for example, could cause the closure of satellite facilities in rural areas. Reductions in payments for home dialysis could also reduce the availability of the preferred form of treatment for most pediatric patients.
- CPT tracking codes. While ACP supports creating national payment policy and determining national payment amounts for CPT tracking codes, also known as category III codes, the College argued that the CMS needs to work closely with the RUC and specialty societies.
The College's letter is online at http://www.acponline.org/hpp/medprog_feesched.htm.
Clinical news in the headlines
The following articles appear in today's Annals of Internal Medicine. The full text of the issue is available to College members and subscribers online at http://www.annals.org?wkly.
Caffeinated coffee may be linked to lower type 2 diabetes risk. Patients who drink more coffee and caffeinated beverages may be less likely to develop type 2 diabetes. Researchers examined data from a study of more than 126,000 men and women who tracked their caffeine consumption for between 12 and 18 years. They found that the association between coffee and type 2 diabetes was similar in strength to the association between tea consumption and risk for diabetes. While researchers said their data do not mean that people should drink more caffeinated beverages to prevent type 2 diabetes, they noted that the link between caffeine and glucose tolerance warrants further study. http://www.annals.org/cgi/content/full/140/1/1
Kidney disease may be associated with new metabolic risk factors for heart disease. Researchers found that nontraditional risk factors for cardiovascular disease (substances that can cause inflammation) appear more commonly in people with kidney disease. They concluded that because the death rate from cardiovascular risk factors is 10 to 20 times higher in patients who also have kidney disease, treating the new risk factors may reduce the chance that these patients will develop heart disease. http://www.annals.org/cgi/content/full/140/1/9
Giving statins to patients who suffer from lone atrial fibrillation may help reduce recurrences of the condition.
According to an article in the Dec. 1 American Journal of Cardiology, researchers examined patients who had successfully undergone cardioversion for atrial fibrillation that had lasted for at least three months.
A Dec. 25 Reuters article said that after two years, 40% of patients receiving statins had experienced a recurrence, compared to 84% of patients who did not receive the drugs. Researchers said that further analysis found that using statins was associated with a significant reduction in the reoccurrence of arrhythmias.
Researchers said that their data suggested that statins created functional changes in the heart. While noting that the precise mechanism of that change is uncertain, they speculated that the drugs helped in part by slowing the progression of coronary artery disease.
An abstract of the study is online at http://www.sciencedirect.com/science?_ob=ArticleURL&_udi
The Reuters article is online at http://www.reuters.com/newsArticle.jhtml?type=topNews&storyID=4044940.
The FDA last week announced a ban on sales of ephedra, a popular weight-loss and bodybuilding supplement. The ban will take effect within the next two months.
The decision marks the first time the federal agency has moved to outlaw sales of a dietary supplement, according to the Dec. 31 Washington Post.
The supplement, which raises blood pressure, has been linked to heart problems and strokes. It has also been implicated in more than 100 deaths, including several high-profile fatalities of national and high school athletes.
Notoriety about the supplement's health consequences led experts to predict that sales of ephedra in 2003 would total between $300 million and $400 million. That figure would be down from 2002 sales of $1.3 billion.
Government officials said they expected the ban to be challenged by supplement manufacturers. They also said the ban would be the first step in designing a framework for taking action against other additives and supplements.
According to the Washington Post, sales of ephedra—which is also marketed as ma huang, pinellia and sida cordifolia—are already banned in Illinois, New York and California.
FDA materials on the ephedra ban are online at http://www.fda.gov/oc/initiatives/ephedra/december2003/.
The Washington Post article is online at http://www.washingtonpost.com/ac2/wp-dyn/A43065-2003Dec30.
Late last month, the International Society for Clinical Densitometry (ISCD) issued new guidelines for the clinical use of bone density testing to evaluate patients at risk for osteoporosis.
For the first time, those recommendations include guidelines for testing male patients. They also broaden previous guidelines calling for testing to monitor patients undergoing several types of medical treatments.
The new guidelines say that patients indicated for bone density testing include: women age 65 and older; men age 70 and older; postmenopausal women under age 65 who have risk factors for osteoporosis; adults with a fragility fracture; adults with a disease or condition or taking medication associated with low bone mass or bone loss; any patient being considered for pharmacologic therapy; and any patient being treated for osteoporosis (to monitor treatment effectiveness).
The guidelines also state that women discontinuing estrogen should be considered for testing if they fall within indication categories.
The new guidelines also discuss how physicians should interpret the results of bone density testing. They also address reporting methods, terminology and interpretative differences among patients of different ages.
A list of ISCD guidelines is online at http://www.iscd.org/Visitors/official.cfm.
HHS announced last month that it is accepting applications for J-1 visa waiver positions for 2004. The agency also issued new requirements for facilities requesting J-1 visa waiver physicians.
Facilities that want to recruit physicians with J-1 visa waivers must be located in health professional shortage areas that score 14 or higher in the government's shortage area database. Facilities must also be either a health center as defined by the public health service act; a rural health clinic; or a Native American or an Alaska Native tribal medical facility.
According to an HHS press release, the new requirements aim to ensure that only communities in the greatest need of primary care and mental health services can apply for J-1 visa waiver physicians.
Potential candidates can see which areas qualify by searching HHS' shortage area database. Waivers allow physicians with J-1 visas to defer returning to their home countries for at least two years after they finish training in the United States. Physicians with waivers must typically practice in health shortage areas for three to five years.
Positions posted by the National Health Service Corps may be filled by J-1 visa waiver physicians only if those positions are unfilled by service corps physicians.
A press release announcing the 2004 requirements is online at http://www.globalhealth.gov/newguidelines1.shtml.
The Health Professional Shortage Area database is online at http://belize.hrsa.gov/newhpsa/newhpsa.cfm.
Register for Annual Session 2004 in New Orleans by Feb. 12, and you'll save up to $75 off registration fees. You'll also get your pick of reserved scientific sessions and hotels.
Annual Session, internal medicine's premier educational and networking event, helps you keep abreast of the latest information and find answers to common patient management problems.
The meeting features more than 260 CME offerings in general internal medicine and its subspecialties. Learning Center activities and hands-on clinical skills workshops allow you to learn valuable skills in physical examination, office-based procedures and more.
Annual Session 2004 will be held in New Orleans from April 22-24, 2004. ACP members who register by Feb. 12 will receive the discounted rate.
For more information or to register, go to http://www.acponline.org/cme/as/2004/?ow.
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Copyright 2004 by the American College of Physicians.
A 67-year-old man is evaluated for a 6-month history of worsening exertional dyspnea. He has severe COPD, previously with minimal exertional symptoms, but now notes activity-limiting shortness of breath when walking short distances. He does not have chest pain, gastrointestinal symptoms, or sleep-related symptoms. Medical history is otherwise unremarkable. Medications are a twice-daily fluticasone/salmeterol inhaler and an as-needed albuterol/ipratropium metered-dose inhaler. He has a 55-pack-year smoking history but quit when COPD was diagnosed. Following a physical exam, chest radiograph, and transthoracic echocardiogram, what is the most appropriate diagnostic test to perform next?
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