Medicare Patients Welcome
Most physicians have kept their doors open to Medicare patients despite previous reductions in their pay, according to a study from the Center for Studying Health System Change (HSC). The proportion of U.S. physicians willing to treat Medicare patients stabilized during the last half of 2004 and the first half of 2005, with nearly 75% reporting their practices were open to all new Medicare patients. In 2004–2005, 73% of physicians reported accepting all new Medicare patients, an increase from 71% in 2000–2001, but not statistically different. Physicians' willingness to treat Medicare patients remained high, despite a 5.4% payment cut in 2002 that was not fully offset by smaller increases in subsequent years. Only 3.4% of physicians reported closing their practices to new Medicare patients in 2004–2005, also statistically unchanged from 2000–2001. Moreover, the proportion of primary care physicians accepting all new Medicare patients increased significantly from 62% in 2000–2001 to 65% in 2004–2005. “While concerns about Medicare beneficiary access have focused on physician payment, policymakers should recognize that Medicare fees are only one factor in physician decisions to accept new patients,” said HSC President Paul B. Ginsburg, Ph.D.
Ban on False Information
The Health and Human Services Department may not deliberately disseminate false or misleading scientific information under a recent federal law. The provision, part of the fiscal 2006 HHS appropriations law, also prohibits the questioning of scientific advisory panel nominees about their political affiliation, voting history, and positions on topics unrelated to the capacity in which they are to serve. “If your doctor gives you misleading scientific information, it's called malpractice,” said Dr. Francesca Grifo, senior scientist and director of the scientific integrity program at the Union of Concerned Scientists. “It should already have been illegal for political appointees in government posts to knowingly provide false information, so this ban at HHS represents a modest but important first step in ensuring scientific integrity in federal policy-making and better health care for us all.”
Cardiac Rehab Coverage Expanded
Medicare is proposing to expand national coverage for cardiac rehabilitation services to three additional groups of beneficiaries: those who have had heart valve repair or replacement, percutaneous transluminal coronary angioplasty (PTCA), and heart or combined heart-lung transplant. “With this proposed coverage decision, [the Centers for Medicare and Medicaid Services] seeks to expand coverage to a greater number of beneficiaries with cardiac illness,” said Administrator Dr. Mark B. McClellan. “But just as importantly, we hope that our proposed decision will raise the public's awareness regarding cardiac rehabilitation services in general.” The agency further proposed that cardiac rehabilitation services be comprehensive and include medical evaluation, education, and nutrition services. Medicare has covered cardiac rehabilitation services for beneficiaries following heart attack, coronary artery bypass surgery, and angina since the 1980s and this coverage will continue. A comment period on the proposed decision ended Jan. 23. CMS plans to issue a final decision within 60 days of the close of the comment period.
Patterns of Trial Registration
The act of clinical trial registration alone is not a good indicator of adherence to registration policies, according to a study of the quality of information provided during the registration process, and patterns of trial registration (N. Engl. J. Med. 2005;353:2779–87). The researchers reviewed clinicaltrials.gov records to assess patterns of completion of the “Intervention Name” and “Primary Outcome Measure” data fields for trials registered during the period from May 20 to Oct. 11, 2005. “When trial sponsors have the option of providing information of marginal clinical value in a particular data field, our findings show that some companies provide useful information and others do not,” the researchers found. This may indicate varying degrees of comfort with different levels of disclosure. For example, of the 2,670 studies registered by industry between the two dates, 76% provided information in the Primary Outcome measure field, although these entries varied markedly in their degree of specificity. “It is unacceptable for a trial sponsor not to register its trial in a complete, meaningful, and timely fashion,” Dr. Jeffrey Drazen and Dr. Alastair J.J. Wood wrote in a related editorial. “If a company continues to register trials using meaningless data, with no respect for the registration process and the patients who participate in those trials, investigators and patients should refuse to participate.”
Top Stories of 2005
The growing number of uninsured patients, the public health impact of Hurricane Katrina, and registration for the new Medicare drug benefit were among the top health policy stories of 2005, according to an informal Commonwealth Fund/Health Affairs survey. The survey listed 15 policy stories, compiled by fund staff and journal editors, and asked Web site visitors to select the five they considered the most important. Other top vote-getters among the 1,100 respondents were stories indicating that the U.S. health care system, the most expensive in the world, doesn't perform as well as those of several other industrialized nations on various clinical indicators and in reported patient experiences, and that health care costs continue to increase.