- Estimated cost of Medicare reform bill rises to $540 billion
- CMS may deny payments for unapproved cancer drugs
- Medicare releases national provider identifier rule
Clinical news in the headlines
- FDA finds link between antidepressant use and suicide risk in children
- CDC urges increased surveillance for potential avian flu cases
- Highlights from the Feb. 3 Annals of Internal Medicine
- Physicians urged to increase support for family caregivers
- CMS announces deadlines for hospital quality initiative
- College seeks clarification of CMS' quality improvement program
Access to coverage
- ACP: Mental health benefits need parity with other health insurance
- New ACP resource catalog now available
- Save $75 on Annual Session registration
- TV showing of ACP patient education video changed
The administration last week raised the estimated price tag for implementing Medicare reform to $540 billion over 10 years—a figure that is one-third higher than was forecast when the legislation passed last year.
The Medicare reform bill, signed into law on Dec. 8, will offer prescription drug benefits to 41 million seniors and disabled people. The Congressional Budget Office has maintained that the cost of the benefit plan would be about $400 billion over 10 years.
However, White House officials are now pegging the actual price at closer to $530 billion to $540 billion, according to the Jan. 30 New York Times. Analysts say several factors may be driving the higher estimate. Under the provisions of the new law, more Medicare patients will enroll in HMOs and other private health plans. And payments to private health plans will rise considerably, making them a more expensive alternative than the traditional Medicare program.
According to the Jan. 30 Modern Healthcare, analysts say that the higher estimated costs may translate into smaller payment updates for physicians and hospitals, as the government looks for ways to afford Medicare reform.
The New York Times article is online at http://www.nytimes.com/2004/01/30/politics/30DEFI.html?hp. (Free registration is required.)
Modern Healthcare is online at http://www.modernhealthcare.com/news.cms?newsId=2020.
CMS officials are considering whether to refuse to pay for cancer drugs when they are used for unapproved treatments. Oncologists and patient advocates are concerned that the move, if taken, could force doctors to change treatment strategies if patients can't pay for expensive cancer drugs.
The Jan. 30 New York Times reported that CMS officials are currently reviewing four drugs, which are being used experimentally to treat patients with either non-Hodgkin's lymphoma or colorectal cancer. Analysts say that many more drugs may come up for CMS review.
The review is part of a comprehensive overhaul of Medicare's drug reimbursement policies in light of the program's new prescription drug benefit. If CMS decides to reimburse drugs only when they are used as approved, physicians may not be able to offer patients promising treatments—or patients may have to pay out-of-pocket for drugs that can cost more than $20,000.
Oncologists and patient advocates cautioned that such a decision would limit access to experimental treatments, often the last hope for cancer patients.
The New York Times is online at http://www.nytimes.com/2004/01/30/business/30drug.html.
On Jan. 23, CMS released the Standard Unique Health Identifier for Health Care Providers, the latest in the series of HIPAA rules.
The rule requires all HIPAA covered entities to use National Provider Identifiers (NPIs) after the compliance date of May 23, 2007. (Small health plans will have until May 23, 2008 to comply.)
A new unit of CMS, the National Provider System, will issue a unique 10-digit numeric NPI for all health care providers, including physicians, group practices, hospitals and other providers designated as covered entities under HIPAA.
The new standard identifier will replace all previously required provider identifiers, including the Medicare UPIN and the provider IDs issued by all private and other public payers. Each physician and medical group will continue to have a separate unique provider ID.
Health care providers may begin applying for NPIs on the effective date of the final rule, which is May 23, 2005. Health care providers that are covered entities must obtain and use NPIs, while physicians or other providers who are not covered entities may also apply for numbers.
More information about the new rule is online at http://www.cms.gov/hipaa/hipaa2/default.asp.
Clinical news in the headlines
FDA officials this week said they found a link in clinical trial data between the use of some selective serotonin reuptake inhibitors (SSRIs) in young patients and a higher risk of suicide. The announcement contradicts findings of the psychiatric community, but echoes concerns raised last year in the United Kingdom, where prescribing some antidepressants to patients under age 18 has been banned.
FDA officials did not take any regulatory action, however, and are waiting for an analysis of trial data that should be completed this summer, according to the Feb. 3 Washington Post. In 2002, more than two million children were prescribed antidepressants. Fluoxetine (Prozac) is the only antidepressant approved by the FDA for treating younger patients.
Analyzing clinical trial data is complicated by the fact that different pharmaceutical companies use different methods of classifying suicidal tendencies among patients. In addition, many drug companies screen out young patients with a history of suicidal tendencies before trials, whereas physicians have to treat those children.
Last week, the Jan. 29 Washington Post highlighted another problem: that drug companies do not publish the results of privately funded studies, particularly if those results cast their products in a negative light. The FDA has asked nine pharmaceuticals to submit details on SSRI use in children from 25 different trials.
The Feb. 3 Washington Post is online at http://www.washingtonpost.com/wp-dyn/articles/A7008-2004Feb2.html.
The Jan. 29 Washington Post is online at http://www.washingtonpost.com/wp-dyn/articles/A58130-2004Jan28.html.
In the face of mounting concern over the spread of avian flu in Asia, the CDC last week urged physicians, public health officials and hospital staff to carefully watch for patients who have unexplained pneumonia or severe respiratory illness and have traveled to Asian countries with confirmed bird flu outbreaks.
No cases have yet been reported in people or birds in North America, and no travel advisories have been issued. However, the Jan. 27 Associated Press reported that at least 10 people have died in Vietnam and Thailand from the virus, which has spread to 10 Asian countries, including China. The CDC advised patients who have been in places with bird flu outbreaks to be tested for Influenza A. If a test is positive, patients should be further tested for the H5N1 bird flu strain.
In guidance released last week, the CDC said that travelers to Asian countries should consider getting the 2003-04 trivalent influenza vaccine, which protects against three flu viruses. Travelers to Asian countries should also avoid poultry farms and any contact with animals or animal waste.
The Associated Press is online at http://health.yahoo.com/search/healthnews?lb=s&p=id%3A52890.
For CDC information, see http://www.cdc.gov/flu/avian/index.htm.
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.
Study suggests that higher doses of aspirin may prevent colorectal cancer. A study of more than 27,000 women found that those who took higher doses of aspirin seemed to have lower risk for developing adenomas than those who reported never using or rarely using aspirin. Women who reported taking up to 14 tablets per week had the lowest relative risk. http://www.annals.org/cgi/content/full/140/3/157
HRT: publication of clinical trial results lowered use. Release of data from two long-term studies on HRT was followed by a decline in the use of the therapy. Authors surmised that widespread news coverage—especially after the termination of one study that found HRT was linked to higher risk for heart disease and breast cancer—resulted in rapid change in medical practice. http://www.annals.org/cgi/content/full/140/3/184
Family caregivers, who play a crucial role in caring for patients with serious illnesses, need help from physicians to identify resources and coordinate patient care. Fulfilling those responsibilities to family caregivers can also give physicians a great deal of satisfaction, according to a report in the Jan. 28 Journal of the American Medical Association (JAMA).
To improve resources for family caregivers, physicians are urged to be aware of the substantial burdens that caregiving puts on family members. They should also seek to improve their ability to communicate with family members; their role in advance planning and decision making; their support of home care, with detailed medication orders and instructions; their empathy to family dynamics; and their sensitivity to family members' grief during end-of-life care.
The article also includes detailed recommendations to holding decision-making sessions with family members when patients are too ill to take part.
An abstract of the JAMA study is online at http://jama.ama-assn.org/cgi/content/abstract/291/4/483. (Full text is available only to subscribers.)
CMS last week released deadlines and guidelines for hospitals to comply with the agency's new quality improvement initiative mandated by last year's Medicare reform. According to the Jan. 28 Modern Physician, hospitals will receive different Medicare fee updates in fiscal 2005, depending on their participation in the initiative.
A CMS press release said the initiative will examine hospitals' performance on measures related to three common medical conditions: heart attack, heart failure and pneumonia. The 10 quality measures—which have been endorsed by the National Quality Forum, a national standard-setting group—include giving a pneumococcal vaccination to pneumonia patients and prescribing ACE inhibitors to heart failure patients.
Hospitals must submit data for all patients, not just Medicare patients. Those hospitals that want to participate must register with CMS' data warehouse by June 1 and begin transmitting the required data by July 1. (A 30-day grace period will be allowed to complete data submission that has been started by the deadline.)
Hospitals that submit performance data will receive the full 2005 update, while those that don't will see their payments reduced in 2005 by 0.4%.
Modern Physician is online at http://www.modernphysician.com/news.cms?newsId=1742.
The CMS' press release is online at: http://www.cms.gov/media/press/release.asp?Counter=955.
In a Jan. 23 letter sent to CMS, the College asked for clarification of several key points contained in the framework of CMS' quality improvement program, which wants to improve quality by providing incentives and measuring physician quality performance.
Specifically, the letter asked CMS to spell out what kind of assistance or incentives the agency's quality improvement programs would offer physicians to improve their performance on quality measures. The College also asked CMS to clarify how the care of patients with chronic illnesses might be "redesigned" under quality improvement programs, and what new preventive services those programs would entail.
The College pointed out that any performance measures that are applied to physicians should measure only that care over which physicians actually exert control, and should be adjusted for patients' illness severity and co-morbidities.
While the College expressed support for the CMS' quality improvement program, it asked CMS to thoroughly pilot-test quality improvement programs before expanding them to include the nation's physicians.
The letter is online at http://www.acponline.org/hpp/cms_framework.htm.
Access to coverage
In a letter faxed to every member of Congress, the College expressed support for bills before both the Senate and the House of Representatives that would establish parity between health plans' mental health coverage and their medical/surgical benefits.
The Mental Health Equitable Treatment Act (S. 486 and H.R. 953) would require health plans that have mental health benefits to not impose different treatment limits or higher out-of-pocket costs for those benefits than for other medical coverage. The letter, which was signed by more than 45 national specialty societies and 50 state medical societies, notes that mental disorders that are left untreated may cost the country $70 billion a year in sick leave pay and reduced productivity.
The Jan. 29 letter also noted that the cost of establishing parity between mental health benefits and medical/surgical coverage would increase average costs to health plans by less than 1%.
The letter is online at http://www.acponline.org/hpp/s486.htm.
ACP members can now find the full array of College resources and services in one location: the new 2004 ACP Resources for Internists catalog. The comprehensive, full-color 40-page catalog describes member benefits, new publications, CME offerings, practice management materials and more. The catalog was mailed to all ACP members in January.
For an additional copy, contact ACP Customer Service at 800-523-1546, ext. 2600. The catalog may also be found online at http://www.acponline.org/catalog/?ow.
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.
ACP's new patient education video, "Living with Diabetes: A Guide for African Americans," which was previously scheduled to air in Detroit on Sunday, Feb. 1, has been rescheduled. It will now air on Sunday, Feb. 21 on Detroit's WWJ-CBS from 12:30-1:00 p.m.
Learn more about the video and other cities where it will air at http://www.acponline.org/weekly/2004/1/20/index.html#video.
About ACP ObserverWeekly
ACP ObserverWeekly is a weekly newsletter produced by the staff of ACP Observer. It is automatically sent to all College members who have an e-mail address on file with ACP.
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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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