In the News for the Week of 1-17-06
- ACP offers help to physicians dealing with Part D 'dual-eligible' issues
- Survey asks physicians to rate Medicare claims contractors
Clinical news in the headlines
- Annals highlights: Exercise and dementia risk; managing ‘problem doctors’
- Decades-long study finds obesity a stand-alone risk factor for heart disease
- Study fuels more suspicion about value of prostate cancer screening
Health care spending
- Drug industry spending fuels full pipeline but few FDA approvals
- Nation spent less on drugs, more on services in 2004
- FDA approves first home infusion device for immune disorders
- ACP International Update conference is nearly sold out
- Chapter meetings offer education, networking opportunities
The College is aware that Medicare beneficiaries, particularly the 'dual eligibles,' and prescribing physicians are experiencing difficulties under Medicare's new Part D drug benefit.
The College offers the following resources to help address these problems.
An ACP Medicare Part D Web site contains practical information for you, your staff and patients regarding the Part D benefit. There is also an ACP member Web site, where ACP staff will help those College members who e-mail descriptions of specific problems about the Part D benefit. Or, if you prefer, you can call the ACP member Part D "Help Center" at 800-338-2746, ext. 4535.
The CMS has launched a new provider-satisfaction survey aimed at assessing the effectiveness of its claims process.
Survey participants will evaluate 42 Medicare contractors responsible for claims processing and reimbursement. The contractors, which process and pay more than $280 billion in claims annually, also will be rated on how well they educate providers about changes in policy and respond to inquiries.
The survey, in keeping with the 2003 Medicare Modernization Act, will focus on seven areas: provider inquiries, claims processing, appeals, provider enrollment, medical review, and provider audit and reimbursement. The CMS is now distributing the surveys to 25,000 randomly selected providers, suppliers and health care practitioners from a pool of 1.2 million who participate in its fee-for-service program.
The College is encouraging all of its members who receive the survey to respond by the Jan. 25, 2006 deadline. Results from the 76-question survey, which the CMS said takes about 20 minutes to complete, will be used by contractors to make improvements and to track physician satisfaction. The 42 contractors include carriers, durable medical equipment regional carriers and regional home health intermediaries.
Survey results can be submitted via secure Web site, mail or fax. The final report is expected in July 2006.
The CMS news release is online.
A copy of the survey is also online.
Clinical news in the headlines
The following articles appear in the Jan. 17 issue of Annals of Internal Medicine. Full text is available to College members and subscribers online.
Study: Exercise reduces risk for dementia by 30% to 40%
A large prospective study—the most definitive yet on the relationship between exercise and dementia—found that older adults who exercised at least three times per week were less likely to develop dementia than those who were less active.
The study participants, who were 65 or older with normal mental function, were followed for six years. Of the 1,740 subjects, 158 developed dementia and 107 developed Alzheimer’s disease. Statistically, the rate of dementia was 13.0 per 1,000 person-years for people who exercised three or more times per week, compared with 19.7 per 1,000 person-years for those who exercised fewer than three times per week.
An editorial noted that this study is the “first to report an interaction between the level of physical function and physical activity and dementia risk.” Future research should try to determine whether this association is causal or whether physical activity is a proxy for “life engagement,” or other lifestyle or sociodemographic characteristics. Research is also needed to determine the “type, frequency, intensity or duration of physical activity that is most beneficial in preventing cognitive deterioration.”
Hospital systems should monitor 'problem doctors'
“At least one third of all physicians will experience … a condition that impairs their ability to practice medicine safely,” says an article in the “Improving Patient Care” series.
Hospitals, which already have credentialing processes in place, are the ideal places to implement a nationwide system to monitor physician performance based on validated clinical and behavioral measures, said the article. The authors outline such a national system, but add that hospitals must be supported by “those that already bear a fiduciary responsibility for ensuring safe, competent care,” such as state medical boards, medical specialty boards, and the Joint Commission on Accreditation of Healthcare Organizations.
Wealth disparities do not cause disparate death rates from heart attacks
Some studies have found that wealthier patients have lower death rates after myocardial infarctions than poorer patients. However, a new study finds that income status was not a determinant when data were adjusted for age, sex, ethnicity, social support, cardiovascular history and risk, and other health conditions. The new study found that the most important risk factors for heart attacks were age and health status before the event.
This study looked at 3,407 patients hospitalized for acute myocardial infarction between 1999 and 2003 in a universal health system in which medical services, regardless of income, were available.
An accompanying editorial is also available.
A new study found that excess weight in middle age is a significant risk factor for heart disease, even in people with normal blood pressure and cholesterol levels.
In the study, researchers tracked 17,643 men and women in the Chicago area, ages 31-64, who did not have coronary heart disease or diabetes, for an average of 32 years. They found that those who were overweight or obese had a higher risk of hospitalization and mortality from coronary heart disease, cardiovascular disease and diabetes after age 65 than those of normal weight with similar risk factors. The study appears in the Jan. 11 Journal of the American Medical Association.
The study was significant because it adds to growing evidence that being overweight is an independent risk factor for heart disease and diabetes, said the Jan. 10 Washington Post. In the study, those who were obese but with normal blood pressure and cholesterol were 43% more likely than people of normal weight to die of heart disease after age 65.
The authors noted that the Framingham Risk Score, commonly used to measure risk of heart disease, does not include obesity. Conventional wisdom has been that obesity’s effects are expressed through the major risk factors of blood pressure, serum total cholesterol and diabetes.
While overweight people in the study might have developed one or more of the major risk factors during the study, said the authors, the results still suggest that body mass index should be taken into account early in life when assessing risk. The study provides strong support, they added, for population-level primary prevention of obesity starting at a young age.
The Washington Post is online.
A JAMA abstract is online.
Newly published research on prostate cancer concluded that the most common screening methods have little impact on survival.
In the study, researchers examined the records of 71,667 men who had been outpatients between 1989 and 1990 at 10 VA centers in New England. From that group, they selected 501 men who had died from prostate cancer as of 1999 and compared them with a control group of live patients. They found that screening using prostate specific antigen (PSA) or digital rectal examination tests did not reduce mortality.
The study appears in the Jan. 9 Archives of Internal Medicine.
There has long been controversy about the efficacy of the PSA test, reported the Jan. 10 New York Times. An abnormal PSA level does not necessarily mean cancer and the subsequent biopsy is often inconclusive.
There is also debate about the value of surgery when cancer is found, as many tumors grow so slowly that the cancer never becomes dangerous, said the article. Many men are wary of surgery because it can cause erectile dysfunction and incontinence.
Given the risk-benefit equation, routine PSA tests should not be recommended, said the authors. In addition, physicians should carefully explain the risks and uncertainties to patients to help them make informed decisions.
The New York Times is online.
An Archives of Internal Medicine abstract is online.
Health care spending
While drug companies poured more money into research last year, new government statistics show that the number of new drugs approved was low.
The FDA approved 20 drugs in 2005, down from 36 the previous year, said the Jan. 11 New York Times. Meanwhile, research spending by pharmaceutical companies reached more than $38 billion, a new high.
While the spike in research spending suggests a rich pipeline of potential drugs that may emerge in the next several years, the statistics also point to problems with the development and approval process, said the New York Times. The FDA is looking at new ways to speed approval, such as using “surrogate endpoints”—for example, approving a cancer drug based on evidence that it shrinks tumors rather than whether it prolongs life.
Some experts interviewed in the article suggested that the slow approval process is a reaction by the FDA to criticism over approving Merck’s Vioxx, (rofecoxib) which was removed from the market due to heart attack and stroke risks. However, others said that the FDA had approved so few drugs because many therapies under development are at the beginning of the 10-year cycle to get a drug to market.
The New York Times is online.
The government released new figures showing a drop in drug spending in 2004 but a significant rise in spending on hospitals and physician services.
Spending on medical services in 2004 reached its highest level in more than a decade, said the Jan. 10 New York Times. Spending for hospital care increased from 2003 by 8.6%, to $570.8 billion, while payments to doctors rose by 9% to $399.9 billion, compared with an increase of 8.2% for prescription drugs, the first year of single-digit growth in 10 years.
Total health care spending increased by almost 8% in 2004 to $1.9 trillion, or $6,280 per person, said the New York Times. That puts health spending at 16% of the national economy, the highest percentage ever recorded. Medicare spending grew by 8.9% in 2004, faster than the growth in private health care spending, while spending on Medicaid slowed to 7.9%, from 9% the previous year.
A Medicare spokesperson interviewed in the article attributed the slowdown in drug spending in part to greater use of generic drugs and mail-order services. The higher payments to doctors, said the article, were driven by higher Medicare fees for more complex services.
The New York Times is online.
The FDA last week approved a new device that will help people with rare immune disorders self-administer therapy at home.
The approval of Vivaglobin, made by Germany’s ZLB Behring GmbH, marks the first approval of an immune globulin product for subcutaneous injection, said a Jan. 9 FDA news release. The device allows people with primary immune deficiency diseases to self-administer replacement antibodies on a weekly basis using an infusion pump.
The device provides an alternative for patients with rare immune disorders who visit clinics or physicians’ offices to receive intravenous infusions, said the Jan. 11 Philadelphia Inquirer. The procedure typically takes several hours and must be given every three weeks.
Primary immune deficiency diseases are rare genetic disorders affecting about 50,000 people in the United States, said the FDA release. These patients require regular treatment with immune globulin to prevent serious or life-threatening infections. The company expects the device to be available in a few months.
The FDA news release is online.
The Philadelphia Inquirer is online.
Now is the time to register for the ACP International Update conference in Mexico City.
This two-day conference, to be held Feb. 24-25, 2006, is nearly sold out. The program, developed by ACP and the LiveMed Institut—a CME provider based in Mexico—covers the latest advances in diagnoses and treatment of illnesses that are seen on both sides of the border.
The program includes updates on diabetes, dyslipidemia, hypertension, AIDS, drug interactions in older adults, asthma and chronic renal disease. Leading experts from the United States and Latin America will lead the sessions, which will be conducted in English and Spanish.
More information is online.
This spring, 26 ACP chapters around the world are holding chapter meetings, giving internists the chance to learn about the latest medical advances while developing valuable professional networks.
These meetings allow members and guests to earn CME credits and enjoy the collegiality of their fellow members. Regular attendance is also important for those interested in applying for College Fellowship. And, these meetings are an excellent way to combine seeing a new part of the country—or world—with clinical education. Meeting locations range from Colorado to Alaska and Hawaii to Puerto Rico.
A complete calendar of chapter meetings, including clinical content information, is online.
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Copyright 2006 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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