In the News for the Week of 5-24-05
- 2005 Leadership Day draws record number of College members
- College promotes new bill on information technology
- PIER releases new module on Ebola, Marburg viruses
Physician payment update
- Bill aims to reform physician payment system
Clinical news in the headlines
Health care access
- More adults with chronic diseases have trouble affording drugs
- CMS posters help Medicare patients find prescription resources
- Journal editors renew call for public drug research registry
At ACP's annual Leadership Day event last week, College members arrived on Capitol Hill to lobby legislators on key medical issues.
This year's event—which was held May 17-18—attracted 260 attendees from 43 states and the District of Columbia, the highest attendance for the event. Also attending were a record number of younger members, including 60 Associates and 19 Student Members.
Attendees heard from several legislators and guest speakers before meeting with senators and representatives from their home states. Key issues on the agenda were correcting the dysfunctional Medicare payment system and improving quality of care through information technology and pay-for-quality programs. Associates and students also talked to legislators about the importance of supporting graduate medical education and relieving student debt.
Keynote speaker Mark McClellan, FACP, CMS administrator, told members at a briefing that Medicare is shifting its focus from paying for services to emphasizing prevention. Dr. McClellan was also presented with the College's prestigious Joseph F. Boyle Award for Distinguished Public Service.
Other speakers who addressed ACP members included Sen. Charles Grassley (R-Iowa), chair of the Senate Finance Committee; Rep. Michael Burgess, MD (R-Texas), a member of the House Energy and Commerce Committee; and Rep. Rahm Emanuel (D-Ill.), a member of the House Ways and Means Committee.
The College presented its Key Contact of the Year award posthumously to Jeevan Paul, FACP, of Minneapolis, Minn., for his work in recruiting an unprecedented number of Minnesota internists into the College's Key Congressional Contact program.
Special recognition awards also went to other ACP Key Contacts, including:
- Dawn E. Clancy, FACP (Johns Island, S.C.)
- Sarah Corley, FACP (Annandale, Va.)
- Robert Englund, FACP (Munsonville, N.H.)
- Stella Hines, ACP Associate (Chicago)
- Craig Kitchens, FACP (Gainesville, Fla.)
- Robert Lebow, FACP (Southbridge, Mass.)
- Eric Mazur, FACP (Norwalk, Conn.)
- Robert M. McLean, FACP (New Haven, Conn.)
- Richard Neubauer, FACP (Anchorage, Alaska)
- Susan Sprau, FACP (Santa Monica, Calif.)
More information on the Key Contact program is online.
The College joined more than a dozen other organizations in urging members of Congress to support key provisions in a newly introduced bill that would help fund the use of electronic information technology.
In a May 11 letter to the bill's bipartisan sponsors, ACP and other signatories said that the bill—the 21st Century Health Information Act of 2005 (H.R. 2234)—is important because it allows Medicare and Medicaid funding to be used to advance the development and implementation of information technology, including electronic health records (EHRs).
Specifically, the bill would adjust Medicare payments to physicians who participate in health information networks to improve the quality of patient care. The bill would also allow Medicaid funding to be used to develop and implement regional health information networks.
And the bill, if passed, would help remove communication barriers by providing for the adoption of interoperable data standards to allow information to be exchanged. The measure also includes necessary privacy and security protections, as well as a safe harbor for equipment and services used in constructing a health information network that would not violate Medicare self-referral and anti-kickback provisions.
In addition to ACP, those signing the letter included other medical societies, including the American College of Emergency Physicians; health care information groups, including eHealth Initiative and the National Alliance for Primary Care Informatics; and several manufacturers, including IBM, Intel Corp., Dell Corp. and Siemens Medical Solutions.
The letter is online.
A copy of the bill is online.
PIER—ACP's point-of-care decision support resource—has expanded its section on infectious diseases to include Ebola and Marburg viruses.
The module was written by epidemiologist Daniel Bausch, MD, MPH, an associate professor of tropical medicine at Tulane University and Tulane School of Public Health in New Orleans. The module allows physicians to consider Ebola or Marburg virus in patients presenting with fever and nonspecific symptoms who have traveled in rural sub-Saharan Africa. The new module includes point-of-care information on history and physical exam, lab tests and differential diagnoses.
The World Health Organization (WHO) last week announced that Marburg virus has killed more than 300 people in Angola during this latest outbreak, according to the May 19 MSNBC. While the outbreak is not yet contained, a WHO spokesperson said that increased public awareness had resulted in more patients being brought to hospitals, thereby preventing an increase in deaths from the disease.
The Web-based PIER now contains 378 modules that provide guidance and information on 275 diseases and conditions. Other new modules focus on acute hepatic injury, glioblastoma, leprosy, tracheal intubation and ethical issues concerning disability determination.
The new module is online.
Physician payment update
A bill introduced in the U.S. House of Representatives last week proposes to tie physician fee increases to practice cost increases rather than to fluctuations in the economy.
The Preserving Patient Access to Physicians Act of 2005 (H.R. 2356) would replace the current sustainable growth rate (SGR) formula, which links physician fee updates to the gross domestic product, with a formula based on changes in practice costs, according to the May 19 Modern Physician. The bill, which has bipartisan support, was backed by the College and the AMA. ACP has long advocated for replacing the SGR with a formula that would tie physician fee updates to the actual costs of providing medical services.
Under the current SGR formula used by Medicare, physician fees are expected to be cut by 26% over the next six years, with a 4.3% decrease slated for January 2006. The new bill would update payments by at least 2.7% in 2006, said Modern Physician, with annual updates beginning in 2007.
Modern Physician is online.
The College's recommendations for improving the dysfunctional payment system, including changing the SGR, are online.
Clinical news in the headlines
Finding that sigmoidoscopy missed precancerous growths twice as often in women as in men, a new study released last week concluded that colonoscopy should be the preferred method for colon cancer screening in women.
In the study, 1,463 women ages 50-79 underwent colonoscopy, revealing advanced neoplasia in 4.9%, compared with 1.7% using flexible sigmoidoscopy. (Among participants, 15.7% had a family history of colon cancer.)
Sigmoidoscopy found precancerous tumors in only 35.2% of women with advanced neoplasia, the authors reported, compared with 66.3% of men enrolled in another VA cooperative study. The study appeared in the May 19 New England Journal of Medicine.
Colonoscopy, which is more reliable but also more expensive than sigmoidoscopy, is already preferred by many patients and physicians, according to the May 19 Philadelphia Inquirer. While colonoscopy is becoming more common, sigmoidoscopy is still performed because it is faster, does not require using a sedative and costs about $150 vs. $400 or more for colonoscopy. Current guidelines recommend regular screening for colon cancer after age 50, the Philadelphia Inquirer reported.
While the study, which was funded by the National Cancer Institute, confirms what many already suspected about the limitations of sigmoidoscopy, the findings on gender differences were surprising, the Philadelphia Inquirer reported.
The New England Journal of Medicine abstract is online.
The Philadelphia Inquirer is online.
According to a recent trial, implanted cardioverter defibrillators (ICDs) helped reduce deaths from arrhythmia in heart attack victims, but the benefits were offset by deaths from other causes.
The study, which involved 674 patients age 18 to 80 who had recently suffered a myocardial infarction, compared prophylactic ICD use with conventional therapy. ICD therapy reduced arrhythmia-related deaths from 8.5% to 3.6% in patients with recent MI and left ventricular dysfunction.
However, all-cause mortality was not reduced because of the higher rate of non-arrhythmia-related deaths. The study is abstracted in the May-June ACP Journal Club.
The benefits of using ICDs may have been offset by deaths from progressive pump failure, for example, or sudden deaths from thrombotic causes, said the Journal Club reviewer. More information is needed, he said, on how specific factors—such as time since the myocardial infarction, ejection fraction, history of coronary revascularization and the usefulness of concomitant cardiac resynchronization therapy—influence the effectiveness of ICDs.
There is general consensus that ICDs can effectively reduce arrhythmia-related deaths, the reviewer noted, but clinicians must weigh the risks, benefits and costs on an individual basis.
The ACP Journal Club is online.
Health care access
More than 14 million U.S. adults with chronic diseases could not afford to fill all of their prescriptions last year, a recent survey found. That figure represents a two-year increase of almost 2%.
Of the 18% of adults who had prescription drug access problems in 2003, more than half had incomes below 200% of the federal poverty level, according to a national study by the Center for Studying Health System Change (HSC). According to a May 18 HSC news release, adults with chronic conditions were more than twice as likely as other adults in 2003 to have trouble affording prescription drugs.
Privately insured, working-age adults with chronic conditions also had access problems, with 15.2% reporting that they did not fill at least one prescription due to cost, up from 12.7% in 2001, the release said. The study's authors attributed the increase in part to more prescriptions being written and increased patient cost sharing.
The national study is based on the HSC Community Tracking Study Household Survey, which included 36,500 adults in 2003. Other results from the 2003 study included:
- Nearly 60% of low-income, uninsured, working-age adults with chronic diseases had cost-related access problems.
- More elderly Medicare beneficiaries who did not have supplemental private coverage had access problems, 16.4% in 2003 vs. 12.4% in 2001.
- About half of low-income working age adults with chronic conditions paid more than 5% of their incomes on medical expenses—and many paid more than 10%, while still being unable to afford all of their prescriptions.
- Privately insured, working-age blacks with chronic diseases were almost twice as likely as whites (22% vs. 13%) to not be able to afford all of their prescriptions, while 17% of elderly black Medicare beneficiaries had cost problems compared with 9% of whites.
Physicians can now order free posters from the CMS that promote prescription resources for Medicare beneficiaries with limited incomes.
The "Have Limited Income? Social Security Can Help with Prescription Costs" posters direct Medicare patients who have limited incomes to a toll-free number where they can find out if they are eligible for help with the costs of their prescription drugs. Flat posters are suitable for wall display, while easel posters can be used on counters. Both posters can be ordered free of charge.
You can order posters online.
In an joint editorial published online yesterday, the editors of 11 international medical journals—including Annals of Internal Medicine—repeated their call for all clinical drug trials to be registered in a public registry.
The members of the International Committee of Medical Journal Editors (ICMJE) announced that they will consider publishing results of clinical trials that begin enrollment on or after July 1, 2005, only if that trial has been entered in a registry. The registry must be electronically searchable and available to the public at no charge, according to an Annals news release. Journals will accept retrospective registration of trials that began enrolling participants before July 2005 as long as registration is complete by Sept. 13, 2005.
According to Senior Vice President and Annals Editor Harold Sox, MACP, the editorial expands the drug registry concept first put forth by the editors' group in September 2004. The new editorial spells out key information that researchers must include when registering a trial, including naming the treatment in such a way that patients and others will understand what intervention is being studied.
The ICMJE has adopted the World Health Organization's minimal data set, which lists the required items that each trial must include.
The editorial 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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