March 2010 issue of the ACCME Report

is now available; click here to access.

Thoughts from physicians on how to control health care costs

From the New York Times article "Doctors Offer Thoughts on Cutting Health Care Costs":

How can the country reduce health care costs while not compromising quality?

During the health care debate, government officials, insurers, drug companies and medical associations all weighed in with their opinions. But what about the people who receive so much of our out-of-pocket health care payments: the doctors on the medical front lines? What do they think the country — in other words, you and me — should do to help moderate costs?

To read the physicians' answers, click here.

Texas Tech announces incentives to future family practice physicians

From the Associated Press article:

Texas Tech University's medical school will soon become the first in the U.S. to offer aspiring family doctors a three-year degree at half the cost of a traditional four-year path, university officials said.

The program, which begins this fall, is aimed at addressing a national shortage of family physicians. One study estimates the country will need about 39,000 more family doctors by 2020.

Click here to access the AP article.

Physician Sunshine Act now law

The Pew Prescription Project has just posted a fact sheet this new law—an excerpt:

The Physician Payments Sunshine provisions in health care reform legislation require drug and medical device manufacturers to publicly report gifts and payments made to physicians and teaching hospitals.

The Physician Payment Sunshine provisions were included in the Patient Protection and Affordable Care Act of 2009 (H.R. 3590, section 6002) which was signed into law on March 23, 2010.

Are gifts and payments limited?
The law requires public disclosure, but does not limit financial relationships.

Who must report? How often?
All U.S. manufacturers (and other entities under common ownership) of drug, device, biologics, and medical supplies covered under Medicare, Medicaid, or SCHIP must report payments on an annual basis to the department of Health and Human Services, which will post the information on a public website. The Secretary of Health and Human Services is further required to submit annual summary reports to Congress, as well as annual reports to each state.

What sort of payments count?
The health care reform law requires disclosure of payments whether cash or in-kind transfers to all covered recipients including: compensation; food, entertainment or gifts; travel; consulting fees; honoraria; research funding or grants; education or conference funding; stocks or stock options; ownership or investment interest; royalties or licenses; charitable contributions; and any other transfer of value as described by the secretary.

Click here to access the PPP fact sheet.

Closing the gap

From the Associated Press article:

Stylish hospital gowns that snap down the side were unveiled in Britain on Tuesday, intended to replace those shapeless cloth sacks with useless ties that flash open at the worst possible moments.

I love it! Click here to access the AP article and see some photos.

Stanford extends policy to adjunct faculty

From the New York Times article:

The Stanford University School of Medicine plans on Monday to introduce rules that would prohibit its volunteer teaching staff — called adjunct faculty — from giving paid speeches drafted by the makers of drugs or medical devices.

Stanford already has one of the most comprehensive policies in the country governing the interactions between academic faculty and the medical industry. The policy, enacted in 2006, is intended to limit potential industry influence on day-to-day clinical practice and medical education, according to a Stanford press release.

The policy prohibits faculty members from participating in industry speakers’ bureaus in which drug and medical device makers pay a physician to give company-prepared speeches to doctors about company medical products. It also prohibits Stanford faculty members from accepting free gifts, including drug samples for patients.

And as of Monday, the 660 community physicians who volunteer their time to teach at Stanford will also have to abide by the same policy — or give up their Stanford titles.

Click here to access the NYT article. Hap tip to Pharmalot.

The difficulty with C. difficile

From the infectioncontroltoday.com article:

Clostridium difficile infections (CDIs) are quickly becoming a significant issue in healthcare based upon recent studies. Preliminary data collected from nursing homes and highlighted in a Supplementary Pennsylvania Patient Safety Advisory shows that almost 40 percent of gastrointestinal infections reported are CDIs.

"Our first look at infection data submitted from Pennsylvania nursing homes confirms what prior studies have found in hospitals -- C. diff infections are a real problem in healthcare institutions," Mike Doering, executive director of the Pennsylvania Patient Safety Authority said. "Elderly patients are particularly at risk because of their age and their use of hospitals and nursing homes where the infection can spread more easily."

Click here to read this article.

From the Washington Post article:

As one superbug seems to be fading as a threat in hospitals, another is on the rise, a new study suggests.

A dangerous, drug-resistant staph infection called MRSA is often seen as the biggest germ threat to patients in hospitals and other health care facilities. But infections from Clostridium difficile - known as C-diff - are surpassing MRSA infections, the study of 28 hospitals in the Southeast found.

Click here to access the WP article.

Financial toll of Hospital Acquired Conditions (HACs)

The Healthcare Management Council, Inc. has released news that a 200-bed hospital can save up to $2 million a year by eliminating HACs. From their news release:

Using federal Agency for Healthcare Research and Quality (AHRQ) indicators, HMC has analyzed the performance of hundreds of facilities ranging in size from 75 beds to over 800 beds. Now in a recent study, HMC identified the top Hospital Acquired Conditions (HACs) and established how much extra care each of these HACs requires. HACs have resulted in nonpayment from Medicare and Medicaid, and in the future, private insurers will likely stop covering HAC-related costs, as well.

The most common HACs are (in order of prevalence)

• Decubitis ulcers
• Postoperative pulmonary embolism and deep-vein thrombosis (DVT)
• Accidental puncture and laceration
• Post-operative respiratory failure
• Infections due to medical care

Click here to access HMC's news release.

The Medicare issue...

From Daniel Callahan's article (The Hastings Center):

As presently organized, Medicare violates every rule of an efficient enterprise. It has no CEO with powers of a kind expected in business. Its stakeholders, the Congress, have a right to interfere with its day-to-day operation. It has no annual budget or the fiscal discipline that imposes. It can set few limits to its expenditures, even to the present point of running an annual deficit. And it underpays its administrators in comparison with those with like responsibilities in the private sector – just as it has too few administrators in the first place.

The National Institutes of Health, the world’s preeminent biomedical research institution, exemplifies everything Medicare lacks. It has a director with strong authority, an annual and tightly managed budget, lay advisory groups, and a good relationship with Congress, one marked by deference on the latter’s part and considerable discretion in setting its priorities. Atul Gawande among others has celebrated the quality and efficiency of the Mayo Clinic, the Geisinger Health System, and Intermountain. They are all private but share a similar budget and administrative structure akin to that of the NIH—everything Medicare lacks.

Click here to access Dr. Callahan's article.

From the NEJM article by Robert Mechanic, M.B.A., and Stuart Altman, Ph.D.:

One approach to accelerating delivery-system change would be comprehensive reform of Medicare’s provider-payment system. Such reform was proposed early in last year’s debate but was eliminated as legislators began to understand that comprehensive payment reform could be highly disruptive for hospitals and physicians who are unprepared to rapidly modify their clinical operations. Instead, legislation passed by both the House and the Senate directed the Centers for Medicare and Medicaid Services (CMS) to implement a series of voluntary pilot programs, including a national payment-bundling demonstration and a program allowing accountable care organizations that successfully control growth in per-beneficiary spending while meeting quality goals to share in Medicare’s savings.

Congressional reform proposals also include a new Center for Medicare and Medicaid Innovation (CMI) intended to facilitate beneficial delivery-system changes.

Click here to access the NEJM article.

New York Times Q&A with Dr. Brody

From the NYT article:

Q. You write that doctors have an ethical responsibility to advocate health care reform. Why?

A. Doctors have two responsibilities. First, they have a moral duty as an individual advocate. A doctor has a responsibility to his or her individual patients to make them healthier and to help them live longer.

But doctors have a second moral duty: they have an obligation to the general public to be prudent stewards of scarce resources. Doctors only get about 10 percent of health care costs in their pockets, but they control about 80 percent. That isn’t our money — it’s someone else’s — and the public has entrusted us to spend it as wisely as possible.

Click here to access the NTY article. Click here to access the NEJM editorial by Dr. Brody on health care reform.

AAFP supports two ACCME proposals

From the AAFP News Now article:

The AAFP is supporting two proposals recently made by the Accreditation Council for Continuing Medical Education, or ACCME. One would modify the ACCME's complaints and inquiries process with the aim of balancing transparency in the CME enterprise with CME providers' confidentiality. The other would acknowledge that CME should facilitate changes in knowledge, competence, performance and/or patient outcomes.

Click here to access this article.