In the News for the Week of 7-14-04
- Physicians asked to recruit patients for CMS' discount drug demo
Clinical news in the headlines
- Rate of PSA rise may be key predictor of prostate cancer death
- Highlights of the July 6 Annals of Internal Medicine
- Diabetics may run higher risk for certain cancers
- Highlights of ACP Journal Club
- Study finds higher rate of early death among uninsured
- ABIM seeks reviewers for exam questions
- Program looking for language-service innovations among small practices
- New College publication collects the best of Annual Session Updates
- College calls on Congress to create incentives for information technology
- ACP: CDC restructuring may dilute minority health efforts
The CMS is urging physicians to help recruit Medicare beneficiaries for a new discount drug demonstration project due to begin Sept. 30.
The $500 million project will allow up to 50,000 Medicare beneficiaries who don't have comprehensive drug coverage to be covered for certain self-administered medications. Those drugs would replace medications currently delivered in a physician's office and reimbursed under Medicare Part B. Covered drugs include those used to treat patients with rheumatoid arthritis, multiple sclerosis, pulmonary hypertension and a variety of cancers.
The CMS is asking physicians to help recruit eligible patients and to assist them in completing an application by the Sept. 30 deadline. To participate, beneficiaries must present a signed certification from their physician, saying they require one of the drugs included in the project. The CMS' Web site contains a list of drugs covered, as well as a patient brochure with eligibility requirements, an application and physician certification form, information on financial assistance and benefit categories, and a list of frequently asked questions.
The Web site is updated regularly with new information about covered drugs and conditions, so physicians are asked to check it regularly.
Information and materials are available online.
You can also call the project contractor's call center at 866-563-5386 between 8 a.m. and 7:30 p.m., Monday through Friday.
Clinical news in the headlines
A new study suggests that the rate at which a man's prostate-specific antigen (PSA) level increases is a more accurate predictor of his risk of death from prostate cancer, rather than the PSA level alone.
The study tracked the PSA levels of close to 1,100 men with localized prostate cancer who had undergone radical prostatectomy. Researchers found that the risk of death from prostate cancer among patients whose PSA level increased by more than 2.0 ng per milliliter in the year before diagnosis was almost 10 times as high as among men with a lower PSA velocity. Study participants ranged in age from 43 to 83 and were followed for up to 13 years. Results were published in the July 8 New England Journal of Medicine (NEJM).
The findings suggest that tracking the rise of PSA levels is a new tool to help physicians assess the aggressiveness of prostate cancer, according to the July 8 Washington Post. The study authors said that men whose PSA levels have risen rapidly in the year before diagnosis may not benefit from watchful waiting, but need more aggressive treatment.
The authors also suggest that men should have a baseline PSA test between the ages of 35 and 40, with annual tests beginning by age 45 to 50. Prostate cancer kills an estimated 30,000 Americans each year and is the second leading cause of cancer death among men.
The NEJM abstract is online.
The Washington Post is online.
The following articles appeared in last week's Annals of Internal Medicine. The full text of the issue is available to College members and subscribers online.
Ginseng reduces blood thinner's effect. A study has found that American ginseng, a widely used herbal supplement, reduced the anticoagulant effect of warfarin, a commonly prescribed blood thinner. At the end of the four-week study involving 20 young, healthy volunteers, those who took ginseng had lower blood levels of warfarin and less of an effect on blood clotting than volunteers who took placebo.
Study: Only 57% of doctors follow handwashing rules. Researchers observing the handwashing practices of 163 physicians in a university hospital in Switzerland found that on average, only an average of 57% followed standard hand hygiene practices. Internists and medical students washed hands most often, while surgeons, anesthesiologists and critical care physicians washed hands least often.
A large study has concluded that diabetes increases patients' risk of death from a variety of cancers.
The study, led by CDC researchers, tracked a group of almost 500,000 men and almost 600,000 women who were free of cancer when they enrolled in the study in 1982, the July 2 Reuters reported. Patients were followed for 16 years.
Researchers found a link between patients with diabetes and those who died from colon and pancreatic cancers.
The study, published in a recent American Journal of Epidemiology, also revealed a link between diabetes and a higher risk of death from liver and bladder cancers in men, and from breast cancer in women. Researchers noted that the higher cancer risk was not influenced by obesity, which is common among diabetics.
The American Journal of Epidemiology abstract is online.
Reuters is online.
Doctors should not recommend a firm mattress for patients with chronic low-back pain, according to a recent study indicating that firmer sleeping surfaces have virtually no effect on mitigating back pain.
The trial, abstracted in the July-August ACP Journal Club, reports on a study involving more than 300 adults who had experienced at least three months of chronic low-back pain. Researchers allocated half of the patients to medium-firm mattresses and the others to firm mattresses for 90 days.
The patients who slept on medium-firm mattresses were more likely to report improvements in pain-related disability (82%) than those on firm mattresses (68%), while the mattresses did not affect pain while patients were lying in bed or rising.
The findings undercut the popular notion that a firmer mattress is good for a bad back. Based on the evidence, physicians should stick with over-the-counter analgesics and advise patients to stay active when counseling them for chronic low-back pain.
ACP Journal Club is online.
A new study predicts that nearly 100,000 uninsured patients will die prematurely over the next eight years because they lack health insurance.
The study found that uninsured Americans aged 50 to 64 with diabetes, heart disease or high blood pressure are especially vulnerable to early death as their health deteriorates and they don't access preventive or chronic care services. The study was published in the July/August Health Affairs.
According to the July 7 Boston Herald, uninsured patients face a 43% greater chance of dying prematurely compared with patients who have health insurance. The problem becomes more severe as uninsured baby boomers near retirement age but still don't qualify for Medicare, the Boston Herald reported. Extending coverage to uninsured patients before they qualify for Medicare would relieve some of Medicare's eventual financial burden, the study's authors said.
A Health Journal abstract is online.
The Boston Herald is online.
For more on the links between lack of coverage and poor health, see the College's 2000 report "No Health Insurance? It's Enough to Make You Sick" online.
The American Board of Internal Medicine (ABIM) invites ACP members to help review and rate questions being considered for the certification and maintenance of certification exams.
To participate, you must spend a majority of your professional time in direct patient care in the United States or Canada and hold an active ABIM certificate. As a reviewer, you will be asked to rate 10-20 questions in your field, using a scale of 1-5 to indicate how relevant each question is to your clinical practice. You may also be asked to answer the questions.
You can choose how many cycles of review you'd like to do, and participation is voluntary. Participating as a reviewer is not linked to CME credit nor to your own certification status.
The review process is designed to ensure that exam questions are relevant to clinical practice, with more than 3,000 diplomates taking part in the process every year.
For more information or to volunteer as a relevance reviewer, contact the ABIM via e-mail.
The nonpartisan legal advocacy group is seeking successful case studies of language services provided by solo or small group practices.
The National Health Law Program is looking for practices with innovative approaches to providing language services to non-English speaking patients. The program will conduct site visits and survey practices with promising language-service innovations. The case studies may be highlighted in a report from the Commonwealth Fund slated for publication in 2005. Practices can contact Mara Youdelman at 202-289-7661 or by e-mail.
Each year at Annual Session, thousands of internists attend the popular "Updates" sessions to learn about the latest advances in internal medicine and its subspecialties. Now, ACP members have access to that body of knowledge through a new College product.
"Internal Medicine Updates 2004" contains notes and handouts from the Updates sessions at Annual Session 2004. The 352-page softcover book also includes handouts from this year's Multiple Small Feedings of the Mind sessions, which address clinically important questions that internists commonly face in practice. The book is designed for practicing physicians, program directors and any physician looking to stay current in internal medicine.
"Internal Medicine Updates 2004" costs $19 ($21 for nonmembers). You can order the book online or by calling ACP Customer Service at 800-523-1546, ext. 2600, or 215-351-2600. (Refer to product code 330300930.)
ACP is urging Congress to back incentives to encourage the widespread and uniform adoption of health information technology across the country.
In written comments to the House Ways and Means Committee's Subcommitee on Health, ACP said widespread use of information technology would result in fewer medical errors. However, reports show that less than 10% of physicians regularly use electronic health records, compared to England where a $17 billion national investment will result in universal electronic health records by 2005.
The cost of implementing information technology and the lack of financial incentives are major obstacles to widespread adoption. The College recommended that Congress take the following steps:
Create a revolving health technology loan program modeled on the current student loan program, with subsidizing grants for physicians who agree to buy health technology linked to support tools or who voluntarily participate in performance programs.
Authorize tax credits aimed at physicians in small or solo practices who purchase information technology.
Replace the flawed Medicare SGR formula with a new formula that recognizes the acquisition and ongoing costs associated with information technology.
Build into the Medicare RBRVS system an add-on code to reimburse physicians for services assisted by an electronic health record.
Reimburse telephone and e-mail consults that result in a distinctly identifiable medical service.
The College's comments are online.
In related news, the College expressed its commitment to working with the CMS on a demonstration project geared at improving health care quality through the use of health information technology.
The CMS' Doctors Office Quality Information Technology (DOQ-IT) demonstration project program represents the first opportunity to measure improvement in care quality through the use of information technology, the College wrote in a July 7 letter to Mark B. McClellan, FACP, the CMS' administrator.
Although the program is expected to offer participating physicians financial incentives to adopt information technology, those incentives have not yet been finalized and physicians will be reluctant to participate in the program.
The College made several recommendations for a financial model for the program, including establishing financial incentives sufficient to offset a major portion of the costs of acquiring information technology and linking incentives to program participation rather than to outcomes.
The College's letter is online.
In response to a planned restructuring of the CDC, the College has urged the public health agency to maintain the functions of its office of minority health to safeguard the CDC's efforts to reduce racial health care disparities.
In a June 30 letter to the CDC director, College President Charles K. Francis, FACP, expressed concern that the agency's reorganization may weaken the CDC's ability to address minority health issues. While ACP agrees with the overall goals of the restructuring initiative-to boost health promotion and disease prevention-it fears the initiative may hamper critical functions of the minority health office by curtailing office activities and parsing those activities among other offices within the agency.
The minority health office, Dr. Francis wrote, now coordinates the CDC's efforts to reduce racial health care disparities and facilitates research on minority health issues. While the letter acknowledged the agency's need to shift some government resources to address issues of bioterrorism and homeland security, those priorities should not be met at the expense of vital domestic programs, the letter said.
The College's letter is online.
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Copyright 2004 by the American College of Physicians.
A 62-year-old man is evaluated for declining exercise capacity over the past year. He was diagnosed with moderate COPD 3 years ago. His symptoms had previously been well controlled with tiotropium and as-needed albuterol. He has not had any hospitalizations. He is adherent to his medication regimen, and his inhaler technique is good. Following a physical exam and review of previously performed chest radiographs and pulmonary function testing, what is the most appropriate management?
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