In the News for the Week of 5-11-04
Focus on the uninsured
- Physicians provide more than $5 billion in uncompensated care
New College publication
- New book offers latest evidence for disease screening and prevention
- CMS launches a drug discount card, transitional assistance program
- Survey: Primary care salaries drop, while subspecialists gain
- Teaching hospital makes $35 million fraud settlement
- Nominations sought for program director awards
- Fast-growing movement faces challenges
Physician payment update
- GAO predicts physician fee cuts
Clinical medicine in the news
- Diabetic women at higher heart attack risk than diabetic men
Focus on the uninsured
ACP has released a new white paper, "The Cost of Lack of Health Insurance," to coincide with the Cover the Uninsured Week taking place May 10-16.
According to the paper, rising health care costs and unemployment are making access to coverage even more difficult. In 2001, for instance, the American health care system provided close to $99 billion in care to uninsured patients, $35 billion of which was uncompensated.
Hospitals provided $24 billion of that care while physicians volunteered about $5.1 billion in uncompensated care, including donated time.
The paper noted that studies have shown that physicians are concerned that they won't be able to continue to provide uncompensated care because of changes in health system structures and financing.
Nearly 1,500 public events are taking place around the country during Cover the Uninsured Week. The College is one of many health care organizations supporting the campaign, aimed at drawing attention to the problem of rising numbers of uninsured Americans.
The ACP paper is online.
In related news, another recent report found that almost half of the nation's 44 million uninsured are working adults. In some states, at least one in five working adults is uninsured.
The report was released last week by the Robert Wood Johnson Foundation. The report was compiled using data from a 2002 national survey by the CDC.
As previous ACP studies have found, the report—which surveyed adults ages 18-64—showed that uninsured adults experience significant gaps in medical care compared to patients with health coverage. Those gaps include:
Uninsured adults are less likely to seek medical care. Almost one in five uninsured adults (19%) said they were unable to get needed medical care in the past year.
Uninsured patients are less likely to have a personal doctor or health care provider. Among uninsured adults, 56% said they did not have a personal physician.
The uninsured are less likely to receive preventive services. Nearly half of uninsured women said they do not have recommended mammograms, while about 70% of uninsured men said they did not get recommended prostate cancer screenings.
In addition, the report found that Texas had the highest rate of uninsured adults (27%), followed by Louisiana (23%) and Mississippi (22%). Minnesota and Hawaii had the lowest uninsured rate at 7%.
A Robert Wood Johnson press release, as well as links to the full "Characteristics of the Uninsured: A View from the States" report, are online.
New College publication
"Screening for Diseases: Prevention in Primary Care," a new ACP book edited by Vincenza Snow, FACP, provides the latest evidence on screening and prevention for nine common diseases and conditions. They include hypertension; type 2 diabetes; osteoporosis; cardiovascular events; depression; hormone replacement therapy; and breast, colorectal and prostate cancer.
The book provides guidelines that define which patients should be screened, recommendations on screening frequency to optimize cost-effective patient care and key points that summarize basic "take-home" messages for each condition.
The 350-page book is $36 for ACP members, $40 for non-members. More information and ordering is available online. You can also order by phone at 800-523-1546, ext. 2600, and refer to product #330300320.
CMS has developed resources to help physicians inform patients about the new Medicare prescription drug discount cards.
Beneficiaries can now subscribe to those cards to start receiving discounts on prescription drugs beginning June 1. Low-income patients may also be eligible for a $600 credit to purchase prescriptions when they enroll in the discount card program.
Most of the resources provide general information and instructions to direct interested beneficiaries to the Medicare toll-free line or the CMS Web site for more specific information. Available resources include:
A pamphlet on the card discount program and traditional assistance program that physicians can distribute to patients.
An educational article aimed at physicians.
An informational advertisement that CMS is placing in selected medical journals.
An informational poster that physicians can order from the CMS Web site and display.
The CMS Web site also allows beneficiaries to identify the best discount card for their specific drugs, by comparing prices available with different discount cards. Beneficiaries can access the resource online.
Also, Medicare representatives are available through a toll free phone line to help beneficiaries compare prices of different discount cards if those patients don't have Internet access. The representatives will mail a printed copy of beneficiary-specific card selection information. The toll-free number is 1-800-MEDICARE (1-800-633-4227).
CMS also provides additional information for physicians who want to take an active role in educating and counseling patients on how to achieve maximum benefits from the drug card discount program. Drug discount cards can be used until Dec. 31, 2005, as the Medicare prescription drug benefit begins Jan. 1, 2006.
More information is available at the CMS Web site.
Survey results released last week of salaries in academic medical practices in 2003 found that while salaries of subspecialists rose last year, those of primary care physicians and internists were stagnant or declined.
According to a May 5 press release from Medical Group Management Association (MGMA), which conducted the survey, the overall salaries of primary care physicians in academic practices fell almost 3% last year, while general internists saw their salaries drop by 4.6%.
Subspecialist salaries, however, increased an average of more than 3%. Noninvasive cardiologists enjoyed an almost 5% salary boost, while diagnostic radiologists saw salary increases of almost 12%.
Analysts quoted in the release said that rising subspecialty salaries were linked to advances in medical technology, which have increased the demand for subspecialists in the academic setting.
The MGMA press release is online.
In the largest fraud settlement ever made by an American teaching hospital, the University of Washington (UW) has agreed to pay $35 million to settle a fraud suit brought by the federal government for allegedly overbilling Medicare and Medicaid for physician services.
The suit claimed that physicians who were part of a group practice associated with the teaching hospital billed for procedures actually performed by residents. According to the May 1 Seattle Times, the suit further alleged that group audit reports, which uncovered a widespread pattern of overcoding, were destroyed and then rewritten to conceal the overbilling.
University officials contend that no records were deliberately destroyed. Since the suit was filed in 1999, the university has instituted many changes to improve compliance, including replacing most of its billing staff.
The Seattle Times is online
The Accreditation Council for Graduate Medical Education (ACGME) is now soliciting nominations for awards to honor quality and innovation in administering residency programs.
The ACGME's Parker J. Palmer Award is given out every year to 10 outstanding program directors. The due date for nominations is June 15, with candidates to be selected in September. (The awards will be presented in February 2005.)
Information and nomination applications are online. Scroll down the left-hand links to the Parker J. Palmer Award.
The hospitalist movement continues to enjoy rapid growth, even as it wrestles with continuing challenges.
Those were the conclusions reached in a commentary in the May 6 New England Journal of Medicine (NEJM) by Robert M. Wachter, FACP, one of the founders of the movement. According to Dr. Wachter, the number of hospitalists has grown over the past eight years to 8,000, with figures expected to eventually reach 20,000.
The rapidly-growing model faces several challenges, however. The most serious obstacle to growth is finding financial support for programs, Dr. Wachter said. Many of hospitalists' core duties are nonbillable, such as systems improvement, teaching duties and uncompensated care.
While many medical groups, hospitals and health plans now fund hospitalist programs, there is a danger that funding will fall off as programs mature and improvements in efficiency or quality naturally plateau. Financial challenges could lead to physician burnout, as hospitalists face growing workloads and uncertain support.
Dr. Wachter also noted that, even as primary care physicians assign their patients to hospitalists, many office-based physicians regret losing the collegiality of rounding at hospitals. He pointed out, however, that even if the hospitalist model had not been created, the proportion of office-based physicians' inpatient time has fallen from 40% of their practice to 10% in the last few decades.
An excerpt of the NEJM commentary is online. (Full text is available only to subscribers.)
Physician payment update
According to a report released last week by the General Accounting Office (GAO), physicians will begin to see annual Medicare fee update cuts of 5% beginning in 2006 if federal officials don't revise the formula used to calculate those updates.
The report claimed that the current update formula, known as the sustainable growth rate (SGR) formula, will mandate cutting physician payments to offset increases in the volume and cost of Medicare services. The College has long lobbied against the use of the SGR, an economic indicator that in part links physician fee updates to the gross domestic product.
The GAO report said that, if the SGR continues in place, physician fee cuts will be needed to recoup excess spending from higher-than-expected service increases and from averted physician pay cuts.
The GAO report is online.
Clinical medicine in the news
Women with type 2 diabetes mellitus have a higher risk of heart disease than both nondiabetic women and diabetic men.
According to a study published in the May 10 Archives of Internal Medicine, several studies on the role of diabetes and hyperglycemia in heart disease found that the risk of heart attack for diabetic women is 150% higher than for nondiabetic women, but only 50% greater in diabetic than in nondiabetic men.
The authors noted that heart disease is the leading cause of death in U.S. women, claiming almost 500,000 lives in 2001. However, surveys show that many women do not perceive heart disease as a major threat.
Several strategies were recommended for treatment, including controlling blood glucose levels, preventing diabetes through weight loss and exercise, and reducing cholesterol with lipid-lowering medications.
An Archives abstract is online.
To encourage physicians to shift to electronic prescribing, a national health plan is offering physicians in its provider network e-prescribing software and a free, one-year subscription to an e-prescribing service.
The California-based WellPoint Health Networks, the second-largest health plan in the country, will provide the e-prescribing software free to the 19,000 physicians in its provider network. That network includes physicians in California, Georgia, Missouri and Wisconsin. The effort is part of the health plan's $40 million e-prescribing initiative, according to a recent CNET News.com article.
WellPoint will roll out a pilot program with 2,000 physicians, extending the service to all of its physicians over the next year. The health plan is partnering with Microsoft's Healthcare and Life Sciences Group as well as software providers Allscripts Healthcare Solutions and ZixCorp.
CNET News.com is online.
The Agency of Healthcare Research and Quality (AHRQ) recently introduced a new interactive tool for PDAs designed to help physicians determine which preventive services are appropriate for patients, based on their age and gender.
The tool, called the Preventive Services Selector, will be regularly updated. It is based on the latest recommendations from the U.S. Preventive Services Task Force and is currently available in Palm OS, Pocket PC and HTML formats, with other applications under development.
You can download the free tool from AHRQ's Web site.
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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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