In the News for the Week of 5-4-04
New College products, programs and services
- PIER debuts for PDAs
- College newsgroup offers help for hiring new staff
- New program promotes international physician exchange
Clinical news in the headlines
- Highlights of the May 4 Annals of Internal Medicine
- CMS launches new Web site to compare drug prices
- Administration urges move to EMRs within 10 years
The business of medicine
- Federal court finalizes Cigna claims settlement
- New substance abuse treatment resource available
- College calls for student loan, deferment reform
- ACP urges Senate support for ending racial and ethnic disparities
- College supports online mechanism for physician complaints about health plans
New College products, programs and services
ACP Members can now access the Physicians' Information and Education Resource (PIER) even more directly at the point of care.
The College's evidence-based decision support tool, previously available only via the Internet, is now available exclusively to College members on PDA for an annual subscription of $99. Subscribers will have access to the PalmOS, Pocket PC and wireless PIER versions.
The application includes all of the PIER disease modules that are available on the full PIER Web site, integrated with a complete drug reference.
PIER PDA is available for PalmOS devices, version 3.5 or higher, and Pocket PC devices with ARM-based processors. Memory requirements are 15MB of free memory on a desktop and 15MB of free device memory, either internally or on an external memory card.
For more details and ordering information, visit PIER PDA online at http://www.acponline.org/catalog/pierpda/pier_pda.htm.
When you're interviewing a candidate for a staff position, you want to find out if the person will be a good fit—especially if you have a small practice. What questions can you ask, and which should you steer clear of?
Find out online this month on ACP's Small Practice Management Discussion Group. This month's featured topic is "Hiring staff: Getting the most out of an interview without getting in trouble," moderated by Guy Hudson, the College's Director of Human Resources.
Mr. Hudson has more than 20 years of human resources experience in compensation, benefits, pensions, recruitment and retention, employee relations and human resource information systems. While he cannot offer specific legal counsel, he will present practical advice about interviewing and staffing.
Targeted to members in practices with between one and five physicians, the Small Practice Newsgroup features a new topic each month, allowing participants to exchange information about what works in the small-practice setting.
You can access the newsgroup online at http://www.acponline.org/pmc/spm/.
ACP has launched a new international exchange program to bring physicians from around the world to the United States and Canada to participate in short-term medical fellowships under the mentorship of senior physicians.
The International Fellowship Exchange Program is being sponsored by the Pfizer Medical Humanities Initiative. A limited number of scholarships will be awarded every year, each with a stipend to cover travel, living and other expenses.
The sponsored fellowships are observational in nature and are expected to last two months each. Participating internists will also receive additional funding to attend ACP's Annual Session.
The program's first participant is Norah Olubunmi Akinola, MBchB, PhD, an internist and hematologist who serves as a senior lecturer and consultant at Obafemi Awolowo University in Ile-Ife, Nigeria. Starting this month, she is in residence at Cornell Medical Center, studying techniques for the diagnosis and management of patients with HIV/AIDS.
Interested international physicians must be internists or subspecialists of internal medicine and members of ACP (or willing to become one). A brochure and application are online at http://www.acponline.org/college/international/?ow.
Clinical news in the headlines
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.
Mammography and Pap tests screening for women over age 70 should target only healthy women. A new study found that three-quarters of women over age 70 surveyed by telephone reported having had a recent mammography, Pap test or both. Women who reported being in worse health were as likely to get those tests as those in better health, although it is known that older women whose life expectancy is less than five years are unlikely to benefit from screening mammography or Pap test screening. An accompanying editorial notes that screening can have, at best, only a limited effect on mortality among the elderly. http://www.annals.org/cgi/content/full/140/9/681
Drug management for older adults needs improvement. A study compared the management of pharmacologic care of 372 vulnerable elderly patients in two managed care organizations against explicit quality indicators. Researchers found failures in educating patients on proper use of medications, monitoring medications appropriately, documenting necessary information, educating patients about their medications and coordinating patient care with other physicians. Researchers also found underuse of potentially beneficial medications but did not find problems with inappropriate prescribing. http://www.annals.org/cgi/content/full/140/9/714
Medicare last week launched a new Web site to allow beneficiaries to compare prices of prescription drugs.
The site is designed to help Medicare enrollees decide which Medicare-certified drug discount card to subscribe to when the discount card program begins on June 1. The rationale is that patients will be able to use the site to determine which discount card offers them the most cost benefits for their specific prescriptions.
The administration is promoting the site as a quick and easy way for Medicare patients to decide which cards to subscribe to, according to the April 29 New York Times. Enrollees will pay annual subscription fees of up to $30 for the cards, which the government claims will allow subscribers to save as much as 35% on name-brand drugs and more on some generic drugs. The administration is expecting as many as 7 million Medicare patients to subscribe.
Critics contend, however, that several online companies—such as Drugstore.com—already provide drug-price comparison services. They further claim that the discount cards won't offer substantial savings over discounts already being offered by many stores and online pharmacies.
The card program is a precursor to the Medicare drug benefit that was approved last year by Congress and begins in 2006, when enrollees will get outright prescription subsidies. The discount card program now includes 39 national drug discount cards and 33 local and regional cards sponsored by drug makers, insurers, drugstore chains and pharmacy benefit management companies.
Medicare's price-comparison Web site is online at http://www.medicare.gov.
The New York Times is online at http://www.nytimes.com/2004/04/29/business/29drug.html.
The administration has called for all Americans to have personal electronic medical records (EMRs) within 10 years and for hiring a technology czar to coordinate that initiative.
In a speech given last week, the president proposed doubling annual government grants to support the conversion to EMRs to $100 million, according to the April 27 Los Angeles Times. Those efforts would fall under the direction of a national health and information technology coordinator, a newly created position within HHS. The coordinator, who has yet to be named, will be charged with developing specifications leading to electronic data standards by the end of this year.
President Bush described the current record system as severely outdated and noted that EMRs would reduce medical errors and curtail administrative costs.
The president announced the plan as part of several technology initiatives that also included funding hydrogen fuel research and expanding broadband Internet access.
The Los Angeles Times is online at http://www.latimes.com/news/printedition/asection/la-na-bush27apr27,1,5598467.story?coll=la-news-a_section.
The business of medicine
A federal judge last week cleared the way for a $540 million settlement between Cigna Corp. and 700,000 physicians nationwide who had charged the insurer with conspiring to underpay on claims.
The judge dismissed claims by a small group of physicians who had attempted to pursue the suit through the courts instead of accepting the settlement, according to the April 23 Los Angeles Times. The settlement ends Philadelphia-based Cigna's part in lawsuits filed by physician organizations in the late 1990s, which charged several insurers with denying or delaying reimbursements and with rejecting claims for medically necessary treatments.
Under the terms of the settlement, Cigna agreed to pay $400 million to revamp its reimbursement practices, $70 million to physicians covering 12 years of reimbursements and $55 million in legal fees. It also agreed to donate $15 million to fund a foundation that will address health concerns identified by physicians and medical groups.
Aetna Inc., another health plan named in the suit, reached a $470 million settlement with physicians last May. The other defendants now scheduled to go to trial later this year include Humana Health Plan, PacifiCare Health Systems, Prudential Insurance Co. of America, United HealthCare, WellPoint Health Networks and Foundation Health Systems.
The Los Angeles Times is online at http://www.latimes.com/business/la-fi-cigna23apr23,1,1193350.story
Physicians can now order free copies of an up-to-date directory that lists more than 11,000 community-based drug and alcohol abuse treatment programs nationwide.
The updated directory from the HHS' Substance Abuse and Mental Health Services Administration (SAMHSA) includes information about hotlines, crisis centers and emergency services. It contains listings for both public and private facilities, as well as short- and long-term institutional programs.
Order copies by calling 800-729-6686. You can also use SAMHSA's online facility locator at http://www.findtreatment.samhsa.gov.
ACP signed on with 24 other medical groups last month in recommending that lawmakers extend the economic deferment for qualified borrowers and increase the subsidized loan limit for medical students.
In a letter sent to both House and Senate leaders working on reauthorizing the Higher Education Act, the College urged them to increase limits for subsidized Stafford Loans to at least $12,000 a year.
The letter also urged Congressional leaders to extend residents' economic hardship deferment to cover their entire training period. That deferment is currently available for only three years, and extending current deferment can be very expensive for residents, the letter stated, because interest accrues and may be capitalized.
The College also urged leaders to include all educational loans, including school-certified private or alternative loans as well as institutional loans, when calculating deferment eligibility.
The letter is online at http://www.acponline.org/hpp/house_hea.pdf.
The College last month joined with 65 other groups to urge Senate majority and minority leaders to work together to ensure enactment of a bill to eliminate racial and ethnic disparities in health and health care.
Calling disparities "an ongoing national crisis," the letter recommended passage of a bill that, among other provisions, would include:
- enhancing opportunities for research;
- fostering outreach innovations;
- increasing the diversity of the health care workforce; and
- establishing minority health offices at federal agencies, such as the FDA and the CMS.
The letter is online at http://www.acponline.org/hpp/health_disparities.pdf.
ACP is urging the National Association of Insurance Commissioners (NAIC) to develop an electronic model to enable physicians to file grievances about health plan payment policies.
In a letter sent last month to NAIC's president, the then Chair of the College's Medical Service Committee, C. Anderson Hedberg, FACP, noted that such a model should be shared with state insurance departments to allow aggressive collection of physician grievances concerning noncompliance with prompt pay laws.
The letter further recommended that the NAIC expand current programs and databases that collect consumer complaints about health plans. Such a dual system, the letter said, would encourage better enforcement of state laws on claims payments and correct suspected under-reporting of physician complaints.
The letter is online at http://www.acponline.org/hpp/model_comppro.htm.
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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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