American College of Physicians: Internal Medicine — Doctors for Adults ®


In the News for the Week of 5-25-04

CMS update

The business of medicine

Clinical headlines in the news

Patient education

ACP news

CMS update

Seniors struggle with drug card hotline

A 24-hour telephone hotline set up this month by the CMS to help seniors choose Medicare drug discount cards has been overwhelmed by demand.

The hotline--1-800-MEDICARE (1-800-633-4227)--has received as many as 1.6 million phone calls a week since it was set up earlier this month. Thousands of callers have been disconnected or have been put on hold for 20 minutes or longer.

According to the May 18 Philadelphia Inquirer, CMS administrator Mark McClellan, ACP Member, said that a major part of the problem was that only 1,000 benefit counselors had been hired to man the hotline. Dr. McClellan announced last week that the CMS had hired an additional 500 counselors.

He also urged beneficiaries to call later in the day when demand isn't as high, or on Thursdays, Fridays and Sundays. To save time during phone calls, beneficiaries should have the names of their prescription drugs as well as those drugs' prices and dosages on hand when they call.

Seniors are also advised to research their options for Medicare discount drug cards online to avoid high telephone call volume.

Seniors can compare savings with different drug cards online.

The Philadelphia Inquirer is online.


The business of medicine

New study examines growth of quality incentive programs

A new study has found that pay-for-performance programs are gradually gaining favor as health plans look for ways to tie physician payments to improvements in patient care.

A recent study found that pay-for-performance programs are still in formative stages in most states. These early programs, however, may provide a springboard for more widespread implementation and acceptance, according to an issue brief released last week by the nonprofit Center for Studying Health system Change (HSC). The brief looked at pay-for-performance plans now being used in 12 different U.S. markets.

Researchers found that most programs measure patient satisfaction scores as well as physicians' use of preventive care measures--data, the brief pointed out, that are fairly easy to collect. Incentive payments are modest-ranging from 1% to 5% of total payments-and typically take the form of bonuses beyond physicians' base payment rates.

The brief noted, however, that it is far less common for programs to measure outcomes and processes, such as the specific care a patient received. The brief also pointed out that many physicians are skeptical about incentive programs but are reluctant to criticize them for fear of being labeled anti-quality improvement.

Researchers also claimed that incentive plans are more likely to drive quality improvements if programs were sponsored by large health plans. Some of the country's largest incentive programs are in California where, the brief noted, the state's major health plans are expected to make their first large incentive payments to physicians later this year.

An HSC press release, with a link to the issue brief, are online.


Study: Higher drug co-pays affect compliance

A study released last week found that higher co-pays for prescription drugs may cause patients with chronic diseases to cut back on the medications they use. That reduction in drug use in the long run may lead to much higher health care costs.

The study, issued by the Rand Corporation, found that patients cut back on drugs needed to manage their chronic conditions when drug co-pays doubled. For several years, employers have been shifting more drug costs to employees in the form of higher co-pays as a way to reduce health care insurance premiums.

The study found that patients with diabetes and asthma cut back on their use of medications as much as 23% after their drug co-pays doubled, while higher co-pays caused patients with gastric disorders to cut their prescription drug use by 17%. The study was published in the May 19 Journal of the American Medical Association (JAMA).

Those attempts to save money on co-pays may lead to higher health care costs. According to a May 18 press release from the Agency for Healthcare Research and Quality (AHRQ), which helped fund the study, early evidence suggests that as chronic disease management declined, patients made 17% more visits to emergency rooms while their hospital lengths of stays increased 10%.

The JAMA abstract is online.

The AHRQ press release is online.


Clinical news

Highlights of ACP Journal Club: Parathyroid hormone plus alendronate not better than monotherapy in postmenopausal osteoporosis

Studies have found that parathyroid hormone (PTH) used in combination with alendronate was not more effective than using either agent alone in increasing bone mineral density (BMD) in postmenopausal women with osteoporosis.

The study, abstracted in the May/June ACP Journal Club, compared two studies that tested the hypothesis that the two agents, both of which increase BMD, would work better together than alone. In both studies, the volumetric BMD of the spine increased more in the PTH group than in the combination group. This and other data led researchers to conclude that alendronate impairs the effect of PTH.

The studies have implications for treatment of osteoporosis, the researchers reported. First, physicians should consider PTH only in patients with severe osteoporosis because of the cost and inconvenience of daily injections. Second, PTH should be used alone, not with bisphosponates in patients starting new treatment.

In patients already receiving treatment, physicians should consider halting bisphosphonate when starting PTH therapy. However, further clinical trials are needed to determine whether this method will be effective.

The ACP Journal Club commentary is online.


Retirees can suffer from problem drinking

Older adults who have trouble adjusting to retirement may resort to increased drinking, while physicians may mistake patients' symptoms for other signs of aging.

Statistics suggest that less than 5% of adults ages 60 to 64 are alcoholics, although many more older adults may be prone to alcohol misuse. According to the May 18 New York Times, even light drinking can cause problems for the elderly because the effects of alcohol are amplified with age.

In addition, older patients are taking medications that can compound the effects of alcohol. And alcohol can counter the effects of some medications, including blood thinners, the New York Times reported.

Physicians often attribute symptoms such as falls, tremors and memory loss to aging or dementia, but these can be signs of problem drinking. In addition, retirees themselves often don't recognize warning signs because they may have no family members or employers to alert them to signs of problems.

Triggers for alcohol misuse include retirement, depression, divorce and physical disabilities. While very few educational or treatment programs are directed at retirees, several Florida counties have launched pilot programs to treat alcohol misuse, featuring home visits and counseling.

The New York Times is online.

In related news, a new online newsletter offers physicians free access to the latest clinical research on alcohol abuse.

"Alcohol and Health: Current Evidence," supported by the National Institute on Alcohol Abuse and Alcoholism, features brief summaries of current issues and commentary relevant to primary care physicians.

Topics in the first issue include:

  • Screening and brief intervention in general practice for risky drinking.
  • A discussion of whether average consumption influences mortality.
  • A comparison of alcohol screening questionnaires for women.

The bimonthly newsletter also includes downloadable PowerPoint slide presentations designed as teaching tools. You can sign up online to receive e-mail alerts about future issues.

The current issue is online.


Patient education

National diabetes program targets high risk patients

A new national educational campaign on type 2 diabetes aims to boost diabetes awareness and prevention among high risk patient groups.

The "Small Steps. Big Rewards. Prevent type 2 Diabetes" program focuses on educating people at high risk of developing type 2 diabetes to make modest lifestyle changes that can prevent or delay the onset of the disease.

Campaign materials include motivational tip sheets for patients as well as print and radio public service ads. Each set of materials is specifically tailored to one of the high risk groups, including African Americans; Hispanic and Latino Americans; American Indians and Alaska Natives; Asian Americans and Pacific Islanders; and adults ages 60 and older.

The campaign has been launched by HHS' National Diabetes Education Program, which is sponsored by the NIH's National Institute of Diabetes and Digestive and Kidney Diseases and the CDC.

For more information or to order campaign materials, go online.

You can also order free copies of program materials by calling 800-438-5383.


ACP news

College calls for formal investigation of prisoner abuse

ACP last week called on the administration to order a formal review of U.S. interrogation practices of military prisoners and detainees.

In a letter sent to the White House May 17, College President Charles K. Francis, FACP, said that the College's Ethics Manual and position papers condemn interrogation techniques that inflict physical or psychological harm as a means of obtaining information. Those techniques, the letter pointed out, are also prohibited by international law.

The College applauded the administration's condemnation earlier this month of alleged abusive practices in Iraqi military prisons. However, the letter stated that investigations of abuse must go beyond allegations in Iraq to include detention center practices in Afghanistan and Guantanamo Bay.

The College had first expressed its concern about reported abuses in an October 2003 letter sent by then-ACP President, Munsey S. Wheby, MACP. The administration did not respond to that letter.

The letter is online.


Fall Governors resolutions due June 30

Resolutions to be heard at the fall Board of Governors meeting are due by Wednesday, June 30.

ACP members may initiate a resolution on any issue or topic by submitting it to their Governor and/or chapter council. Once the council approves a resolution, it becomes a resolution of the chapter.

A resolution should clearly distinguish the action requested within its resolved clause(s) as either a policy resolve ("Resolved that ACP policy …"), or a directive, requesting action or study on an issue ("Resolved that the Board of Regents …"). If you are proposing more than one action, give each its own resolved clause.

The Governors review new resolutions and present recommendations to the Board of Regents for follow up. Once the Regents have considered the Governors' recommendations, resolutions can be adopted and implemented or forwarded to committees and staff for study. If you have questions about the resolutions process or how to format a resolution, contact your Governor.

You can search ACP's archive of resolutions in the Resolutions Database. The database allows you to search by text of resolution (keyword search), date submitted or sponsor.

You can also research the College's position on key health policy issues in the "Advocacy" section of ACP Online.


College applauds bill to reduce liability insurance costs

ACP has thanked a member of the House of Representatives for introducing legislation aimed at reducing the cost of medical malpractice insurance.

In a letter sent earlier this month, College President Charles K. Francis, FACP, thanked Rep. James Greenwood (R-Pa.) for introducing the "Help Efficient, Accessible, Low-Cost, Timely Health Care Act of 2004" (H.R. 4280).

The HEALTH Act, the letter stated, presents commonsense solutions to the growing problem of liability coverage for physicians. Internists are especially hard-hit because their premiums have increased at a much higher rate than other medical specialties, the letter said. Coupled with declining Medicare reimbursements and growing regulatory burdens, many internists must now choose to pay escalating premiums, change insurance carriers, move to another state to practice or retire.

By incorporating reforms that have proved effective in California, the letter stated, the HEALTH Act--if passed--would safeguard patient access to care while controlling the cost of liability insurance premiums.

The letter is online.

In related news, the College this month joined more than 40 other members of the Health Coalition on Liability and Access in expressing the coalition's support of the HEALTH Act in a letter to Rep. Greenwood.

The letter cited a poll in which more than 70% of respondents said they would support limits on pain and suffering awards in malpractice cases. Coalition members include professional associations and societies, liability carriers, health plans, and consumer groups.

The coalition letter is online.


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Copyright 2004 by the American College of Physicians.

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A 67-year-old man is evaluated for a recent diagnosis of primary hyperparathyroidism after an elevated serum calcium level was incidentally detected on laboratory testing. Medical history is significant only for hypertension, and his only medication is ramipril. Following a physical exam and lab studies, what is the most appropriate management of this patient?

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