In the News for the Week of 10-19-04
- CDC announces redistribution plan for unshipped flu vaccine
Clinical news in the headlines
- Pfizer issues CV risk warning for Bextra
- Highlights of the Oct. 19 Annals of Internal Medicine
- FDA orders "black box" warning label for antidepressants
Business of medicine
- CMS revises payment cuts for cancer care
- North Carolina Blues to cover obesity treatments
- Government awards $139 million in technology grants
- Surgeon General issues first report on bone health
- Free handbook available on working with older patients
- JCAHO hosts symposium on safety, liability
- College launches "Recruit-a-Colleague" program
To help meet this season's flu vaccine shortage, the CDC last week began partnering with vaccine maker Aventis Pasteur to distribute the remaining unshipped 22.4 million doses of vaccine. About 14.2 million doses will be distributed over the next six weeks directly to high-priority vaccine providers such as hospitals, long-term care facilities, nursing homes and pediatricians. The CDC has issued a priority list of high-risk patients including adults aged 65 and over and patients ages 2-64 with underlying chronic medical conditions.
The CDC will ship the remaining 8.2 million doses to high-need areas as flu outbreaks occur across the country. The flu season typically peaks in the United States from December-March.
Government officials last week also continued talks with Canada's drug regulatory agency about acquiring some of Canada's excess vaccine supply, the Oct. 15 New York Times reported. However, officials said that imported vaccine would require FDA approval, making it unlikely the vaccine could be used this season.
And the Oct. 14 Washington Post reported that some distributors were asking for up to 10 times the normal price for flu vaccine doses. However, some hospitals were able to get a limited number of moderately-priced doses from local public health systems redistributing their supplies.
This season's vaccine price hikes are especially high due to the severity of the shortage, the Washington Post noted. Pharmaceutical giant Chiron Corp.—which was scheduled to supply almost half the 100 million doses ordered in the United States—had its vaccine quarantined earlier this month because of alleged contamination at its British production facility.
The CDC press release is online.
The New York Times is online.
The Washington Post is online.
In other vaccine-related news, several health plans announced they will cover the intranasal flu vaccine spray FluMist as an alternative to traditional flu shots. They include Aetna, Cigna and some Blue Cross Blue Shield plans, according to the Oct. 13 Washington Business Journal.
FluMist's manufacturer, MedImmune Inc., announced it would increase its production from 1.1 million doses to 2 million doses. The live intranasal vaccine is approved only for healthy patients aged 5-49.
The Washington Business Journal is online.
And the Centers for Medicare and Medicaid Services (CMS) has announced that Medicare will pay $10.10 for the influenza vaccine product and $23.28 for the pneumoccocal vaccine product.
Physicians should use CPT 90658 to bill the influenza vaccine to Medicare and CPT 90732 to bill the pneumoccocal vaccine. Physicians who administer the influenza virus vaccination and the pneumoccocal vaccination must take assignment on the claim for the vaccine. Annual Part B deductible and coinsurance amounts do not apply.
More information on immunization payment rates is on the CMS Web site.
Clinical news in the headlines
Pfizer Inc. last week announced that two studies had found a higher risk of cardiovascular events among coronary artery bypass graft (CABG) surgery patients taking its drug valdecoxib (Bextra).
The increased risk among CABG patients was observed in patients taking valdecoxib alone and in combination with parecoxib, according to an Oct. 15 Pfizer press release. The announcement came two weeks after Merck Inc. withdrew its COX-2 inhibitor rofecoxib (Vioxx), after a study found that patients doubled their risk of heart attack or stroke after taking rofecoxib for more than 18 months.
The FDA plans to convene a panel in January to study the safety of COX-2 inhibitors, the Oct. 16 New York Times reported. Pfizer announced that it is studying whether valdecoxib increases the risk of cardiovascular events among patients who take the drug for chronic pain, including pain associated with osteoarthritis and rheumatoid arthritis.
The Pfizer press release is online.
The New York Times is online.
The following articles appear in this week's Annals of Internal Medicine. Full text is available to College members and subscribers online.
Chronic prostatitis and pelvic pain not reduced by antibiotic or a-blocker. A six-week study of 196 men with moderately severe symptoms of chronic prostate/chronic pelvic pain (CP/CPP) found that neither of two commonly prescribed drugs—ciprofloxacin, an antibiotic, or tamsulosin, an a-receptor blocker—successfully relieved symptoms.
CP/CPP, a common disorder in men, is characterized primarily by pain in the pelvic region, while some patients also have lower urinary tract symptoms and sexual dysfunction. Its cause is not known, but it is usually treated with an antibiotic and/or an a-receptor blocker.
An accompanying editorial says the study shows that antibiotics aren't useful but notes that patients in some studies have shown improvement if a-receptor blockers are used for three to six months. More.
Simple exercises can help with vertigo and dizziness. Simple exercises markedly improved dizziness in a study of 170 adults assigned to either an exercise or a usual-care group. Patients in the former met with a nurse, then recorded and performed at home daily exercises, such as head rotations.
The exercise program, known as vestibular rehabilitation, is seldom offered in primary care settings. An editorial points out, however, that it is an easy, inexpensive and effective method to control balance and is especially important in an aging population. More.
Study seeks best blood pressure drugs for black patients. A meta-analysis of studies looking at the effect of different antihypertensive drugs in black adults with hypertension found that commonly used drugs differ in their ability to reduce blood pressure.
Choice of drugs is important because black people are more likely to develop hypertension than others, and the disorder is often more severe, more resistant to treatment and more likely to be fatal at an earlier age. Authors say that until future research clarifies issues such as the effects of different drugs on mortality, morbidity, the incidence of diabetes and on blood pressure, physicians should prescribe antihypertensive drugs with the lowest possible risk for side effects. More.
Childhood cancer survivors are at risk for subsequent breast cancer. In a study of more than 6,000 women who had childhood cancer, 95 subsequently developed breast cancer. Those most at risk had been treated previously with chest radiation therapy, had a family history of breast cancer or had a personal history of thyroid disease. More.
The FDA last week announced that it will require manufacturers of antidepressants to include black box package labeling to warn of increased risk of suicidal thoughts and behavior in children and adolescents who take the medications.
According to an Oct. 15 FDA press release, the new directive applies to all antidepressants because there is not enough available data to exclude any of the medications from an association with increased suicidality risk. Only fluoxetine (Prozac) has been approved for use in children and adolescents.
The FDA is also directing antidepressant manufacturers to develop patient medication guides to be given by pharmacists to young patients with antidepressant prescriptions.
In response to the new labeling mandate, the National Mental Health Association (NMHA) issued a statement saying it applauded the FDA's action. The NMHA noted, however, that new package labels should not be written to stigmatize children's mental health or create unnecessary panic for young patients and their families.
The FDA press release is online.
The NMHA's position paper is online.
Business of medicine
The Center for Medicare and Medicaid Services (CMS) last week announced coding changes that would ameliorate previously announced pay cuts to oncologists for administering cancer drugs.
The revisions will restore about $100 million of the proposed $500 million in payment cuts previously announced, an Oct. 14 American Society of Clinical Oncology (ASCO) news release reported.
The ASCO release noted that the CMS' code changes establish new and revised codes for drug administration, and reimburse staff time and physician supervision for pharmaceutical preparation.
In announcing these coding changes, the CMS deviated from its usual protocol of not discussing coding and payment changes before publishing the final Medicare 2005 physician fee schedule in its entirety. The CMS announced the revisions in response to a Congressional inquiry.
However, the CMS announcement did not include the final payment rate for cancer drugs. All coding and payment changes for 2005 will be included in the CMS' final 2005 physician fee schedule when it is published around Nov. 1.
The ASCO press release is online.
Blue Cross Blue Shield of North Carolina announced last week that it will begin covering the costs of obesity treatment for eligible members starting next year. Coverage, which will include diagnostic testing and office visits, will treat obesity "as a primary condition," an Oct. 12 company news release said.
The coverage will include four doctor visits a year, nutrition counseling and prescriptions for weight-control medications sibutramine (Meridia) and orlistat (Xenical). The insurer will also refer morbidly obese patients for bariatric surgery. Under the new coverage plan, office visits will be covered as of April 1, 2005, while coverage for nutrition counseling and prescriptions will take effect Oct. 1, 2005.
According to the carrier, overweight members accounted for more than $83 million last year in health care costs related to such conditions as hypertension and diabetes. Obese members incurred 32% more in claims than normal-weight members, the company said.
Medicare recently announced that it would begin covering obesity treatments if patients' obesity affects underlying medical conditions such as hypothyroidism, Cushing's disease and hypothalamic lesions.
The company news release is online.
The HHS last week awarded $139 million in grants and contracts to promote the use of health care information technology.
The awards, made through the Agency for Healthcare Research and Quality, will be used to improve access to technology in communities in 38 states, with a particular focus on rural and small hospitals, according to an Oct. 13 HHS news release. More than 100 grants were given to communities, hospitals and health care systems. First-year funding is $41 million and will increase to $96 million over three years.
Five states—Colorado, Indiana, Rhode Island, Tennessee and Utah—will each receive $25 million over five years to develop secure statewide and regional networks for storing health information. A $18.5 million grant was given to a research organization at the University of Chicago to create a national health information technology resource center. That center will provide technical assistance to other grantees and serve as a resource to providers on adopting health information technology.
Other award winners included:
The California Rural Indian Health Board in Sacramento, Calif., was awarded $1.5 million to implement electronic health records at three rural tribal health programs.
Yale University in New Haven, Conn., received $1.47 million to develop a Web-based renal transplant patient medication system.
Lincoln Health Center in Mattoon, Ill., received $175,000 to develop a plan for sharing patient record access in rural health settings.
The HHS news release is online.
A complete list of award winners is online.
The U.S. Surgeon General last week issued the government's first report on bone health. It calls for bone density screening for women age 65 and older and for all patients over age 50 who have fractures.
However, the report did not call for screening women who have osteoporos in their family history, according to the Oct. 14 New York Times. The report also recommends that patients take preventative steps by eating more leafy green vegetables, dairy products and other foods high in calcium and vitamin D, and getting more exercise.
The 400-page report noted that 10 million Americans over age 50 have osteoporosis and another 34 million are at risk. Those figures are expected to grow to about 14 million older adults and 47 million at risk by 2020. Risk factors for osteoporosis include smoking, heavy drinking, poor diet and early onset of menopause, as well as the use of steroids, chemotherapy drugs and other medicines that affect bone mass.
You can order a free copy of the Surgeon General's report online or by calling 1-866-718-BONE.
The New York Times is online.
The National Institute on Aging (NIA) has issued a revised free handbook with tips and strategies for clinicians who treat older patients.
The 46-page booklet, entitled "Working with Your Older Patient: A Clinician's Handbook," covers topics that include encouraging prevention and wellness; discussing sensitive subjects like driving, cognitive problems and incontinence; and breaking bad news.
The booklet also provides an extensive list of Web sites and phone numbers for resources for senior patients, including many disease associations.
Physicians can order a free copy of the NIA booklet online or by calling the NIA Information Center at 1-800-222-2225.
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) next month is holding a public policy symposium that targets patient safety and medical liability.
The symposium will be held Nov. 8-9 in Alexandria, Va. Among other topics, the conference will focus on strategies for achieving comprehensive tort reform, ways to avoid litigation when adverse events occur, reporting mechanisms that can help prevent medical errors and tips for disclosing medical errors.
Featured speakers include Dennis O'Leary, MD, JCAHO president, Lucian Leape, MD, professor of health policy and public management at the Harvard School of Public Health, and Eric B. Larson, Chair of ACP's Board of Regents.
More information and a registration form are online.
ACP members can now earn dues credits by recruiting non-member colleagues to become full ACP members.
Members will receive a $100 credit for referring one member and an additional $100 credit for two. If they recruit three or more colleagues, they will have their next year's dues payment waived. (Total credits cannot exceed member dues.) The current "Recruit-a-Colleague" program runs from October 2004 to March 1, 2005.
For every colleague they refer within this promotional period, members will receive a chance to win a trip to Annual Session 2006, including registration, airfare and four days of hotel accommodations.
To be considered a "recruited" member, your colleague must meet the following:
Be a nonmember (or former member) eligible for full ACP membership, so Associate or medical student members do not qualify.
Submit a membership application, along with his or her national annual dues payment, between October 1, 2004 and March 1, 2005.
Include your name in the recruiter box at the top of the membership application.
Complete details of the program are online. You can use the same site to send a personalized recruitment e-mail to a colleague, or to download and print a membership application to personally deliver.
Membership inquiry kits are also available from ACP Customer Service at 800-523-1546, ext. 2600 (9 a.m.-5 p.m. ET).
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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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