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

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Special Disaster Relief Edition

Annals.org has posted a Hurricane Katrina resource page with updated information for physicians who want to help with hurricane relief efforts.

Disaster relief

Access to coverage

  • U.S. Census: Uninsured figures rise, while costs shift to government

Advocacy alert

Clinical news in the headlines

  • Study finds statins after heart attack reduces mortality risk

Business of medicine

Medicare update

  • Competition among plans may make drug benefit more affordable

Disaster relief

Physician volunteers needed in aftermath of Hurricane Katrina

The Office of The Surgeon General and the Office of Public Health Emergency Preparedness are in the process of mobilizing and identifying healthcare professionals and relief personnel to assist in Hurricane Katrina relief efforts. As our nation and global community is now aware, the healthcare needs resulting from Katrina are critical. General information about the HHS response to Katrina is at http://www.hhs.gov/emergency/hurricane.html. The volunteer application is available at https://volunteer.ccrf.hhs.gov/.

Annals of Internal Medicine staff have set up a resource page for physicians looking for ways to help with the recovery. The page includes links to information on potential disease issues caused by the storm, as well as a list of organizations mobilizing volunteers and information on how to prepare to volunteer during future disasters.

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Growing public health crisis overwhelms Gulf states

Speaking at a news conference in Atlanta about the aftermath of Hurricane Katrina, CDC officials this week warned of the potential spread of disease via contaminated drinking water, spoiled food, and insect and animal bites, according to the Aug. 31 New York Times. Besides setting up emergency shelters, the government and the CDC began sending in first-aid and suture kids, sterile gloves, bandages, blankets and portable oxygen tanks.

Health officials were also concerned about falls, broken glass and downed wires, the New York Times said. In addition, rising waters contain poisonous snakes and alligators while raccoons may spread rabies and leptospirosis, which can precede meningitis, kidney damage and liver failure.

Hospitals have been evacuated, with patients taken by helicopter to other facilities. Health care officials also noted that some patients might be without access to medications used regularly to control diabetes, heart disease and other chronic conditions. At the same time, local pharmacies will need imports of vital drugs such as insulin as their supplies dwindle.

The New York Times is online.

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Access to coverage

U.S. Census: Uninsured figures rise, while costs shift to government

The percentage of uninsured in the nation remained steady last year according to the latest U.S. Census report, but a heavier burden fell on government to provide insurance as private businesses faced increasing cost pressures.

The total number of people without health insurance rose from 45 million in 2003 to 45.8 million in 2004, while the percentage of uninsured remained steady at 15.7%, according to a report released Aug. 30 by the U.S. Census Bureau. The percentage of people covered by government health insurance, however, increased from 26.6% to 27.2% during the same period, while those insured by private employers declined from 60.4% to 59.8%.

The drop in private coverage was sparked by escalating costs, said the Aug. 31 Chicago Tribune. Premiums are rising faster than inflation, prompting many small businesses to reduce or eliminate coverage.

An increase in the number of people living in poverty—from 35.9 million in 2003 to 37 million last year—put more pressure on Medicaid to provide coverage. The Census Bureau report noted that the percentage of those covered by Medicaid grew from 12.4% to 12.9%. The poverty income threshold is currently $19,307 for a family of four and $9,645 for an individual.

According to this year's report, the percentage of uninsured was 12.9% in 1987, the first year for which statistics are available. The rate peaked at 16.7% in 1998, dropped to 14.2% in 2000 and has been rising for the past three years.

A U.S. Census Bureau fact sheet and news release are online.

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Advocacy alert

Members urged to contact representatives now on payment reform, quality

ACP is calling on the entire College membership to contact their U.S. representatives and senators now to urge their support of physician payment reform and Medicare quality improvement.

When Congress returns Sept. 6 after the August recess, it faces an increasingly full agenda and very few legislative days to complete its work for the session. The College’s Medicare payment and quality agenda will be competing with unfinished appropriations bills (only two of 13 have passed), debate on efforts to find $10 billion in Medicaid savings, and proposals for new Medicare spending, with required offsetting savings.

Other national priorities include the nomination of John Roberts to the Supreme Court and funding for Hurricane Katrina recovery. Failure to meet the targeted adjournment of Sept. 30 became official last month when Senate Majority Leader Bill Frist, MD (R-Tenn.) announced the October legislative schedule.

Unless Congress acts soon, the projected 4.3% reduction in Medicare payments to physicians will go into effect Jan. 1. To ensure you receive notices to contact your representatives at critical points in the legislative process, enroll today as an ACP Legislative Key Contact.

Background information and sample letters are provided on the Web site of ACP Legislative Action Center. For more information about the Key Contact Program or assistance in enrolling, contact Tracy Novak, Grassroots Associate, by phone at 800-338-2746, ext. 4532, or e-mail.

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ACP, others present pay-for-performance phase-in plan

The College and 70 other national medical societies have sent Congressional leaders a five-year plan to phase in pay for performance in Medicare.

The Aug. 23 letter that accompanied the plan pointed out that pay for performance would work only if Congress takes into account the diversity of clinical practices across the country and moves to eliminate the sustainable growth rate formula (SGR). Maintaining the SGR, the letter said, would threaten physicians with financial loss and limit patient access. The SGR should be replaced with the Medical Economic Index (MEI), the letter said.

Highlights of the five-year plan include:

  • 2006: Pay for performance pilot programs would begin. Congress would allocate funds to fix the SGR and making reimbursement equal to the increase in the MEI.

  • 2007: Reporting of basic quality information begins, including participation in patient safety programs and use of information technology functions such as patient registries. Congress would continue to allocate additional dollars to fix the SGR and fund a pay-for-reporting program.

  • 2008-2009: The program would transition to participating in more advanced quality improvement programs and reporting, with performance data transmitted back to physicians for internal quality improvement. This phase would test the feasibility of collecting data and measuring physician performance. Additional funding to fix the SGR continues.

  • 2010: A certain percentage of Medicare payments for all physicians is based on quality performance. Public reporting begins after adequate safeguards are put in place to prevent deselection. Pay-for-performance provisions are triggered contingent on repealing the SGR formula.

The letter and framework are online.

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Clinical news in the headlines

Study finds statins after heart attack reduces mortality risk

Giving statin drugs to patients immediately following a heart attack significantly reduced the risk of death, according to a recent study.

The study suggests that like aspirin, statins might become a standard post-heart attack medication, according to the Aug. 30 Wall Street Journal. While statins are already given to most heart attack patients before they are discharged from the hospital, the article reported, study results suggest the drugs may benefit patients as soon as they arrive in the emergency department. The study appeared in the September 2005 American Journal of Cardiology.

The study collected data on almost 175,000 patients who had acute myocardial infarction listed in the National Registry of Myocardial Infarction. Patients who received new or continued statin therapy within the first 24 hours of being admitted had a decreased risk of mortality of between 4% and 5.3% compared with a 15.4% risk for those who did not receive a statin.

In addition, discontinuing statin treatment was associated with a 16.5% increased risk of mortality, the study said. Those who received early statin treatment also had a lower incidence of cardiogenic shock, arrhythmia, cardiac arrest and rupture.

An American Journal of Cardiology abstract is online.

The Wall Street Journal is online (subscription required).

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Business of medicine

Internists’ gains one of few bright spots in salary survey

For the first time in several years, compensation for primary care physicians grew faster than that of subspecialty doctors, with internists leading the way in primary care, according to a survey released last week.

While overall physician salaries were flat, primary care physicians’ pay increased by 3.13% in 2004, with general internists’ seeing a 5.36% increase to an average of $168,551, according to the latest physician compensation and production survey from the Medical Group Management Association (MGMA). At the same time, subspecialty doctors’ compensation grew by only 0.18% overall, with some reporting declines. The national survey covers more than 41,000 providers in 105 specialties and 30 non-physician specialties.

Specialties faring the worst included ophthalmologists, whose compensation declined by 6.56% to $280,353 in 2004, and urologists, who saw a 2.41% drop to $335,731, the MGMA report said. Specialties reporting increases included neurology (10.54%), general surgery (6.86%) and psychiatry (12.44%).

Contributing to the slowdown in specialty income was an aggressive attempt by Medicare and other payers to hold down reimbursements, said MGMA officials. Increasing practice costs also played a role.

The survey included data from the National Association of Physician Recruiters showing that the median signing bonuses for new physicians in 2004 ranged from $5,000 for pediatricians to $25,000 for orthopedic surgeons. The report also found that internists received 4.4% higher guarantees in multispecialty practices than in single-specialty or solo practices.

An MGMA news release is online.

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Medicare update

Competition among drug plans provides more affordable options

The CMS announced last week that some plans that will participate in the Medicare drug benefit taking effect next year would offer monthly premiums of $20 or lower or zero deductible plans.

Private-plan options will include paying monthly premiums of $20 or less, paying no deductible, or less than the standard $250 annual deductible if seniors opt for fee-for-service Medicare drug coverage, according to an Aug. 29 CMS news release. The CMS estimates that the average monthly premium for the fee-for-service drug benefit will be $32.20.

The lower cost options are being driven by competition among drug plans, said the CMS release. In every region of the country except Alaska, beneficiaries will be able to opt for at least one plan with premiums below $20 a month, with low-income seniors throughout the country able to choose among five different plans with zero premiums.

CMS officials are still reviewing as many as 23 stand-alone prescription drug plans, as well as plans offered by Medicare Advantage providers, to determine if they meet government standards, the release said. By mid-October, beneficiaries should receive the CMS’ "Medicare & You" handbook and be able to access personalized information on plans online (www.medicare.gov) or by calling 1-800-MEDICARE.

Beneficiaries can begin enrolling in the new drug plans starting Nov. 15.

The CMS news release is online.

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Copyright 2005 by the American College of Physicians.

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