Progress for Project 100
Officials at the U.S. Bone and Joint Decade are moving forward with their initiative to increase the amount of musculoskeletal course work required in medical schools. The effort, called Project 100, aims to get 100% of medical schools to incorporate musculoskeletal medicine into their core curricula. Officials at the Decade are working with the National Board of Medical Examiners to create a subject test in musculoskeletal medicine that would quiz students in broad areas of the discipline. The idea is that the creation of the test could make it easier for schools to offer courses in musculoskeletal medicine. The goal is to make the subject test happen this year, said Decade spokesman Toby King. In addition, the Association of American Medical Colleges Objectives Project Panel in Musculoskeletal Medicine is finalizing a white paper report on the best education objectives for the discipline.
Bone Fracture Coverage
Medicare officials plan to begin providing coverage for noninvasive ultrasound stimulation for the treatment of nonunion bone fractures prior to a surgical intervention. Officials at the Centers for Medicare and Medicaid Services (CMS) plan to change the Medicare National Coverage Determinations Manual to remove the requirement that a patient fail at least one surgical intervention before the ultrasound stimulation can be used. The agency took up a review of those requirements at the request of Smith & Nephew Inc., the manufacturer of an ultrasound bone healing system. Based on the scientific literature and expert opinion, the agency determined that there was adequate evidence to support using the procedure prior to surgery; however, CMS plans to continue examining the overall net health benefits of the procedure.
The Chosen Profession
“Be a physician” is the most common career advice that Americans give young adults, according to a Gallup poll of 1,003 adults aged 18 years and older. Twenty percent of those who responded to the survey recommended that young women become doctors, while 17% suggested medicine as a career for young men. By comparison, only 11% and 8% suggested that women and men choose careers in computers, respectively. Nursing continues to be viewed as a women's profession: 13% thought women should choose nursing, but that choice did not even make the top five careers for men. Medicine has always been cited as a top career choice for men, although the percentages have been rising steadily over the years for women, as more pursue careers as physicians. “These poll results offer great encouragement for a profession facing a diversity gap and a workforce deficit,” said Jordan Cohen, M.D., president of the Association of American Medical Colleges.
Illinois Malpractice Bill
Another state has taken steps to curb rising malpractice costs. At the end of May, the Illinois General Assembly approved legislation to place caps of $500,000 per physician and $1 million per hospital on noneconomic damages. The legislation also calls for increased physician scrutiny by posting disciplinary actions and malpractice lawsuit outcomes on the Internet, and requires insurers to release actuarial data during public hearings called to review rate increases. Steve Schneider, vice president of the American Insurance Association, Midwest Region, took issue with this last provision, indicating it would “send the wrong message to insurers who may be considering entering the market.” At press time, Gov. Rod Blagojevich (D) was expected to sign the bill into law.
Pay-for-Performance Shortfalls
The much talked about “pay-for-performance” style of reimbursement system is still largely untested and is not designed to reap cost savings, “particularly since most of the quality measures it targets are measures of underuse,” Meredith B. Rosenthal, Ph.D., of Harvard School of Public Health, Boston, said during testimony before a subcommittee of the House Committee on Education and the Workforce. In addition, there is little guidance in the literature for purchasers and health plans to reference when they set out to design their pay-for-performance programs. Coordination among payers in using these measures is needed, she said. “If only a few of the many payers that a provider contracts with are paying for performance, or if each payer focuses on a different measure set, the effects of pay for performance may be dulled.” She suggested that Congress fund more research by the Agency for Healthcare Research and Quality to identify approaches that would improve this method's cost-effectiveness and increase the likely gains in quality of care.
Studies on Gender Differences Stall
Research into gender differences is receiving limited funding at the National Institutes of Health, according to the Society for Women's Health Research (SWHR). Grants awarded to study gender differences make up only a small percentage of the total number of NIH grants, and none of the NIH institutes had devoted more than 8% of its funded grants to research on gender differences from 2000 to 2003, according to a report from SWHR. “We looked at NIH research grants awarded between 2000 and 2003 and found that across all institutes, an average of just 3% of grants focused on sex differences,” Sherry Marts, Ph.D., SWHR vice president for scientific affairs and the study author, said in a statement. SWHR officials said they had hoped to see increasing levels of funding, but they are encouraged that some NIH institutes have established mechanisms to foster this research.