In the News for the Week of 4-13-04
- Law may protect Match from resident class-action suit
- Medicare spending: More doesn't always mean better care
- Hospitals urged to register for quality initiative
- Order MKSAP 13 online and receive a free update
Clinical news in the headlines
- Sexual activity doesn't increase risk of prostate cancer
- Physicians question effectiveness of Alzheimer's drugs
- Highlights of ACP Journal Club: Interventions to improve Parkinson disease symptoms
- Low literacy linked to poorer health
State board update
- State disciplinary actions against physicians on the rise
- Annual Session program and handouts now available for PDAs
- ACP newsgroup offers online billing and collection advice to small practices
Federal legislation signed into law over the weekend may shield the National Resident Matching Program (NRMP)—as well as other defendants, including more than two dozen teaching hospitals—from a class action suit filed by former residents who claimed the Match violates antitrust protections.
An amendment to a major pension bill, the law effectively gives teaching hospitals antitrust exemption, according to the April 13 Washington Post. Attorneys representing the residents in the suit were quoted in the Washington Post as saying they would review further options. However, a spokesperson from the American Hospital Association countered that he did not believe the new law offered plaintiffs "a loophole."
According to Patrick Hope, JD, the College's Legislative Counsel, both Sens. Russ Feingold (D-Wis.) and Jeff Bingaman (D-N.M.) noted in statements made on the Senate floor that the legislation would not apply to the residents' lawsuit. Mr. Hope said the new law's applicability to the NRMP suit will ultimately have to be decided by the judge reviewing the residents' case.
The class-action suit was originally filed in 2002, with residents alleging that the Match violates antitrust laws by unfairly restricting residents' ability to negotiate wages and work hours.
Earlier this year, a federal judge dropped several of the defendants named in the original suit, including the AMA, the American Board of Medical Specialties and the Council of Medical Specialty Societies. He ruled, however, that the suit could proceed against the NRMP, the Association of American Medical Colleges, the Accreditation Council for Graduate Medical Education and 27 teaching hospitals.
The Washington Post is online at http://www.washingtonpost.com/wp-dyn/articles/A6574-2004Apr12.html.
Researchers have found that patients in states that log the highest payments for seniors' health care do not necessarily receive better care.
The study, conducted by two economists at Dartmouth College, looked at how often physicians in different states prescribed 24 high quality, low cost treatments, such as mammograms for older women, antibiotics to treat pneumonia and aspirin for heart patients. According to the April 7 Washington Post, researchers theorized that patients weren't receiving certain low cost treatments in some states because those states didn't spend enough on Medicare.
Instead, researchers found that lower spending didn't translate to worse care. The study, which appeared in the April 7 Health Affairs, found that the highest spending states tended to invest in expensive care provided by specialists, while states that spent less had more general practitioners. Patients in high-spending states were also more likely to be admitted to intensive care during the last months of their life.
A Dartmouth release on the study notes that New Hampshire, which spent about $5,000 per Medicare beneficiary, was ranked highest for quality, while Louisiana, which spent $8,000 per person, the highest of all states, was ranked lowest.
Instead of cutting Medicare funding, the study recommended using those funds more effectively by creating national standards for basic care and encouraging people to seek treatment from general practitioners.
A Dartmouth College press release is online at http://www.dartmouth.edu/~news/releases/2004/04/07.html.
The Washington Post is online at http://www.washingtonpost.com/wp-dyn/articles/A56778-2004Apr7.html.
The Health Affairs article is online at http://content.healthaffairs.org/cgi/content/full/hlthaff.w4.184v1/DC1.
The American Hospital Association (AHA) issued an advisory last week, urging acute care hospitals that have not already done so to begin the registration process for the Medicare quality reporting initiative by May 1.
Only hospitals that are registered and submitting data on specific quality indicators will be eligible to receive the full Medicare inpatient inflation update for FY 2005, which begins Oct. 1, 2004. Hospitals that don't register or participate will receive payment updates that are 0.4% below inflation.
Hospitals must register by June 1 and begin transmitting to their state Medicare quality improvement organization data on 10 quality measures by July 1. Those measure include five related to treating heart attacks, two related to treating heart failure and three on treating pneumonia. Hospitals' performance on those measures will be posted on the Internet for consumers early next year.
The AHA advisory and a registration form are online at http://www.hospitalconnect.com/aha/key_issues/patient_safety/
Now through April 30, new MKSAP 13 subscribers who order online will receive a free copy of the MKSAP 13 Update CD-ROM—a $109 value—when the Update is released.
Building upon the success of previous versions, the new MKSAP 13 provides the latest developments in internal medicine and its subspecialties. Created by internists for internists, MKSAP 13 allows internists to learn at their own pace, reinforce content they already understand and identify topics where they need further attention.
The program, which is available in print and on CD-ROM, covers 14 areas in internal medicine and includes 10 books containing more than 1,500 pages. For the first time, the new version of MKSAP also includes answers to and critiques of the 1,000 best-answer multiple-choice questions in the syllabus books.
MKSAP 13 also offers users the opportunity to earn up to 140 category 1 CME credits—more than previous versions—as long as they score "better than chance" on the self-assessment tests. Computer scoring is available until June 30, 2006.
The free MKSAP 13 Update CD-ROM offer is available only to new subscribers who order online using ACP's secure Web site. More information is online at http://www.acponline.org/catalog/mksap/13/?ow.
Clinical news in the headlines
In one of the largest studies to date on the relationship between male ejaculation and prostate cancer, researchers have discovered that more frequent ejaculation may actually decrease a man's risk of developing the disease.
The study by NIH researchers surveyed more than 29,000 men over an eight-year period. The men were asked to estimate the average number of ejaculations they had per month during their 20s, their 40s and over the past year. The study was published in the April 7 Journal of the American Medical Association (JAMA).
Results showed that men who had the most ejaculations per month—21 or more—reduced their risk of developing prostate cancer by one-third compared to men who reported having the fewest ejaculations (four to seven per month).
Previous studies had suggested a link between sexual activity and increased risk of prostate cancer, possibly due to higher levels of testosterone or the presence of infectious agents, according to the April 7 San Francisco Chronicle. The NIH study—part of the Health Professionals Follow-up Study, which looked at the health habits of 52,000 men—was the first to track a large group of men for several years.
None of the men had cancer when the study began and researchers accounted for differences in diet, exercise and other risk factors.
The San Francisco Chronicle is online at http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2004/04/07/MNGS161ML91.DTL.
A JAMA abstract is online at http://jama.ama-assn.org/cgi/content/abstract/291/13/1578?lookupType=volpage&vol=291&fp=1578&view=short.
Physicians are frustrated by the disappointing results patients are having with drugs that treat Alzheimer's disease, and some experts say it may be decades before real progress will be made in treating the disease.
According to a April 7 New York Times, experts at a meeting held last month at Johns Hopkins University offered conflicting recommendations on how physicians should prescribe drugs approved to treat patients with Alzheimer's. One expert recommended a six-to-eight week regimen and then discontinuing medications if no improvement was seen, while another recommended that patients stay on a drug for at least six months.
Experts also offered different views on the efficacy of the drugs, with one presenter saying only 10% of his patients with Alzheimer's had any cognitive or functional improvement with one of the approved drugs. Another presenter, however, said medications should help slow the progressive deterioration of the disease.
The FDA has approved four drugs to treat mild to moderate Alzheimer's disease and one drug for patients with moderate to severe disease. The New York Times reported that each of the drugs costs about $120 a month. About 1 million people take the medications, out of 4.5 million Americans affected by the disease.
The debate is complicated by the fact that there is ongoing controversy over how data in trials conducted on drugs for Alzheimer's has been analyzed.
The New York Times is online at http://www.nytimes.com/2004/04/07/health/07ALZH.html?hp.
In a study abstracted in the March/April 2004 ACP Journal Club, researchers performing a meta analysis of randomized trials documented the effects of some pharmacologic, physiotherapeutic, surgical and psychiatric interventions for Parkinson disease symptoms.
Researchers concluded, for instance, that carbidopa enhanced the effect of L-dopa, while dopamine agonists, such as bromocriptine, did not. Deep brain stimulation and fetal cell transplantations both reduced "on" scores but not "off" scores, while pallidotomy did not reduce either.
More information on the study is online at http://www.acpjc.org/Content/140/2/issue/ACPJC-2004-140-2-042.htm.
Two studies released last week detail the effects of low literacy on health outcomes. Adults who have lower-than-average reading skills are less likely to seek out preventative health procedures, such as mammograms and Pap smears, according to a new report.
One report, commissioned by the Agency for Healthcare Research and Quality (AHRQ), found that an estimated 90 million American adults have trouble reading newspapers and other simple information. According to an April 8 AHRQ press release, researchers found that these people were less likely than others to get screening tests and immunizations, and to take their children for regular health checkups.
And a report issued by the Institute of Medicine (IOM) found that low health literacy is linked to higher health care costs. According to a summary of the report, Americans with low health literacy have a higher rate of hospitalization and emergency department use, leading to billions of dollars spent in "avoidable health care costs."
The AHRQ release, with a link to the study and to literacy-related materials, is online at http://www.ahrq.gov/news/press/pr2004/litpr.htm.
The IOM report can be accessed or ordered online at http://www.iom.edu/report.asp?id=19723.
State board update
Disciplinary actions by state medical boards against physicians increased by 7% in 2003 over the previous year.
A report released last week by the Federation of State Medical Boards (FSMB) found that there were 5,230 actions taken against physicians last year, 4590 of which were "prejudicial actions" that included revoking or suspending a physician's license or issuing a formal reprimand. According to an April 6 FSMB release, the remaining cases were "non-prejudicial," such as reinstating licenses after probation.
California, which has the largest number of physicians, had the most cases filed at 565, more than 200 of which were prejudicial actions, the April 7 Modern Physician reported. Many states make board actions available on their Web sites, which are listed on FSMB's site. Consumers can also search for physicians by name on the Federation Physician Data Center website at http://www.docinfo.org.
The FSMB release is at http://www.fsmb.org/.
Modern Physician is online at http://www.modernphysician.com/news.cms?newsId=1996.
Members registered for Annual Session 2004 can now download the Annual Session Scientific Program schedule and course handouts for use on their PDAs.
The Scientific Program schedule is a small, cross-platform document available for both Palm and Pocket PC operating systems. The schedule will also be available for download during the meeting in the main Exhibit Hall.
Course handouts for selected sessions are also available to registered Annual Session attendees in a restricted, password-protected area. The Acrobat PDF files may be downloaded and printed, or converted for viewing on a PDA. Additional handouts will be posted as they become available.
More information on Annual Session, which is being held in New Orleans April 22-24, and directions to download the PDA offerings are online at http://www.acponline.org/cme/as/2004/?ow.
"Outsourcing (or Not) Billing and Collection" is this month's featured topic on ACP's new online Small Practice Management Discussion Group.
Targeted to members in practices with between one and five physicians, the newsgroup features a new topic each month and allows participants to exchange information about what works and what doesn't in the small-practice setting.
Some physicians believe that keeping billing in-house allows them to keep on top of daily issues and problems. Others, however, feel that the task should be handled by an agency experienced in billing and collecting. Raymond Basri, FACP, a solo practitioner for 16 years, has tried both approaches and will moderate this month's discussion.
The discussion group is free to ACP members (registration on ACP Online is required), and may be accessed at http://www.acponline.org/pmc/spm/?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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