Feds Seek Electronic Credentials
The ability to verify the identity and credentials of physicians after a disaster may be achieved via a chip or other technology, Anthony M. Cieri of the Department of Homeland Security said at a briefing sponsored by the Information Technology Association of America. Experts at the meeting pointed to the success of the Veterans Administration in maintaining credentialing information during the response to Hurricane Katrina. Kathryn Enchelmayer, VA director of credentialing, said she was able to “go down in [her] basement at 10:00 p.m.” and verify physician credentials, and quickly send 151 displaced physicians from the area off to other jobs.
Survey: FDA Influenced by Politics
A majority of Americans—82%—believe the Food and Drug Administration is greatly influenced by politics when making decisions about the safety and efficacy of new prescription drugs, according to a Wall Street Journal online Harris Interactive poll. The finding was similar across parties, with 87% of Democrats, 77% of Republicans, and 88% of Independents saying they thought that politics outweighed science greatly or to some extent in decision making. The survey of more than 2,300 adults was conducted in mid-May. In addition, almost 60% said the agency is doing a fair or poor job in ensuring the safety and efficacy of new drugs. Only 36% said the FDA was doing an excellent or good job. That is a reversal from 2 years ago, when 56% had a positive view, and 37% a negative view, of the FDA. Opinions have not changed much on the agency's performance in bringing innovative drugs to market quickly. In 2004, 62% said the FDA was not doing well on that front, compared with 70% in the latest poll. Most of those polled said FDA advisory panel members should not be allowed to have consulting agreements with, or stock in, drug companies.
Too Many Screening Tests?
Physicians are needlessly ordering certain diagnostic tests during routine preventive health exams, which is inflating the cost of medical care, according to a study from Johns Hopkins University, Baltimore. The U.S. Preventive Services Task Force has rated such diagnostics according to level of evidence; the Hopkins researchers looked at five tests. Two tests (complete blood count and hematocrit) had “C” ratings from USPSTF, meaning there was no recommendation for or against their use; three (urinalysis, x-ray, and electrocardiogram) had “D” ratings with a recommendation against routine use. The study, which used National Ambulatory Medical Care Survey data for 1997–2002 for outpatient visits for nonpregnant adults aged 21 years or over, was in the May/June issue of the American Journal of Preventive Medicine, and was led by Dr. Dan Merenstein, who is now at Georgetown University, Washington. Cost data were obtained from the Medicare fee schedule. About 37 million visits were identified as preventive by physicians and 190 million as such by patients. Most visits were to family physicians, ob.gyns., or internists. Urinalysis was performed most frequently, about 25%–33% of the time, but urine cultures were ordered only 3%–6% of the time. Annual direct costs for hematocrit and urinalysis run about $13–$61 million, depending on whether it was a physician- or patient-identified visit, the authors estimated. For the D-rated tests, costs were $47–$194 million.
J-1 Visas for Underserved Areas
J-1 visas remain the primary tool for recruiting physicians to work in underserved areas, according to a report by the U.S. Government Accountability Office. The GAO surveyed the 50 states, the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands regarding their waiver requests for fiscal years 2003–2005. States and federal agencies reported requesting more than 1,000 waivers in each of the 3 years, although the number requested varied by state: About one-fourth of states requested the maximum number of 30 visas, while slightly more than a quarter requested 10 or fewer. About 80% of states said the 30-waiver limit was adequate for their needs, the report noted. Nearly half of the states' waiver requests were for physicians to practice primary care exclusively.
ICD-10 Fraud Concerns
The Blue Cross and Blue Shield Association and the Medical Group Management Association are among those objecting to the planned implementation of ICD-10, the newest version of the comprehensive list of diagnostic billing codes used by health care providers. A bill currently being considered in the House would require payers to switch from the current ICD-9 codes to ICD-10 by Oct. 1, 2009. Blue Cross/Blue Shield argues in a statement that the deadline should be pushed back to 2012 “because much has to be done before a switch to ICD-10 can be started … and providers need time to automate their offices and be trained.” The Blues are particularly concerned because the switch comes at the same time that Medicare is shrinking the number of its claims processors—many of which are Blues plans—from 50 to 15. At a press briefing, the association released a report by D. McCarty Thornton, former chief counsel to the Department of Housing and Human Services Inspector General, which found that forcing the switch to occur in 2009 “will not give the contractors who administer the Medicare fee-for-service claims process and payments systems sufficient time to upgrade their antifraud tools.”