Psych Care Often Inaccessible
Two-thirds of primary care physicians said they couldn't get outpatient mental health services for their patients, according to a study by the Center for Studying Health System Change. The 2004-2005 data are from the center's Community Tracking Study Physician Survey and other sources. A total of 67% of primary care physicians said they couldn't access mental health services for patients, compared with 34% who said they couldn't get specialist referrals and 30% who had trouble getting diagnostic imaging. Problems related to health plan barriers, inadequate insurance coverage, and shortages of providers. The study, funded by the Commonwealth Fund, was published in the online version of the journal Health Affairs.
CMS Considers Hospice Rule
Physicians certifying patients for Medicare-covered hospice stays would be required to write a brief explanation of why a patient has 6 months or less to live, under a new rule proposed by the Centers for Medicare and Medicaid Services. Currently, physicians need only sign a certification to qualify someone for hospice services, although the CMS also requires the medical record to include documentation supporting a terminal prognosis. However, the Medicare Payment Advisory Commission has noted an increasing number of hospice patients with stays longer than 180 days, and the proposed rule is designed to provide more accountability for hospice certification, the CMS said. Comments, including whether the requirement would increase physician engagement in the certification process, are due by June 22.
Medical Discipline Declined
State medical boards seriously disciplined far fewer doctors in 2007 and 2008 than they did in 2004, the peak year for such actions against doctors, according to an analysis by the consumer-advocacy group Public Citizen. In 2008, there were 2.92 serious disciplinary actions per 1,000 physicians, the same rate as in 2007 but 21% lower than in 2004. The states that disciplined the most doctors per 1,000 practitioners were Alaska, Kentucky, Ohio, Arizona, Oklahoma, North Dakota, Louisiana, Iowa, Colorado, and Maine. Minnesota disciplined the fewest physicians, and California, Florida, Maryland, South Carolina, and Wisconsin ranked low on the list, Public Citizen said. The annual rankings are based on data from the Federation of State Medical Boards. Serious disciplinary actions include license revocations and surrenders, suspensions, and probation with restrictions on practice.
Proposed Dialysis Policy Risky
A proposed change in Medicare reimbursement policy could make it more difficult for African Americans with kidney disease to access dialysis services, a study in the Journal of the American Society of Nephrology suggested. Under the possible policy change, CMS would make a single bundled payment to dialysis units to cover both dialysis and injectable medications, which have been reimbursed separately. The analysis of 12,000 patients starting dialysis found that African Americans had lower initial hemoglobin levels, compared with readings in whites who were beginning treatment. The study also found that the average required dose of erythropoiesis-stimulating agents over the first 2 months of dialysis was 11% higher in African American patients. Since dialysis centers no longer will be reimbursed more for the higher doses, the researchers said they are concerned that the new policy could create a financial disincentive for centers to accept African Americans. “If race is not included as a payment adjuster, African Americans could be disadvantaged by this policy change,” asserted study coauthor Dr. Areef Ishani of the University of Minnesota.
PhRMA Revises Trial Standards
The Pharmaceutical Research and Manufacturers of America has revised its voluntary standards for how drug manufacturers run clinical trials and communicate trial results. The new PhRMA standards call on drug makers to register on a public Web site all interventional clinical trials—including some phase I studies. The standards also call for companies to “greatly expand transparency in medical research” by providing summaries of results from for all interventional clinical trials, regardless of whether the research is discontinued or the medication being studied is ever approved. Finally, the new standards call for drug makers to adopt the authorship standards of the International Committee of Medical Journal Editors. The committee says, for instance, that only individuals who make substantial contributions to a manuscript should be included as authors.
Routine HIV Testing Urged
The American College of Physicians and the Infectious Disease Society of America have jointly called for routine HIV testing for sexually active adults, pregnant women, and newborns. Federally supported health care programs should provide coverage for such testing, said the policy statement published in Clinical Infectious Diseases. Public health officials also should promote evidence-based interventions to minimize the risk of HIV transmission—comprehensive sex education, condom distribution, and syringe-exchange programs—the two groups said. They also urged that all patients living with HIV/AIDS in the United States have access to care provided by physicians trained in AIDS treatment.