ICD-10 implementation

October 1, 2013 is the deadline for implementation of the International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS). CMS has published a fact sheet which has a number of recommendations for implementation which, big surprise, includes education and training. The fact sheet also lists website resources. FYI, a number of countries have already implemented ICD-10 coding (Britain, Australia, France, Germany, and Canada). Click here to access a free version of ICD-10-CM index, tabular, and GEMS files courtesy of the CDC (and your taxes). Click here to access the HHS Final Rule.

Failure to disclose?

From the dotmednews.com article:

Under intense scrutiny for not revealing a relationship with Medtronic, Dr. David Polly, a well-known spine surgeon, has resigned from the American Academy of Orthopaedic Surgeons Board.
...
In a letter from Grassley to Medtronic, it was suggested that the payments to Polly could be considered a conflict of interest and that updates from Polly were given to Medtronic in violation of a set agreement with the University of Minnesota and might contain false information to the university's ethics committee.

Click here to access.

ACCME posts updated list of providers

The following additional information is now on the updated list for each provider:

•Current accreditation status (Accreditation, Accreditation with Commendation, Probation or Provisional Accreditation)
•Accredited based on the ACCME 2006 Accreditation Criteria (yes or no)
•Total numbers of activities, hours and participants reported
•Types of activities produced
•Receives commercial support (yes or no)
•Receives income from advertising or exhibits (yes or no)
•Participates in joint sponsorship (yes or no)

Click here to access.

The elephant in the room (the metaphor, not the political party)

Hat tip to Drug and Device Law blog.

Build it and they will use it (imaging that is)

From the New York Times article:

Federal rules allow physicians to profit from the use of machines they own or lease. But Dr. Harlan M. Krumholz, a cardiologist at Yale and an author of the paper, said financial incentives were only part of the reason the number of tests had risen so fast.

“I think the central driver is more about culture than anything else,” Dr. Krumholz said. “People use imaging instead of examining the patient; they use imaging instead of talking to the patient.

“Patients should be asking the question: ‘Do I really need this test? Is the information in this test going to help in the decision-making process?’ ”

In many cases, there is little evidence that the routine use of scans helps physicians make better decisions, especially in cases where the treatments that follow are also of questionable efficacy.

Click here to access the NYT article. Click here to access the NEJM article on this study (sub. req.). Risk/benefits, folks!

On the right road?

From the Forbes article:

Patrick Soon-Shiong, a self-made billionaire through injectable and breakthrough nanoparticle anticancer technology drug development, is now focusing his philanthropic efforts on creating a national highway for health care.
...
The idea is to create a health grid that empowers the patient and the provider. This should be a public utility, basically what I call a U.S. public health grid.

Click here to read more.

Off-label prescription and physician knowledge (or lack thereof)

From the New York Times article "Disparities: Study Finds Risk in Off-Label Prescribing":

Physicians are allowed to use drugs in ways that are not specifically approved by the Food and Drug Administration, a practice called off-label prescribing. There is usually less scientific evidence to support nonapproved uses, and a new survey of physicians has found that many might not even know when they are prescribing off label.

Click here to access the NYT article. Click here to access the peer-reviewed article published in Pharmacoepidemiology and Drug Safety (sub. req.).

Sue Pelletier's blog CAPSULES is back!

Yep, it's true! And not only is her blog back but she is now executive editor of Medical Meetings magazine, which is a great resource for CME folks. Click here to access Sue's blog; click here to access Medical Meetings magazine. I know that we in CME all welcome Sue back to where she belongs!!!!

A haunting?

From the New York Times article "Senator Moves to Block Medical Ghostwriting":

With a letter last week, a senator who helps oversee public funding for medical research signaled that he was running out of patience with the practice of ghostwriting. Senator Charles E. Grassley, an Iowa Republican who has led a long-running investigation of conflicts of interest in medicine, is starting to put pressure on the National Institutes of Health to crack down on the practice.

Click here to access the NYT article. Click here to access Senator Grassley's letter. Click here to see what Dr. Carlat has to say about this (yep that graphic is pretty good, no matter what one's opinion is on this issue).

Macy Foundation on "Developing a Strong Primary Care Workforce"

From the publication:

The United States does not have enough health professionals in primary care to meet the anticipated demand. To have any hope of meeting that demand, major changes in the education and reimbursement for primary care professionals will be required. Any effort at healthcare reform must place healthcare workforce issues front and center.

In April 2009, the Josiah Macy, Jr. Foundation convened a meeting in Washington, DC, to discuss the nation’s healthcare workforce. Individuals representing four organizations with expertise in primary care and prevention were in attendance. These professionals work in the trenches of primary care, representing groups that recruit high school and college students into the health professions, nudge medical education toward a greater appreciation of primary care, and guide training for physicians, nurse practitioners, physician assistants, and others on the front lines of healthcare delivery. Their insights are compelling.

To read this publication (which is a summary of the meeting), click here.

Two noteworthy books by physicians

Check out Obama, Doctors, and Health Reform: A Doctor Assesses the Odds for Success by Richard Reece, M.D. and Declarations of a Dinosaur: 10 Laws I've Learned as a Family Doctor by Doctor Lucy E. Hornstein. Both are sold on amazon.com and both are well worth reading.

The vomiting bug?

From the BBC News article:

A spokeswoman for the Health Protection Agency said: "There are several vaccines for norovirus in development but all are probably several years away from being in general use.

"In the meantime, until one is produced that is effective and safe we recommend strict adherence to the outbreak control measures that exist to stop the virus spreading in hospitals and cruise ships.

"On an individual level, if someone has a norovirus infection they are advised to stay at home and practise good hand hygiene using soap and water to stop the virus from spreading to other members of the household."

Click here to access the BBC News article.

Patient (non)compliance

From the PharmaTimes article:

One third to a half of all US patients do not take their medications as prescribed, and this is costing the nation $290 billion - 13% of total health expenditures - every year, says a new report.

Such poor levels of compliance are fuelling - and are fuelled by - the rising tide of chronic disease, says the report, by researchers at the New England Healthcare Institute (NEHI). In general, people with chronic illnesses are worse at taking their medications as prescribed than those with acute conditions, and medication persistence – the length of time a patient continues to take a prescribed drug – tends to be very low among this group.

Click here to access this article.

A voice of reason on health care reform

Please check out Doctor Reece's blog posting on twenty stories of health care reform by clicking here.

Every woman on earth already knew this!

(Ok, at least those of a certain age)...From the New York Times article:

Men who strongly endorsed old-school notions of masculinity — believing the ideal man is the strong, silent type who doesn’t complain about pain — were only half as likely as other men to seek preventive health care services, like an annual physical or a flu shot, the study found.
...
The analysis is believed to be the first population-based study of men’s masculinity beliefs and preventive health behaviors.

Click here to access the NYT article.

Stanford researchers, comparative research, and labeling

From the individual.com article:

The researchers want the U.S. Food and Drug Administration to require drug manufacturers to state how new medications compare with similar, existing treatments. In many instance, these statements would indicate that there is no evidence that a new drug is more effective than older ones.
...
The Stanford researchers recommend that the FDA require new treatments to carry a label that would read, for instance: "Although this drug has been shown to lower blood pressure more effectively than placebo, it has not been shown to be more effective than other members of the same drug class."

Click here to access the individual.com article. Click here to access the researchers' article published in the NEJM (free full text).

Testosterone and CME

From the Milwaukee Wisconsin Journal Sentinel article "UW tied to male hormone marketing":

A rash of television commercials in recent months have told millions of middle-age men that their diminished sex life and somber mood may be the result of low levels of testosterone.

Setting the stage for the ads was a series of medical journal articles that first appeared four years ago. The articles, which were sponsored by the University of Wisconsin School of Medicine and Public Health, read more like promotions than rigorous research, touting the benefits of testosterone and downplaying the risks.

While the TV commercials were intended for consumers, the medical articles were written for thousands of doctors who could earn continuing medical education credit by reading them. Presumably, they also would write more testosterone prescriptions.

Click here to access the MWSJ article. Click here to access Dr. Carlat's blog posting on this news item.

Multimedia Education Resources added to ACCME's website

Click here to access ACCME's news release. Click here to access the educational resource website.

The New England Journal Medicine

has a website devoted to articles on health care reform. Click here to access said website.

America’s Health Insurance Plans survey on health care pricing

From the New York Times article "Survey Finds High Fees Common in Medical Care":

“A patient in Illinois was charged $12,712 for cataract surgery. Medicare pays $675 for the same procedure. In California, a patient was charged $20,120 for a knee operation that Medicare pays $584 for.
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It’s the wild, wild West when it comes to prices of anything in the U.S. health care system, whether for a doctor visit or for hospital charges,” said Jonathan S. Skinner, a health economist at Dartmouth.
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But Dr. Robert M. Wah, a spokesman for the American Medical Association, said there was another side to the story: insurers’ low payments to doctors who enter into contracts with them and the doctors’ difficulties, in many cases, in getting paid at all.
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Karen M. Ignagni, president and chief executive of America’s Health Insurance Plans, had a different view, saying: “As we think about the health care debate, what’s been talked about is, What are the cost-sharing levels? What are the premium levels? How much do health plans pay? No politician has asked how much is being charged.”

Click here to access the NYT article.

ACCME issues news release to remind providers about

the deadline for corporate structure changes and the need for review of commercial support policies and agreements; this news release also announces the new standard accreditation interview format. Click here to access the release.

National Association for Healthcare Quality publications win awards

From the NAHQ news release:

NAHQ e-news was recognized with a Gold Circle Award by the ASAE & The Center for Association Leadership in the category of Newsletter (Digital/Interactive). Receiving a Gold Circle Award is an outstanding achievement, especially because NAHQ competed against more than 300 associations nationwide this year, including a record-setting number of digital entries.

In addition, NAHQ was awarded two APEX awards for NAHQ e-news and the second edition of Q Solutions: Essential Resources for the Healthcare Quality Professional, which was edited by Luc Pelletier and Christy Beaudin.

Click here to access the news release.

Pharmascold?

From the AMNews article:

In late July, a new organization called the Assn. of Clinical Researchers and Educators held its charter meeting before a 200-plus crowd in an amphitheater at Brigham and Women's Hospital in Boston. Participants assailed conflict-of-interest rules that they argue impede physician-industry collaboration.
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One ACRE founder, Thomas P. Stossel, MD, said critics of physician-industry relationships are "pharmascolds" who aim to bring about a "conflict-of-interest police state."
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Houston endocrinologist Steven M. Petak, MD, led the task force that developed the statement. "There have been some abuses, but for the most part, physicians have the best interest of their patients in mind," he said.

Click here to access the article.

Who is to blame for delays in diagnosis?

From Dr. Pauline Chen's column in the New York Times:

...diagnostic failures are often due to missed steps, so-called “process of care lapses,” that stem from both doctors and patients.

In the June issue of The Journal of General Internal Medicine, for example, investigators from Harvard Medical School studied the records of over 100 women with breast cancer diagnosed late or at advanced stages and found that roughly a quarter of patients had experienced process of care lapses. Examples of such lapses included inadequate physical exams, delayed physician involvement and incomplete diagnostic and laboratory tests. But while the investigators discovered that nearly 20 percent of the women were missing as many as two or more steps in their care, they also found that doctors and patients contributed equally to the resulting diagnostic failures.

Click here to access.

The importance of data

From the USA Today article:

Data can serve as a tool to identify potential solutions, just as a high blood pressure test not only yields a diagnosis but also points the way to better treatment, says Elliot Fisher, director of the Dartmouth institute, which has pioneered the study of variations in health care by Medicare region.

The goal is to combat rising costs without sacrificing quality, he says.
...
The Dartmouth analysis shows that in 2006, hospitals in higher-performing regions had up to 14% fewer medical admissions, 17% fewer days in the hospital and 36% fewer visits to specialists, and they spent up to 21% less on medical imaging.

Their overall Medicare spending was 12.7% to 16.2% lower than hospitals with poorer performance.

Click here to access.

Lilly Faculty Registry for contracted services Q1/2009 posted

Click here to access the faculty registry. Click here to access Lilly's educational grant registry for the U.S.; click here to access Lilly's international educational grant registry.