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Economists and scholars defend Medicare pay board
Washington -- More than 100 academics, analysts and economists are pressing Congress to preserve the Medicare Independent Payment Advisory Board to promote new payment methods and improve the program. Momentum has been building in Washington, led by House Republicans, to pass legislation that would repeal the board as authorized by the health system reform law. A House bill sponsored by Phil Roe, MD (R, Tenn.), has 120 co-sponsors, including several Democrats, who support eliminating the IPAB. President Obama instead has called for the cost control board's charter to be expanded in an effort to curtail Medicare spending growth. A letter from 106 professionals at universities and think tanks across the country urges lawmakers to keep the board intact. "The IPAB is a tool designed to help the Congress slow the rapid projected increases in health care costs in the federal budget and to improve the delivery of health care," the May 20 letter states. "Increases in Medicare, Medicai [Read more]
Panel targets primary care
When it comes to providing primary care, physicians should adopt the motto of the German minimalist architect Ludwig Mies van der Rohe: "Less is more." That is the message of a set of recommendations published online May 23 in Archives of Internal Medicine that advises internists, family physicians and pediatricians on the top five commonly ordered interventions that should be avoided in each of their specialties. A panel of 15 physicians analyzed medical literature to compile top-five "don't" lists of health care activities that are wasteful because they are not supported by evidence. Examples from the three top-five lists include: imaging for low back pain of less than six months when neurological deficits are not present; ordering blood chemistry panels or urinalyses for screening in healthy adults; prescribing antibiotics for sinusitis; and annual electrocardiograms for asymptomatic patients. Researchers then surveyed 255 primary care physicians about whether they agreed t [Read more]
Medicare privatization plan hits wall in Senate
Washington -- The Senate on May 25 declined to consider a House-approved plan to cut spending by $4 trillion over the next decade in part by changing Medicare into a voucher program and Medicaid into a block grant program. A motion to bring to the floor the plan, crafted by House Budget Committee Chair Paul Ryan (R, Wis.), failed on a 40-57 vote, with five GOP senators joining Democrats against the motion: Sens. Lisa Murkowski of Alaska, Scott Brown of Massachusetts, Rand Paul, MD, of Kentucky, and Susan Collins and Olympia Snowe of Maine. The House had approved the Ryan plan on April 14 by a largely party-line vote, although a few Republicans voted with the Democrats in opposition. Democrats have attempted to brand Republicans and the Ryan proposal as representing an attack on the health security of seniors and the poor. But despite backing off some of their initial rhetoric on the plan, most Republicans have stood by Ryan even as polls show that most Americans oppose the propos [Read more]
Young doctors find general internal medicine doesn't pay
Many young physicians continue to steer away from general internal medicine, despite increased exposure to the field during medical school and a more favorable view of the specialty among medical students. The decline is contributing to a growing shortage of primary care physicians when demand for such services is on the rise, said Mark D. Schwartz, MD, associate professor at New York University School of Medicine. He is the lead author of a study on the subject in the April 25 Archives of Internal Medicine. (http://archinte.ama-assn.org/cgi/content/full/171/8/744). The widening gap in pay between primary care physicians and specialists, large medical school debts, inflexible schedules and heavy workload are some of the factors that influence students' decisions, he said. "What's happened in primary care practice is that physicians feel they are on a treadmill to maintain their salary," said Dr. Schwartz, a general internist. "Pay hasn't kept up with inflation, so to keep up, [Read more]
Fallacies abound regarding sodium and wine consumption
An American Heart Assn. survey shows that more than half of Americans believe drinking wine is good for the heart, but few know how much to consume to receive the health benefits. The survey also found that most adults incorrectly think that sea salt is lower in sodium than table salt. AHA spokesman Gerald Fletcher, MD, said misconceptions like these could negatively affect adults' cardiovascular health. He said his organization recommends that physicians educate patients on ways to lower their sodium consumption. He also encourages doctors to talk to patients about the negative health effects of drinking too much wine, such as an increase in blood pressure. "Hypertension is a devastating [disease]. ...And it's very strongly influenced by your intake of salt," said Dr. Fletcher, a cardiologist at Mayo Clinic in Jacksonville, Fla. In March, the AHA surveyed 1,000 adults 18 and older on their beliefs about how salt and wine affect heart health. Sixty-one percent consider sea sal [Read more]
Coalition pushes for safe injection practices
More education and research and superior product designs are needed to end unsafe injection practices that have led to 30 infectious-disease outbreaks in the last 10 years, said a coalition of physicians, nurses, manufacturers and government officials. In the last decade, more than 125,000 patients have been notified about potential exposure to infectious diseases such as hepatitis C due to reuse of syringes, according to the Safe Injection Practices Coalition, which was formed in 2008. Along with Premier, an alliance of more than 2,500 U.S. hospitals, the coalition co-sponsored an April 26 meeting in Washington, D.C., to discuss the problem (www.premierinc.com/quality-safety/tools-services/safety/topics/safe_injection_practices/meeting.jsp). "These are largely preventable medical errors -- they are not so different from wrong-side surgery," said Joseph Perz, DrPH, who leads the prevention team in the Division of Healthcare Quality Promotion at the Centers for Disease Control and [Read more]
House OKs permanent ban on federal abortion funding
Washington -- The House has approved a bill that permanently would prohibit federal funds from being used to pay for abortions or buy insurance plans that cover abortions. The legislation is now in the Democratic-controlled Senate, where it is unlikely to move forward as a standalone bill. Even if it were approved as part of a larger bill and sent to President Obama's desk, White House senior officials have indicated they would advise him to veto the measure. The House passed the No Taxpayer Funding for Abortion Act, introduced by Rep. Chris Smith (R, N.J.), by a 251-175 vote on May 4. Sixteen Democrats supported the bill, while no Republicans voted against it. The bill would ban federal funding from being used to pay for abortion services or health plans that cover abortion services, except in cases of rape, incest or when the life of the pregnant woman is in danger, according to an analysis by the nonpartisan Congressional Budget Office. The restrictions mirror a ban known a [Read more]
Doctors failed to inquire about Gitmo detainees' injuries, study alleges
Physicians and other health professionals at Guantanamo Bay failed to properly document and report evidence "highly consistent" with detainee allegations of torture, says a case review of nine detainees' medical records published in the April issue of PLoS Medicine. Three of the detainees had documented physical injuries that were highly consistent with their allegations of abuse, including contusions, bone fractures, lacerations and peripheral nerve damage, said the study, written by two experts on the evidence of torture. The reviewers were hired as medical consultants by attorneys for some of the detainees. The detainees said they were exposed to interrogation techniques such as sleep deprivation, extreme temperatures, stress positions, beatings, forced nudity, prolonged isolation and sexual molestation -- all recognized as torture by the United Nations Convention Against Torture as well as the U.S. government before 2002. None of the detainees, held in the U.S. facility at [Read more]
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