November 16th, 2010 by Peggy Polaneczky, M.D. in Better Health Network, Health Tips, News, Opinion, Research
Tags: Big Pharma, Breast Cancer, Dr. Peggy Polaneczky, ERT, Estrogen Replacement Therapy, Gynecology, Hormone Replacement Therapy, HRT, Menopause, Oncology, Progesterone, Risk Factors, TBTAM, The Blog That Ate Manhattan, Women's Health Initiative
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A new analysis of long-term data from the Women’s Health Initiative confirms what we already knew the first time around: Use of combination hormone replacement (HRT*) is associated with a small, but real, risk of breast cancer. This new 11-year followup data carries that knowledge out to its not unexpected conclusion — namely, that some (although not most) breast cancers can be fatal, and therefore the the use of HRT can increase breast cancer mortality.
While it may seem a bit of a “duh,” this study was, in fact, necessary to quell the WHI critics who continued to argue that the breast cancers caused by HRT were somehow less aggressive than those occurring off HRT (which they are not.) It was also a wake-up call for many women who were continuing to use HRT and thinking that somehow its risks did not apply to them. A fair number of these women appear to be coming off of HRT, at least in my practice. Others are staying the course and accepting the risks as they have been defined. Either of which is fine with me.
The spin going on around this study — both for and against HRT use — is tremendous and ultimately confusing to women. The pro-HRT crowd (some of whom have relationships to Pharma) is using language like: “The increased risk from using HRT for five years is the same as if your menopause occurred five years later,” which is technically true, but so what? The bioidentical hormone crowd (usually also selling the same) are using the study to further hype how their regimens are safer than the evil Big Pharma products — based on no data. Which leaves the rest of us to try to find ways to help our patients understand the risks, place them into perspective for themselves, and make a decision about how and if to treat their menopausal symptoms. Read more »
*This blog post was originally published at tbtam*
November 15th, 2010 by GarySchwitzer in Better Health Network, Health Policy, News, Opinion
Tags: American Cancer Society, Complications of Screening Tests, CT Scan Marketing, David Sampson, Evidence and Harm, Evidence-Based Health Media, Evidence-Based Healthcare Decisions, Gary Schwitzer, Harms of Screening Tests, Health Scams, HealthNewsReview.org, Lack of Scientific Medical Evidence, Lung Cancer, Minneapolis Star Tribune, Minneapolis-St. Paul, Minnesota, National Lung Screening Trial, Oncology, Overtesting, Preventive Health, Preventive Medicine, Preventive Screening, Pulmonology, Radiology, Science Reporting, Twin Cities, Unnecessary Medical Tests
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Last week, after the National Lung Screening Trial results were released, David Sampson, American Cancer Society director of medical and scientific communications, wrote that “our greatest fear was that forces with an economic interest in the test would sidestep the scientific process and use the release of the data to start promoting CT scans. Frankly, even we are surprised how quickly that has happened.”
And, yes, the marketing has even hit fly-over country in the Twin Cities, with this ad appearing in the Sunday Minneapolis Star Tribune in the “A” section:
Of course, no where in the ad will you read about the potential harms of such scans, the false positive rate, what happens when you get a false positive (unnecessary followup testing and perhaps unnecessary treatment), and more costs. And nowhere in the ad will you read that 300 heavy smokers had to be scanned in order for just one to get a benefit of extending his life. But six clinics in this chain are standing by to take your money and do your scan.
*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*
November 15th, 2010 by RyanDuBosar in Better Health Network, Health Policy, News
Tags: ACP Internist, American College Of Physicians, Baby Boomers, Geriatrics, Healthcare Politics, Healthcare reform, Lame Duck Session, Medicare Eligibility, Medicare Reimbursement, Medicare SGR Cut, New U.S. Healthcare System, Ryan DuBosar, U.S. Congress
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Today begins a lame duck session of Congress before it breaks for Thanksgiving. It’s the final chance to work out a temporary patch to Medicare reimbursement before a 23 percent cut takes effect Dec. 1. Doctors are going to stop taking new Medicare patients if the cuts happen. And, as one breast cancer surgeon explains, if Medicare stops paying, so to private insurers and even military health programs. Congress will meet in December, but the damage will be done.
This all is happening two weeks before the baby boomers become eligible for Medicare. That populous generation starts to turn 65 beginning on Jan. 1, which means they become eligible for Medicare on Dec. 1, which, as we mentioned, is the day the 23 percent Medicare pay cut kicks in. Boomers will continue to become eligible for Medicare, one person every eight seconds, until December 2029. (CNN, The Washington Post, USA Today)
*This blog post was originally published at ACP Internist*
November 15th, 2010 by KevinMD in Better Health Network, Health Policy, News, Opinion
Tags: Centers For Medicare And Medicaid Services, CMS, Doctors' Pay, Dr. Kevin Pho, Healthcare Costs, Healthcare Politics, Healthcare reform, Jeffrey Parks, KevinMD, Medical Malpractice Crisis, Medical Malpractice Reform, Medicare SGR Cut, No-Fault Malpractice, Non-Economic Damages, Peter Orszag, Physician Reimbursement Cut, Proposed SGR Fix, SGR Reform, Sustainable Growth Rate
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The bipartisan debt commission appointed by President Obama recently released its recommendations on how to pare the country’s debt.
Of interest to doctors is the suggestion to change the way doctors are paid. Physician lobbies have been advocating for removal of the Sustainable Growth Rate (SGR) formula — the flawed method by which Medicare, and subsequently private insurers, pays doctors. According to this method, physicians are due for a pay cut of more than 20 percent next month.
According to the commission:
The plan proposes eliminating the SGR in 2015 and replacing it with a “modest reduction” for physicians and other providers. The plan doesn’t elaborate on what constitutes a “modest reduction” in Medicare reimbursement.
Meanwhile, the Centers for Medicare and Medicaid Services (CMS) should establish a new payment system — one that rewards doctors for quality, and includes accountable care organizations and bundling payments by episodes of care, the report said.
The commission also said in order to pay for the SGR reform, medical malpractice lawyers should be paid less, there should be a cap on noneconomic damages in medical malpractice cases, and that comprehensive tort reform should be adopted.
There’s little question that associating physician reimbursements with the number of tests and treatments ordered is a major driver of health costs. Removing that incentive, and better valuing the time doctors spend with patients, is a positive step in the right direction. Read more »
*This blog post was originally published at KevinMD.com*
November 15th, 2010 by DavidHarlow in Better Health Network, Health Policy, News, Opinion
Tags: Accountable Care Organizations, ACO, David Harlow, Election 2010, Fee-For-Service System, HealthBlawg, Healthcare Economics, Healthcare Finance, Healthcare Law, Healthcare Politics, Healthcare reform, Medical Education, Medical Fraud And Abuse, Medical Schools, Medical Students, New Medical Residents, Office of Inspector General, OIG, Patient Protection and Affordable Care Act, Patient-Centered Medical Home, PPACA, Residency Programs, Roadmap For New Physicians
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In October, the Office of Inspector General (OIG) issued a report on Fraud and Abuse Training in Medical Education, finding that 44 percent of medical schools reported giving some instruction in the anti-kickback statute and related laws, even though they weren’t legally required to do so. (As an aside, do we really live in such a nanny state? Over half of all medical schools don’t teach their students anything about this issue — because nobody’s making them — even though it is an issue that looms large in the practice of medicine.)
On a more positive note, about two-thirds of institutions with residency programs instruct participants on the law, and 90 percent of all medical schools and training programs expressed an interest in having dsome instructional materials on the subject of the anti-kickback statute, physician self-referrals (Stark) rules and the False Claims Act.
So in November, the OIG released a Roadmap for New Physicians – A Guide to Avoiding Fraud and Abuse, available on line and as a PDF. It’s a good 30-page primer on the subject. While some of the examples given are specific to newly-minted physicians, anyone in the health care industry would benefit by reading it. The document offers a window into the thinking of the OIG, its perspective on the wide range of issues summarized within, and is a good touchstone for any individual or organization seeking to structure a relationship that needs to stay within the bounds of these laws. Read more »
*This blog post was originally published at HealthBlawg :: David Harlow's Health Care Law Blog*
