In the News for the Week of 3-23-04
- Match 2004: More U.S. seniors match to internal medicine residencies
HIPAA compliance update
- CMS clarifies deadline for HIPAA claim compliance
Clinical news in the headlines
- FDA advisory calls for new warnings on antidepressant labels
- Long-term use of popular osteoporosis drug appears to be safe
- Radiation therapy after surgery effective with recurring prostate cancer
- Highlights of ACP Journal Club
- College Leadership Day event slated for May 18-19
The number of U. S. medical school seniors matching to residencies in internal medicine increased this year, according to results released last week by the National Resident Matching Program (NRMP). However, interest in primary care and family practice—which has been declining over several years—continued to fall.
Internal medicine programs attracted 3,086 U.S. seniors, up 1.5% over the previous year. U.S. seniors matching to the three internal medicine tracks—categorical, primary care and medicine-pediatrics—represented 22.7% of the total number of seniors in the Match program.
According to a March 18 College press release, the greatest increase was in medicine-pediatrics, with a 14.7% increase over last year's figures, said Steven Weinberger, FACP, the College's Senior Vice President for Medical Knowledge and Education. Interest in categorical internal medicine remained steady, but matches in internal medicine primary care declined by 2.1%.
Seniors also showed less interest in family practice, with this year's Match figures down 3.3% from last year's and nearly 50% since 1997. Match figures for obstetrics and gynecology were also down 5.5% from last year's, a reduction of 26% from 1997 figures.
Nationwide, more than 20,000 seniors matched to residency slots in this year's program, a record number. According to a March 18 NRMP press release, more than 85% of U.S. seniors were matched to one of their top three program choices.
The NRMP's press release is online at www.nrmp.org.
The College's press release is online at www.acponline.org/college/pressroom/match_results04.htm.
HIPAA compliance update
The CMS announced that as of July 1, there will be a change to its transactions contingency plan. While CMS will continue to pay non-HIPAA-compliant electronic claims after that date, physicians who file non-compliant claims will have to wait longer for payments.
As of July 1, the CMS transactions contingency plan will stipulate that compliant electronic claims be paid 14 days after they are received, but that non-compliant claims be held for 27 days. The new ruling gives some more time to providers who are still struggling to meet the October 2003 deadline set by the HIPAA transactions rule, which said that no payments would be made on non-compliant claims after that implementation date.
Due to lobbying by ACP and other groups, the CMS and many other payers last year created contingency plans allowing extra time for providers who were making a good faith effort to become HIPAA compliant. Eventually, however, HIPAA requires that payments of all non-compliant claims must be stopped.
According to CMS requirements, all claims submitted electronically must comply with the HIPAA transactions rule national standards, and all practices with more than 10 employees must submit claims electronically.
More information from the ACP's Practice Management Center is online at www.acponline.org/pmc/hipaa.htm.
Clinical news in the headlines
The FDA this week issued a public health advisory, urging physicians and families to closely monitor patients who are taking antidepressants for signs of behavioral changes or suicidal tendencies. The FDA is also asking drug companies to include stronger warnings about the need for close monitoring on the labels of 10 different drugs.
Physicians are advised to pay special attention to patients who are beginning treatment or are switching to higher or lower antidepressant doses. The advisory, which is aimed at both adults and children, follows a call last month for stronger warning labels on selective serotonin reuptake inhibitors (SSRIs) after some studies suggested that certain medications may promote suicidal thoughts in children.
In a March 22 release, the FDA urged physicians, families and caretakers to watch for increased side effects associated with antidepressant use, such as anxiety, agitation, insomnia or irritability, and to pay particular attention to patients with bipolar disorder. However, the FDA stressed that it is not yet clear whether these drugs cause suicidal thinking or behavior and that it is continuing to evaluate them.
The advisory calls for warning labels on 10 popular antidepressants: bupropion (Wellbutrin), citalopram (Celexa), fluoxetine (Prozac), fluvoxamine (Luvox), mirtazapine (Remeron), nefazodone (Serzone), paroxetine (Paxil), sertraline (Zoloft), escitalopram (Lexapro) and venlafaxine (Effexor).
According to the March 22 Washington Post, psychiatrists are expressing concern that such warnings will discourage depressed patients from taking medications and lead to an increase in suicides.
The FDA release is online at http://www.fda.gov/bbs/topics/ANSWERS/2004/ANS01283.html.
The Washington Post is online at http://www.washingtonpost.com/wp-dyn/articles/A16214-2004Mar22.html.
For more information, see "SSRIs: Too much—or too little—of a good thing?" in the March 2004 ACP Observer at http://www.acponline.org/journals/news/march04/ssri.htm.
A new study has found that postmenopausal women with osteoporosis can safely take alendronate (Fosamax) for up to 10 years to increase bone density. The results may help allay concerns that long-term use of the drug might too severely suppress bone turnover and make patients more prone to fractures.
While about 3 million U.S. women with osteoporosis take the drug, this is the first study to measure its long-term effects, according to the March 19 Washington Post. Hormone replacement therapy was once the first choice for treating bone thinning until concerns arose about HRT's role in increasing breast cancer, stroke and heart attack risk.
The study, which was published in the March 18 New England Journal of Medicine (NEJM), followed 247 postmenopausal women with osteoporosis, ages 44-84, for 10 years. Participants were randomly assigned to take 5 mg, 10 mg or 20 mg of alendronate daily, or placebo. In the 10-mg group, patients' bone mineral density at the lumbar spine increased by almost 14% after 10 years, while 89% of women in that group had an increase in bone density at the hip.
Women who began taking 20 mg of alendronate were switched to placebo after two years, then switched to 5 mg of alendronate for the last five years of the study. That group's bone density levels declined, but remained higher than their initial readings.
The Washington Post noted that the study was sponsored by Merck & Co., the maker of alendronate. Several researchers in the study had ties to the pharmaceutical company as well.
The Washington Post is online at http://www.washingtonpost.com/wp-dyn/articles/A4114-2004Mar18.html.
An NEJM abstract is online at http://content.nejm.org/cgi/content/abstract/350/12/1189.
Treating prostate cancer with radiation therapy instead of hormones at the first signs of relapse after surgery may prolong the lives of many patients, according to a new study.
The study, published in the March 17 Journal of the American Medical Association (JAMA), followed more than 500 men for five years who had a recurrence of prostate cancer after undergoing prostatectomy. After receiving radiation therapy, 50% of those patients lived for at least four years without recurring cancer.
When prostate cancer recurs after surgery, most doctors do not recommend radiation therapy because they assume the disease has metastasized, according to the March 17 New York Times. According to one of the study's authors, patients should receive radiation treatment when their PSA levels are first found to be elevated after surgery. However, the New York Times reported that fewer than 20% of men with recurring prostate cancer get radiation treatment.
About 30,000 men in the United States each year who have had surgery have a recurrence of prostate cancer, the New York Times reported. Without radiation therapy, the study said, about 65% of those patients will develop metastatic bone cancer within 10 years.
The New York Times is online at http://www.nytimes.com/2004/03/17/health/17PROS.html.
The full-text of the JAMA article is online at http://jama.ama-assn.org/cgi/content/full/291/11/1325.
For patients on mechanical ventilation with persistent weaning failure, a study found that early extubation and noninvasive ventilation reduced the period of mechanical ventilation and complications, and increased survival.
The study, which was abstracted in the March/April issue of ACP Journal Club, supports the growing literature on the benefits of integrating noninvasive weaning into critical care.
More information is online at http://www.acpjc.org/Content/140/2/issue/ACPJC-2004-140-2-035.htm.
The College is holding its 12th annual ACP Leadership Day on Capitol Hill, May 18-19.
The event is a way to build the College's advocacy network by having members meet with members of Congress and their staff. This year's event will feature a new optional half-day training session on Tuesday morning, May 18, to help orient first-time attendees. That will be followed by in-depth afternoon briefings by Capitol Hill representatives. On Wednesday, members meet with their congressional representatives.
Past Leadership Day sessions have been instrumental in advancing the College's political agenda, including stopping cuts in Medicare reimbursement and having the College's seven-year plan for universal coverage introduced as a bipartisan bill in both the House and the Senate. Chapters are encouraged to send one or more representatives and to set up meetings in advance with members of Congress who serve on key health committees or in leadership positions.
Members interested in attending should contact their Chapter Governor or Shuan Tomlinson in the College's Washington Office at firstname.lastname@example.org.
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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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