Policy & Practice
Neurologists Rank High in MRI Use
Most magnetic resonance imaging services paid for through Medicare Part B in 2005 were ordered by physicians in four specialties—neurology, internal medicine, orthopedic surgery, and family medicine—according to a report from the Health and Human Services Office of Inspector General. Internists topped the list by ordering 21% of the 2.6 million MRI services, followed by orthopedic surgeons (19%), and family physicians and neurologists (13% each). The “high users” of MRI, defined as those whose allowed charges put them at the 95th percentile or above for all physicians who ordered MRIs, were predominately orthopedic surgeons and neurologists. The study did not evaluate the medical appropriateness or necessity of the services ordered. The full report is available at
www.oig.hhs.gov/oei/reports/oei-01-06-00261.pdf
Imaging Cuts Reduce Costs
Medicare Part B payments for physician-performed imaging services dropped almost 13% between 2006 and 2007 due mainly to caps on physician payments called for under the Deficit Reduction Act (DRA) of 2005, according to an analysis from the Government Accountability Office (GAO). Under the DRA, Medicare fees for certain imaging services provided in the physician's office may not exceed what Medicare pays under the hospital outpatient prospective payment system. The imaging payment cap went into effect on Jan. 1, 2007. As a result, Medicare Part B per-beneficiary expenditures for imaging services fell from $419 in 2006 to $375 in 2007. Expenditures for advanced imaging services such as computer tomography and MRI fell even more. Although per-beneficiary expenditures dropped, utilization of services continued to rise, according to the GAO, which did the analysis at the request of Congress. The GAO concluded that beneficiary access at the national level was not affected by the payment cuts. However, the medical technology trade organization AdvaMed said the report indicated that the payments cuts were deeper than expected and are not in the interest of patients. Requiring accreditation of equipment and personnel in physician offices and developing appropriateness criteria would be a better approach to curb high imaging expenses, according to AdvaMed.
NIH: Environment's Role in PD?
The National Institutes of Health is awarding more than $21 million over 5 years to study how environmental factors contribute to the cause, prevention, and treatment of Parkinson's disease. The recipients of the grants, administered through the National Institute of Environmental Health Sciences (NIEHS), will attempt to develop new biomarkers in the blood that could be used to identify individuals at risk for Parkinson's disease, identify agricultural pesticides that disrupt molecular pathways, and analyze how proteins associated with Parkinson's disease are modified by environmental toxins, Cindy Lawler, Ph.D., NIEHS program administrator, said in a statement.
Cephalon Pays $425 Million
Cephalon Inc. has agreed to pay more than $425 million to settle claims that it inappropriately marketed three drugs for off-label uses, according to the U.S. Justice Department. The settlement will resolve civil and criminal complaints alleging that the company marketed Gabitril (tiagabine), Actiq (oral transmucosal fentanyl), and Provigil (modafinil) for off-label uses. Between 2001 and 2006, Cephalon allegedly promoted Actiq, which is an approved pain treatment in opioid-tolerant cancer patients, as a treatment for migraine, sickle-cell pain, and injuries. The epilepsy treatment Gabitril was allegedly promoted for treatment of anxiety, insomnia, and pain. Provigil, which was originally approved to treat excessive daytime sleepiness associated with narcolepsy, was allegedly promoted off label as a nonstimulant drug for sleepiness, tiredness, decreased activity, and fatigue. Under the settlement, Cephalon has entered into a 5-year Corporate Integrity Agreement with the Heath and Human Services Office of Inspector General. The agreement requires the company to notify physicians of the terms of the settlement and to begin disclosing any payments made to physicians on its Web site by Jan. 31, 2010.
Few Nabbed for Pain Prescribing
Few physicians have been charged or sanctioned for prescribing pain medications improperly, according to a study. From 1998 to 2006, only 725 individual physicians, or about 0.1% of practicing physicians in the United States, had been criminally charged or administratively reviewed for offenses involving the prescribing of opioid analgesics. Nearly 40% of the cases involved family medicine or general practice physicians, and 23.7% involved internists. In contrast, only 3.5% of cases involved pain medicine specialists. The high number of investigations of primary care physicians is not surprising given the shortage of pain specialists, the researchers wrote. “Practicing physicians, including pain medicine specialists, have little objective cause for concern about being prosecuted by law enforcement or disciplined by state medical boards in connection with the prescribing of [controlled substance] pain medications,” the researchers wrote (Pain Med. 2008;9:737-47 [Epub doi:10.1111/ j.1526-4637.2008.00482.x]). The study was conducted by researchers from the National Association of Attorneys General, the Federation of State Medical Boards, and the Center for Practical Bioethics.