In the News for the Week of 10-4-05
- ACP urges members to protest proposed Medicare cuts
- New Web site helps members navigate Medicare Part D
- Government waivers help strapped evacuees get needed care
- Thousands of doctors adrift in storm's wake
Clinical news in the headlines
- Highlights of Annals of Internal Medicine
Medical school debt
- Capitol Hill conference puts spotlight on student debt
- NIH inks deal to develop multiple vaccines for avian flu
- ACP supports prisoner rights legislative amendments
An urgent e-mail went out last week to all College members, asking them to contact their legislative representatives to protest Medicare payment cuts scheduled to take effect next year.
College President C. Anderson Hedberg, FACP, pointed out in the Sept. 27 e-mail that if Congress does not act soon to reform the sustainable growth rate formula (SGR), physicians will see a 4.4% automatic cut in Medicare reimbursements on Jan. 1. If left unchecked, Dr. Hedberg wrote, the SGR will reduce payments to doctors by 26% over the next six years.
Dr. Hedberg urged all members to contact their members of Congress to explain how cuts mandated by the SGR—which ties physician fees to fluctuations in the economy, not to actual health care costs—will adversely affect health care access and quality. Payment cuts will discourage physicians from going into internal medicine and other primary care specialties that care for Medicare beneficiaries, Dr. Hedberg noted. And physicians may be forced to limit their number of Medicare patients or consider early retirement.
Ongoing cuts in physician payments also will hurt quality improvement efforts, Dr. Hedberg said, as most internists will be unable to afford electronic health records or other practice tools that could facilitate quality improvement initiatives.
Members are encouraged to use ACP’s Legislative Action Center to send an e-mail or letter to their senators and representatives.
Members can use the sample letter provided for background and insert personal views or anecdotes about how the proposed cuts would affect their practice. The site also includes state-by-state data on the financial impact of Medicare payment cuts through 2014.
The College’s letter is online.
The College has launched a new Web site to help members and office staff get up to speed on Medicare Part D, the new prescription drug benefit that takes effect Jan. 1, 2006.
The new site, hosted by ACP’s Practice Management Center, provides basic and practical information on the new drug benefit, including links to:
An overview of Medicare Part D.
A CMS "physician toolkit" with downloadable educational materials on the new benefit for physicians, staff and patients.
Patient-oriented brochures on Medicare Part D developed by ACP and ACP Foundation.
The CMS Medicare prescription drug learning network (Medlearn), which has a regularly updated series of educational and training materials on Medicare Part D.
An outline of the benefit's transition, exceptions and appeals processes.
A site where physicians can ask specific Part D-related questions or report problems encountered with a particular drug benefit plan.
This month, Medicare beneficiaries should receive their copy of the "Medicare and You 2006" handbook, with information on the new benefit. Both Medicare–approved drugs plans and Medicare Advantage plans—which provide drug coverage in addition to physician and hospital coverage—began marketing their programs Oct. 1. The CMS estimates that half of all Medicare beneficiaries will rely on their primary health care professional as their first source of information about the new benefit.
The new site is online.
For more information, see "Getting yourself ready for Medicare Rx" in the October ACP Observer.
The federal government has granted enrollment waivers to seven states and the District of Columbia to make it easier for Hurricane Katrina evacuees to get coverage through state Medicaid and the State Children’s Health Insurance Program (SCHIP).
As of last week, waivers had been granted to the District of Columbia and to Alabama, Arkansas, Florida, Georgia, Idaho, Mississippi and Texas, all areas housing a significant number of evacuees, according to a Sept. 29 HHS news release. The waivers allow evacuees to enroll in health care programs without producing required legal documents, such as tax returns or proof of residency.
The HHS established uncompensated care pools in affected states to help physicians and hospitals provide free care to low-income evacuees who lack health insurance, the release said. In addition, the government accelerated $2.3 million in grants to establish 26 new health centers in states affected by the storm.
Eligible evacuees without the means to pay for health care would get Medicaid or SCHIP coverage for up to five months, the HHS said. Those eligible include children up to age 19 and their parents, pregnant women, people with disabilities, low-income Medicare beneficiaries, and those needing long-term care.
To qualify, evacuees will be asked to declare their income and assets, if any, and fill out a simple application, said the HHS. States would waive normal out-of-pocket charges and would help evacuees obtain private insurance as they find jobs and places to live.
The HHS news release is online.
All HHS news about Katrina relief can be found online.
A new Web site, KatrinaHealth.org, allows pharmacists and physicians to access medication histories and dosage information of storm evacuees whose paper records have been destroyed or lost.
Annals has posted a Hurricane Katrina resource page with updated information for physicians who want to help with relief efforts.
A new report found that nearly 6,000 physicians in Louisiana and Mississippi were displaced by Hurricane Katrina, the largest displacement of doctors in the nation’s history.
The physicians worked in 10 counties and parishes in Louisiana and Mississippi that were directly affected by flooding, with the majority in three central New Orleans parishes, according to a report by researchers at the University of North Carolina (UNC) at Chapel Hill. Researchers used data from the March 2005 AMA physician master file and FEMA-posted information.
More than 1,200 of those practicing physicians were in residency programs in the area, said a Sept. 26 UNC news release. Medical students at New Orleans’ Tulane and Louisiana State universities have been moved to other programs in the region.
It was unclear how the displacement will affect health care, according to the Sept. 27 Yahoo Health News. Many doctors are expected to relocate to other areas or opt to retire instead of rebuilding their practices, leaving flood-affected areas with a shortage of health care providers.
UNC researchers noted that one potentially positive result of the disaster might be to increase support for electronic health records, as many paper records were destroyed by the storm.
The UNC news release is online.
Yahoo Health News is online.
For more on disaster relief efforts, see "A physician in New Orleans finds refuge in giving aid" from the October ACP Observer.
Clinical news in the headlines
The following articles appear in the Oct. 4 issue of Annals of Internal Medicine. Full text is available to College members and subscribers online.
More heart patients die in the hospital in December than other months. A study of more than 127,000 Medicare patients hospitalized between 1994 and 1996 with heart attacks found that 30-day death rates were higher in December than in other months, even though delivery of proven therapies was consistent across all monthly time periods.
About 22% of patients hospitalized in December died within 30 days compared to 20.1% of those hospitalized in other months. Authors looked for use of aspirin, beta-blockers, clot-dissolving drugs and procedures such as balloon angioplasty—and concluded they do not know why the December death rate is higher.
Many Americans likely to become overweight or obese. An analysis of data on 4,117 normal-weight white men and women found that within four years, between 10% and 25% became overweight and that a similar proportion of overweight people became obese. Over a period of between 10 and 30 years, authors said, more than 50% of the women and men became overweight, while about one-third of the women and one-quarter of the men became obese.
Researchers point out that their figures are higher than other estimates and suggest that the future burden of obesity-associated chronic diseases—such as cardiovascular disease, several forms of cancer, diabetes and knee arthritis—in the U.S. will be substantial.
New College guideline does not recommend for or against hereditary hemochromatosis screening. After examining published studies on hereditary hemochromatosis, a new ACP guideline states that current evidence does not clearly identify the risks or benefits of screening for the disease. The guideline does state, however, that physicians should perform blood tests to measure serum ferritin as well as transferrin saturation tests to establish a hereditary hemochromatosis diagnosis.
Hemochromatosis, a genetic disease in which the body absorbs too much iron from food, can increase iron deposits in organs. This can cause serious liver damage including cirrhosis and liver cancer, as well as diabetes, heart failure, arthritis and skin discoloration.
Hereditary hemochromatosis is the most common recessive genetic trait among whites. Estimating its prevalence is difficult, guideline authors point out, although one estimate puts prevalence at between three to five people per 1,000 in the general population.
Medical school debt
A conference held last month in Washington addressed the growing problem of medical school debt and how that debt affects medical students' career choices and the diversity of the physician workforce.
The Capitol Hill conference was sponsored by ACP, as well as by the American Medical Student Association (AMSA) and the Association of American Medical Colleges. The summit brought together medical school financial advisers and lenders, Congressional officials and medical students. Kerry Donegan, Chair of ACP's Council of Student Members, was a featured conference speaker.
Conference presenters pointed out that students graduating from public medical schools have as much as $100,000 in debt, while those attending private schools rack up as much as $135,000. More than 25% of medical school graduates report debt in excess of $150,000.
Attendees discussed how debt affects students' career choices, including reduced interest among U.S. medical students in general internal medicine. A generalist career, presenters pointed out, does not deliver the salary level needed to retire medical school debt—a factor that may increasingly affect patients' ability to access primary medical care.
One solution proposed at the conference is to increase the number of service programs tied to loan forgiveness. A coalition of summit organizers will continue to map out debt solutions.
More summit information is on the AMSA Web site.
A Web cast of the summit is available online.
Vaccine maker MedImmune Inc. announced last week that it has agreed to collaborate with government researchers to develop a collection of vaccines targeting multiple and potentially lethal strains of avian flu.
The Gaithersburg, Md.-based MedImmune said it would work with the NIH’s National Institute of Allergy and Infectious Diseases to develop investigational pandemic influenza vaccines, according to a Sept. 28 company news release. Researchers will test versions of MedImmune’s nasal vaccine FluMist for effectiveness against various avian flu strains.
The government has already awarded a $100 million contract to Sanofi Aventis SA to develop vaccines targeting the currently circulating H5N1 strain of avian flu, according to the Sept. 29 Washington Post. MedImmune is charged with developing vaccines for all 16 known strains of the virus.
FluMist uses a live version of the virus, which scientists think may provide protection against multiple strains, the Washington Post said. Using reverse genetics, researchers will reproduce key proteins from the various strains and attach them to the FluMist vaccine.
Officials told the Washington Post that it could take several years to develop the vaccines. The effort is in response to fears that a lethal strain of bird flu in Southeast Asia could become a pandemic.
The MedImmune news release is online.
The Washington Post is online.
The College has voiced support of amendments recently added to a federal defense authorization bill that prohibit cruel, inhumane or degrading treatment to prisoners in U.S. custody.
In a Sept. 21 letter to Sen. John McCain (R-Ariz.), the amendments' author, the College said that it agrees with establishing and maintaining clear policies to prevent prisoner and detainee abuse.
The letter, which was signed by College President C. Anderson Hedberg, FACP, pointed out that both the College's "Ethics Manual, Fifth Edition" and a 1995 position paper require physicians to speak out against torture and to condemn interrogation techniques that inflict physical or psychological harm.
The letter noted that military personnel need to be adequately trained on what actions are legally permitted and that abuses can occur where there is confusion over applicable policy. Sen. McCain's amendments, the letter said, restrict interrogation to authorized techniques and affirm U.S. commitment to human rights and humane prisoner treatment.
The letter is online.
The Ethics Manual is online.
The College position paper, "The Role of the Physician and the Medical Profession in the Prevention of International Torture and in the Treatment of Survivors," is online.
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Copyright 2005 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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