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Members of the Association of Military Osteopathic Physicians and Surgeons (AMOPS) may now take advantage of membership in Pentagon Federal Credit Union. Eligibility has been extended to each AMOPS member and his or her immediate family.
Pentagon Federal is one of the largest and safest credit unions in the country. As a not-for-profit financial cooperative made up of members rather than stockholders, profits are returned to each of its members by offering highly competitive financial products and member services that surpass the offerings of most banks and other financial institutions.
As a member of Pentagon Federal, you can receive some of the lowest interest rates on loans and some of the highest dividend yields on savings and certificates available. As of August 1, 2000, the Annual Percentage Yield (APY) for 3-Year Money Market and IRA Certificates was an astounding 7.75% and 2-Year Certificates offered 7.50%.
Accounts are federally insured by the National Credit Union Administration, an agency of the U. S. government, up to $100,000. Also, unlike most banks and other financial institutions, Pentagon Federal does not charge high service fees.
A Pentagon Federal PenCheck® checking account with Direct Deposit has no monthly service fee and no per-check fee. Pentagon Federal members can manage their accounts and perform transactions 24 hours a day, worldwide using NetTeller, Pentagon Federal's online Internet account service, or Telephone Teller, toll-free automated telephone account service.
Additionally, you can get cash at over 530,000 PenTeller®, network ATM, and POS locations worldwide. Member service representatives are also available to personally assist you day or night, worldwide.
No matter where your career or life's circumstances take you, you can remain a member of Pentagon Federal for life. We hope you will take advantage of this new AMOPS benefit from Pentagon Federal's competitive products and superior service. Visit Pentagon Federal at www.PenFed.org, or call toll-free 800-616-6600, or (703) 838-1491, to join today.
(Reprinted from Newsletter of the Association of Military Osteopathic Physicians & Surgeons, Vol. 19, Issue 4, August 2000)
Military families are accustomed to change. But one constant in their lives is their TRICARE coverage. It goes with them anywhere in the world. A move to another region for TRICARE Prime enrollees simply means that they must change primary care managers (PCM).
If there are no military treatment facilities (MTF) in the service member's newlocation, active duty personnel will use the TRICARE Prime Remote Program to obtain access to primary care from civilian providers. Family members can call the TRICARE regional toll-free number to learn if TRICARE Prime is available. If not, family members will be covered by TRICARE Standard.
If they will not be using Prime, they will need to disenroll after their move. "Doing it after the move helps ensure that if they have a medical problem while traveling, they can call the PCM who knows their medical history, or a health care finder (HCF) at the toll-free telephone number in their home region, and get advice or authorization for care," states Air Force Lt. Col. Loretta Bailey, a TRICARE Management Activity (TMA) representative.
Family members of active duty may select a new PCM by contacting the nearest TRICARE service center (TSC) to complete the transfer and to change providers. They will receive a new TRICARE enrollment card and local health care information. The enrollment transfer is effective as soon as the contractor receives the completed PCM application from the beneficiary. If family members take no action to change PCMs, they will remain enrolled to their former PCM, which can result in expensive point-of-service charges.
Retirees and their eligible family members pay enrollment fees, so there are minor differences in moving with TRICARE for these beneficiaries. They can transfer their TRICARE Prime enrollment from one region to another without paying an additional enrollment fee. To select a new PCM and transfer their enrollment, they can call the contractor in the gaining TRICARE region, or visit the TSC closest to their new home. The enrollment transfer is effective when the contractor receives the completed paperwork.
Retirees and their families may choose to disenroll from TRICARE Prime at any time. Since enrollment fees are not reimbursable, they should arrange to make quarterly payments if they anticipate a move to an area without TRICARE Prime. If the enrollment fee is not paid, the enrollees will be disenrolled.
While the number of transfers of TRICARE Prime enrollment within the same region are unlimited, the number of region-to-region transfers are limited for retirees to two changes per enrollment year as long as the second move is back to the original region of enrollment. When eligible family members live in a different region than their military sponsors, they may split enrollment between regions and only pay one enrollment fee.
If beneficiaries have an emergency while traveling, they should go to the closest hospital emergency department, then report the treatment to their PCM or HCF within 24 hours.
The TRICARE National Mail Order Pharmacy (NMOP) is completely portable, and is a good option for those who anticipate they will need pharmaceuticals while traveling. The retail pharmacy benefit may not be portable to some regions because of certain restrictions between TRICARE contractors and applicable state laws. If beneficiaries need pharmaceuticals, they should contact the HCF in their home region for guidance. The TRICARE contractor in the area where they are traveling or moving to may not have the same network pharmacies as their home region, although some retail chain pharmacies may be the same. Beneficiaries may have to pay for pharmaceuticals up front at certain civilian pharmacies, and later file a claim for reimbursement.
"If beneficiaries do have to pay 'out-of-pocket' for pharmaceuticals, we advise them to immediately complete a claim form, and, if necessary, seek assistance from a health benefits adviser (HBA), a beneficiary counseling and assistance coordinator (BCAC), or a representative at a TRICARE service center," said Army Lt. Col. William Davies. "It is important that these forms be filled out completely and correctly to expedite reimbursement."
For more information about TRICARE, please contact a TRICARE service center or a health benefits adviser at a military treatment facility. Information also is available on the Military Health System/TRICARE Web site at www.tricare.osd.mil.
To ensure that beneficiaries who use the Department of Defense (DoD) Military Health System receive medically necessary care when they need it, DoD leadership developed access standards for TRICARE Prime enrollees. What's important is ensuring that access to care is easy, fast and logical.
TRICARE's standards for access are easy one day or less for urgent care, one week for routine care, one month for specialty or wellness care, 30 minutes or less in the provider's waiting room, and 30 minutes or less travel time to the primary care provider's office.
Emergency services are available and accessible within the TRICARE Prime service area 24 hours a day, seven days a week. In an emergency, TRICARE beneficiaries should call 911 or go to the nearest emergency room.
Access standards give TRICARE leaders a tool to measure the actual waiting and drive times beneficiaries experience and to fix problems when they occur. By measuring access to care, DoD leaders can improve customer service. Their goal is to provide beneficiaries the world's best access to health care. To ensure they receive evaluation of illness in a timely manner, TRICARE Prime enrollees have access to primary care manager services 24 hours a day, seven days a week.
Besides making access to care easy to track and improve, DoD leaders also realize those long waits at the provider's office squander away valuable time. That's why the standards for access also measure how fast beneficiaries receive care for non-emergency situations at the provider's office. TRICARE's goal of beneficiaries being treated within 30 minutes of their arrival at the provider's office is very ambitious compared with other health plans.
With the aid of TRICARE's health care finders, even referrals from primary care managers are handled rapidly. If a beneficiary needs to see a specialist, the care is arranged swiftly through TRICARE's vast provider network. In some regions, the services of a health care finder are available to beneficiaries 24 hours a day, seven days a week. TRICARE's access standard for travel time to the specialty care provider's office is 60 minutes.
TRICARE's worldwide Nurse Advice Line is the logical solution to a variety of health care access needs. Sometimes, all a beneficiary wants to do is ask a question. Why wait to schedule an appointment with a provider, when a qualified health professional can answer questions over the telephone?
Another practical feature of TRICARE is the National Mail Order Pharmacy (NMOP) program. DoD offers this convenient benefit so that TRICARE beneficiaries don't have to drive to a pharmacy every month to receive drugs for chronic conditions. To use the NMOP, beneficiaries simply call Merck-Medco at 1-800-903-4680 to determine eligibility and obtain mail order envelopes with order forms. For a nominal co-payment, beneficiaries may obtain up to a 90-day supply of drugs. That's the kind of convenient access to care TRICARE leaders like to promote.
Even if a health plan is easy, fast and logical to navigate, though, problems can occur. How leadership deals with problems is another form of health care access. For example, TRICARE provides assistance with enrollment, claims and health plan questions through the various TRICARE service centers in the regions.
TRICARE service center contractor representatives are available during regular business hours to provide information about all aspects of TRICARE's health benefits. In addition, health benefits advisers (HBAs) and beneficiary counseling and assistance coordinators (BCACs) are available to answer questions at lead agent offices and at all military treatment facilities.
And, that's all there is to understanding TRICARE's access standards. Following is a list of the categories of care with the corresponding TRICARE access standard. When reading this list, remember that a health care provider using professional standards and clinical judgment may specify more appropriate appointment guidelines, based on the needs of the beneficiary.
**Emergency - a sudden or unexpected condition or the acute worsening of a chronic condition that is threatening to life, limb or sight and that requires immediate medical treatment to relieve suffering from painful symptoms.
Under a recent TRICARE policy change, emphasis is placed on the symptoms that prompted the emergency room visit rather than the final diagnosis. This is called the Prudent Layperson Standard, which means that someone with average knowledge of health and medicine could reasonably expect that the absence of medical attention would result in placing a person's health in serious jeopardy, serious impairment to bodily functions or serious dysfunction of any bodily organ or part. If you experience an emergency, go directly to the nearest emergency room or dial 911.
**Urgent Care - medical attention for a condition that, while not life or limb threatening, could become more serious if not treated. Examples of urgent care include eye or ear infections and suspected bladder infections. When travelling away from home, this type of care, unlike emergency care, requires the authorization of a primary care manager.
If a beneficiary is enrolled in TRICARE Prime, urgent care must be obtained at the primary care manager's office. If a beneficiary is not sure where to go for treatment, he or she may contact a health care finder. The services of health care finders are available 24 hours a day, seven days a week. Urgent care is provided in one day or less.
**Routine Care - is medical care for symptoms-such as colds and flu or low-back pain, for which intervention is required, but is not urgent. The maximum waiting time for routine care is one week.
**Well Care - is medical care to promote health maintenance and prevention, for example Pap tests. The maximum waiting time for well care is four weeks.
**Specialty Care - is provided by a specialist in TRICARE's provider network after referral by a primary care manager. The maximum waiting time for specialty care is four weeks.
American Forces Press Service
WASHINGTON, Sept. 27, 2000 -- TRICARE officials want people to know their Internet home page, www.tricare.osd.mil, is a great first stop for beneficiaries to get information on the program. Experts have worked hard to create a friendly, easy to use design, said Air Force Col. Frank Cumberland, TRICARE Management Agency director of communications and customer service. He said the site designers benchmark their work against some of industry's best Web destinations. The front page is full of the most recent articles about TRICARE from several different news sources on the Internet. A handy A-to-Z drop-down menu at the top of the front page will take visitors to any area of the site they want without a lot of annoying searching from link to link. Cumberland said claims processing is the most asked about issue in TRICARE, so information about claims enjoys a prominent spot on the home page. By clicking on the "CLAIMS Information" button in the upper right edge of the home page, customers will find step-by-step instructions for filing a claim, downloadable forms and answers to frequently asked questions. Other links from this page take people to a list of local claims offices and information on the new Debt Collection Assistance Officer program. The button "TRICARE Beneficiaries: Understanding Your TRICARE Benefits" on the upper left side of the home page takes Web surfers to the most-hit of the site's 26,000 pages: a TRICARE primer -- a page of links that lead to extensive information on every aspect of the program from dental benefits to the Senior Prime demonstration. From the page, visitors can find the toll-free number for their service region, send a change of address to the Defense Eligibility and Enrollment Reporting System, download enrollment forms, and find a nearby authorized healthcare provider, among other things. "One of the real purposes of our site is to serve as a master link to the rest of TRICARE," Cumberland said. "With one visit to our site, people can reach virtually any of our lead agents, our hospitals and our managed care contractors, and obtain 100 percent of the toll-free numbers available." Also within this section is the "Beneficiary Forum," where visitors can ask questions about TRICARE and join in discussions with other beneficiaries. A TRICARE staff member usually answers questions the same day they are posted to the site. Two other key features of the site are the TRICARE Stakeholders Report and new monthly columns by agency director Dr. H. James T. Sears. The two columns are "Plain Talk About TRICARE," for the beneficiary audience, and "TRICARE Grand Rounds," for the healthcare provider and administrator audience. "The purpose of having these right up front is to let beneficiaries worldwide know that we're working on problems with this program, but that we really believe we've got a program that is posting some very, very good results," Cumberland said. "We want to pass the word that TRICARE is a good healthcare benefit and that the TRICARE program has matured and improved over time." One area officials are working to improve in the near-term is information for healthcare providers. "We want to get stronger on information for our own providers, our own clinicians, including medical information resources for them," he said. Farther out, officials hope TRICARE beneficiaries will be able to make appointments and refill prescriptions online.
NOTE: Joint Ethics Regulation (DoD 550.7-R, section 2-301) spells out legal and illegal use of federal communications resources while on the job. In general, the restrictions that guide office telephone use also govern Internet use. See your supervisor or local computer policy experts for details.
WASHINGTON, Oct. 5, 2000 -- Delivery delays of the 2000-2001 influenza vaccine throughout the United States have activated a priority immunization program in DoD and the Coast Guard. DoD officials said the delay stems from two factors -- a slow-growing component of this year's vaccine formulation and production problems at two of the four pharmaceutical companies that produce flu vaccine. The Joint Preventive Medicine Policy Group under the assistant secretary of defense for health affairs developed the plan, which balances military readiness with the responsibility to protect DoD's most vulnerable populations. Officials said DoD and the Coast Guard will delay organized flu vaccination campaigns until early to mid-November, pending receipt of adequate vaccine supplies. They said currently available supplies will be administered first to operational military personnel, health-care workers with direct patient contact, and active duty and nonactive duty Defense Enrollment Eligibility Reporting System enrollees who have high-risk medical conditions. To the extent possible, these groups will be done simultaneously, they noted. Next in order of priority will be military trainees, groups in close contact with high-risk persons, all other military members in priority for deployment, other active duty members and mission-critical DoD civilians at overseas facilities, and all other beneficiaries. DoD used about 2.8 million doses of flu vaccine last year to immunize all its beneficiaries, officials estimated. For vaccination details, visit the TRICARE Web site at www.tricare.osd.mil. For information about the vaccine delay, visit the Centers for Disease Control Web Site at www.cdc.gov. For information about influenza, visit www.cdc.gov/ncidod/diseases/flu/fluvirus.htm
Flu vaccination priority order is:
Recently, the IRS released a memorandum addressing application of the "student FICA exception" to medical residents. The memorandum discusses the exception's requirements and sets forth several tests for determining whether they've been met. The tests are very fact- specific, making it difficult to make broad generalizations about when hospitals will qualify for FICA refunds based on the exception. Hospitals that have filed or plan to file refund claims are advised to evaluate their programs using these tests and consider what documentation may be required to support their claims. This guidance also may be helpful in determining how a hospital's GME program might be restructured to minimize future FICA tax.
IRS agents recently completed a three-day training course focused on this issue and likely will begin auditing refund claims in the near future. Although the memorandum does not have the force of law, IRS field staff can be expected to follow its guidance. The Coalition is preparing comments on the memorandum and considering further options.
Last fall, the American Osteopathic Healthcare Association joined the Medical Resident FICA Coalition, a group of teaching hospitals, medical schools, and related organizations. The Coalition was formed to analyze Federal Insurance Contributions Act (FICA) taxation of medical residents following the decision in Minnesota v. Apfel, a 1998 circuit court of appeals case holding that residents at the University of Minnesota's facilities are primarily students and within the "student FICA exception" to taxation rules. This exception applies to services a student provides to a school, college, or university (S/C/U) or "supporting organization" when the student is enrolled and regularly attending classes at an S/C/U.
In a White Paper submitted to the Internal Revenue Service last December, the Coalition took the position that medical residents in all graduate medical education (GME) programs accredited by the AOA or the Accreditation Council for Graduate Medical Education (ACGME) satisfy the exception's requirements and therefore are not subject to FICA tax. The Coalition also suggested that teaching hospitals should be considered within the common sense meaning of S/C/U for purposes of the exception.
The IRS Office of Chief Counsel recently released a memorandum addressing the application of the student FICA exception to medical residents. This memorandum, issued to assist IRS agents in analyzing FICA refund claims filed by medical schools, hospitals, and other organizations, discusses several tests for determining employer status and student status under the exception. These tests focus on factors such as which entity actually controls the residents' behavior; how the S/C/U, hospital, and residents relate to each other; and whether the residents function primarily as students or as employees during their training. The answers to these questions will depend on a number of specific factors and will vary from situation to situation.
According to the memorandum, the first step in determining whether a medical resident is subject to FICA tax is to determine which entity (e.g., hospital or school) is the resident's common law employer. For these purposes, the common law employer may not necessarily be the organization that pays the resident and treats him or her as an employee for payroll purposes. This determination will depend on which entity has the right to direct and control the resident based on all relevant facts and circumstances.
Under the Internal Revenue Code, to qualify for the exception, the resident's services must be performed in the employ of an S/C/U or a "supporting organization" for such an institution. Whether a hospital satisfies this requirement will depend on all relevant facts and circumstances concerning the hospital and its relationship with the S/C/U. The memorandum states, however, that if a hospital is not part of a medical school or university, services performed by its residents will not qualify for the exception unless the hospital is a "supporting organization." The IRS regulations define "supporting organization" narrowly, as an entity "organized and at all times...operated, exclusively for the benefit of, to perform the functions of, or to carry out the purposes of" or "organized, supervised, or controlled by or in connection with" an S/C/U. The presence of an affiliation agreement or other contractual relationship between the S/C/U and the hospital will not be sufficient to qualify the hospital as a supporting organization unless it satisfies this definition. Even if the hospital satisfies these tests, residents also must meet the "student status" requirement by being "enrolled and regularly attending classes" at an S/C/U. Although "classes" is not interpreted so narrowly that it includes only traditional lectures and labs, this requirement is not as straightforward as it seems. Whether particular residents qualify as students for purposes of the exception will be determined based on all relevant facts and circumstances in the situation.
(Margaret J. Hardy, J. D., Vice President of Federal Relations and Policy, the American Osteopathic Healthcare Association - AOHA Washington Update, 9-22-2000)
As usual, TOMA will continue to provide information/updates on bills of interest in the Texas D.O. and through special alerts. Additionally, physicians wishing to keep track of specific legislation can access www.capitol.state.tx.us.
Prompted by financial pressures, the three entities have held at least two discussions to explore ways in which they might pool resources and divide up medical services to cut costs. The institutions hope to hire a consultant this fall whose analysis should generate recommendations by the middle of next year. (Fort Worth Star-Telegram, 9-19-2000)
The merger increases the size of AmCare's membership from 30,000 subscribers to 80,000 subscribers in 176 Texas counties, while AmCare said it plans to consolidate membership and claims processing operations of both companies under one roof. (Houston Business Journal, 9-11-2000)
The extra $4 million for outreach comes from within the commission's budget, which initially allocated $7 million for two years for CHIP outreach. The program is being advertised through schools, churches and health officials, as well as by bus signs, billboards, radio and television ads. As of September 11, CHIP had enrolled 94,700 Texas children, while the state hopes to sign up 428,000 children by next September. (Associated Press, 9-13-2000)
Dallas County Commissioners approved the hospital district's tax rate of 25.4 cents per $100 of assessed property valuation, a 29 percent increase over last year's tax rate, albeit shy of Parkland's requested 50 percent increase. Parkland officials said the rate increase should obviate additional service reductions at the hospital, which will continue to seek ways to consolidate. (Fort Worth Star-Telegram, 9-12-2000)
The lawsuit charged that Warrick Pharmaceuticals, Dey Laboratories and Roxane Laboratories falsely inflated the reported sales prices of four respiratory drugs, encouraging pharmacies to use the products by letting them keep the additional Medicaid reimbursement, reported the Dallas Morning News. The companies denied wrongdoing. Cornyn's office is continuing the investigation, but would not say whether criminal charges are expected. (Dallas Morning News, 9-8-2000)
Medical Select Management, with 550 primary care and 1,200 specialty care physicians, is in preliminary contracting talks with Cigna as it seeks to sign up insurers after breaking from Harris Methodist Health Plan two years ago. Of Cigna's 314,000 North Texas HMO members, 90,000 are on the Fort Worth side of the Metroplex. Cigna has fee-for-service contracts with many Medical Select physicians. (Fort Worth Star-Telegram, 9-7-2000)
U.S. District Judge Sam Kent issued an injunction against PacifiCare on October 5 that also requires the firm to do its best to rebuild within four months a network of physicians and hospitals that will prevent Medicare-eligible customers of the firm's Secure Horizons health maintenance organization from having to travel long distances for medical services. Members of the Secure Horizons HMO can visit physicians chosen when they joined the plan while the company tries to rebuild its physician network, reported The Daily News. Physicians will be reimbursed at Medicare rates until new contracts are reached. The injunction incorporated a settlement reached by PacifiCare and attorneys for a Texas City couple who complained that Secure Horizons reneged on a promise that they could keep their own physician. (Houston Chronicle, 10-5-2000; Galveston County Daily News, 10-6-2000)
Paracelus Healthcare Corp., which owns ten hospitals in seven states, including the 191-bed acute care hospital in the Houston area, made the filing to restructure debt from a merger with Champion Healthcare Corp. in 1996, which Paracelus said was too high relative to the cash flow that the combined companies were able to generate, reported the Houston Chronicle. Paracelus said it hopes to be out of Chapter 11 in 60 to 90 days and noted that the filing applies only to the parent company and not to the ten hospitals, which operate under separate subsidiaries. (Houston Chronicle, 9-18-2000)
Beginning in January, Secure Horizons and Harris Senior enrollees will pay $19 per month for their health insurance premiums and have their prescription drug spending capped at $1,000 per year. North Texas' only other remaining Medicare HMO, Texas Health Choice, will offer seniors a choice of paying a $34.95 monthly premium with a $2,500 annual drug spending limit or paying no premium with a $1,500 annual drug spending limit. (Forth Worth Star-Telegram, 9-14-2000)
Having inadequate facilities to handle the 200 to 250 patients using the clinic daily, Ripley has been replaced by a new $4 million clinic a few miles away with more than twice the size, into which Ripley's staff will move next week. The new clinic, located at 7550 Office City Drive near the Gulf Freeway and South Loop, will have 45 examination rooms and offer dental care. i>(Houston Chronicle, 9-14-2000)
The state has submitted a proposed rule to extend the Provider Re-enrollment deadline from September 1, 2000 to December 31, 2000. This proposed rule was published in the Texas Register on August 25, 2000. This proposal will become effective following the public comment period and upon adoption by the state.
After the state notifies NHIC of the effective date of the rule, NHIC will notify providers through AIS line messages and their Remittance & Status report.
No providers were disenrolled on September 1, 2000 for re-enrollment. Providers are encouraged to utilize the extension to submit their re-enrollment agreements if they have not already complied. All providers are valuable to the program and NHIC encourages you to re-enroll to prevent any interruption in claims payment. As of September 14, 2000, 73% of osteopathic physicians in solo practice and 84% of osteopathic physicians in group practices had completed the re-enrollment process. Claims will be held for dates of service on or after January 1, 2001 for any provider who has not re-enrolled; this action will be reflected on the Remittance and Status report.
Note: The above information is being published in the November/December Medicaid provider bulletin.
In response to a U.S. District Court ruling last month charging that Texas had failed to improve child Medicaid services such as medical and dental checkups, outreach to families and care to abused children. Texas had appealed and is now requesting the Court to temporarily set aside the order, arguing that a corrective plan by state Medicaid officials would limit the Texas Legislature's ability to pass Medicaid reforms when it convenes in January.The state's decision to request a stay drew mixed reactions from Texas lawmakers, some of whom expressed the desire for flexibility and others the concern that poor children would need to wait longer for reforms to materialize. (Dallas Morning News, 9-22-2000)
Deaths of motorcycle riders in Texas rose 31 percent in the year after the state partially repealed its mandatory helmet law, although serious injuries declined slightly, according to a federal transportation analysis. Helmet use became optional September 1, 1997, for Texas motorcycle operators and passengers over age 21.
The study, by the Department of Transportation’s National Highway Traffic Safety Administration, said helmet use dropped in Texas from 97 percent of riders in 1997 to 66 percent in May of 1998. Statistics from the Texas Department of Public Safety show that 116 motorcycle deaths occurred in the state in 1997, rising to 152 in 1998. (Fort Worth Star-Telegram, 9-21-2000)
The Texas Attorney General has ruled that the Texas State Board of Medical Examiners must release “negative or investigative information” contained in license application files to the Equal Employment Opportunity Commission, even though such information is deemed “privileged and confidential” and “not subject to discovery, subpoena, or …release to anyone” other than TSBME or its employees or agents by a Texas statute. In Opinion No. JC-0280 http://www.oag.state.tx.us/opinopen/opinions/op49cornyn/jc-0280.htm, Attorney General John Cornyn held that because federal law preempts inconsistent Texas state law, he could not construe Texas Occupations Code § 164.007 as allowing TSBME to withhold from the EEOC information relating to an EEOC investigation of charges of discrimination by a public entity under the Americans with Disabilities Act. (Vinson & Elkins Health Headlines, 9-25-2000)
OHRP lifted its shutdown of hundreds of studies involving human volunteers after accepting UTMB's plan to correct problems, which includes establishing a second 20-member Institutional Review Board. OHRP had cited deficiencies in UTMB's informed-consent procedure and study review process. UTMB will re-review the studies OHRP had restricted and may resume some as soon as two weeks and others within one or two months. (Houston Chronicle, 9-27-2000)
The world renowned clinic for the mentally ill made the decision after determining that financial difficulties would jeopardize its solvency if it remained in Topeka, Kansas, where it was founded in 1925, the Associated Press reported. The clinic plans to relocate its research, education and national services programs to Houston by 2002. (Associated Press, 9-28-2000)
The women's hospital rejected BCBS's new reimbursement rates and said it has stopped accepting new BCBS patients and will stop accepting HMO Blue from current patients as of December 31, which will require between 800 to 900 Renaissance patients either to change physicians or pay for services out-of-pocket. Renaissance wrote a letter to patients stating that HMO Blue unilaterally changed reimbursement fees with less than one month's notice and claiming that the insurer would not reveal the new fee schedule until after the date the new fees were effective. (Austin Business Journal, 9-25-2000)
The funds will help sponsor the Center for Health Care Services with the goal of reducing inappropriate placement of mentally ill or retarded patients in hospital emergency rooms, state hospitals and jails by enhancing the center's existing jail and emergency room referral programs and creating new ways to fund children's mental health services. The funding will go toward the ten percent local match sought by Texas, which provides most of the center's grant funds. (San Antonio Express-News, 9-26-2000)
Hours before expiration of their old agreement, the two parties came to an agreement to continue to allow 500,000 UnitedHealthcare members to use Memorial Hermann's services without interruption and to avoid some having to switch physicians. Neither side released details on the rates UnitedHealthcare would reimburse for Memorial Hermann services--the root of the several-month standoff between the parties--although Memorial Hermann was reportedly asking for an average increase of over 40 percent. (Houston Chronicle, 9-28-2000)
PacifiCare sent notification letters to employers and individual policyholders that their PacifiCare contracts will end March 1, a move that will force 3,500 Texans to seek coverage elsewhere. The decision was prompted by insufficient membership growth and inability to obtain favorable provider contracts in those counties, and is part of PacifiCare's strategy of abandoning unprofitable products and markets to shore up the fiscal health of the former Harris Methodist Health Plan, which PacifiCare recently acquired, the Star-Telegram added. (Fort Worth Star-Telegram, 9-28-2000)
The deal would allow the 540-bed St. Paul to retain its name and Catholic identity and would join it with UT Southwestern Medical School and the Zale Lipshy University Hospital. Participants in the discussions hope to reach a final transaction by the end of the year. St. Paul lost $14.5 million in fiscal year 1998. (Dallas Morning News, 10-2-2000)
Dallas-based MedicalEdge's acquisition of The Medical Group of Texas adds 100 physicians to the list of providers available to members of Sierra's Texas Health Choice HMO and increases the number of clinics they can visit in the Dallas-Fort Worth area to 33 from three. MedicalEdge will retain The Medical Group of Texas name, provide service to members of Texas Health Choice for three years, and its physicians will make up about 80 percent of the providers available under Texas Health Choice. (Dallas Morning News, 10-5-2000)
The NCQA full-scale surveys assess PPOs' consumer protection mechanisms, member service, access to care, provider credentialing and oversight, while PPOs will also be required to routinely conduct member satisfaction surveys, noted AMNews. Five organizations, which together cover eight million individuals nationwide, have thus far indicated plans to seek the new NCQA PPO certification. (American Medical News, 9-18-2000)
DeParle left her post as head of the Medicare and Medicaid programs to become a fellow at the John F. Kennedy School of Government's health policy program. A replacement has not been named and HCFA Deputy Administrator Michael Hash is expected to run the agency at least through January. (New York Times, 9-12-2000; Associated Press, 9-11-2000)
Children's Oncology Group (C.O.G.), comprised of Children's Cancer Group, the Intergroup Rhabdomyosarcoma Study Group, the National Wilm's Tumor Study Group and the Pediatric Oncology Group, includes 237 childhood cancer research and treatment centers located in almost every state and province throughout North America. Among C.O.G.'s goals are to expand the participation of children in clinical trials, offer more opportunities for advanced care and create the first national childhood cancer registry. (National Childhood Cancer Foundation, 9-13-2000)
A study by WebsurveyMD.com noted that 19 percent of physicians surveyed expressed interest in an online prescription-writing application, 27 percent said they believed that the Internet will save the health system money over the next five years and 41 percent expressed interest in using the Internet to practice medicine from remote locations. Seventy-five percent of physicians said they use the Internet to get drug information, 68 percent use the Internet to get treatment information, 45 percent use it to take CME courses, 20 percent use it to communicate with patients, 19 percent use it to communicate with colleagues and 16 percent use it to file insurance claims. (Managed Care, 9-18-2000)
The new system, scheduled to be phased in beginning January 1 and fully by 2004, replaces charges set by the service provider with a fee schedule adjusted for mileage and regional wage differences. The American Hospital Association hopes the new system will include shifting of some payments from urban to rural areas to ameliorate equipment and staff costs of low-volume rural hospitals, while HCFA said it will solicit comments on the number, location and characteristics of rural hospitals affected by the proposal. (AHA News, 9-18-2000)
A U.S. Department of Veterans Affairs study of 275 resident physicians measured adherence to standards of care for patient conditions such as coronary artery disease, hypertension, diabetes, atrial fibrillation, myocardial infarction and gastrointestinal bleeding, and found that computerized reminders improved rate of compliance with care standards by 47 percent during specific patient visits. The researchers noted that the beneficial effect of computerized reminders declined over the course of the study, possibly because residents' time in busy clinics lead to neglect of the reminders over time. (Journal of the American Medical Association, 9-20-2000; Department of Veterans Affairs, 9-19-2000)
Analyzing 3.5 million pediatric hospital cases nationwide in 1998, the study noted, for example, that the average length of hospital stay found in actual practice for bacterial meningitis in children was 8.5 days, while Milliman & Robertson's goal length for that diagnosis is three days. Plaintiffs of a federal class action lawsuit filed in Florida plan to use the study to bolster their allegations that health plans use Milliman & Robertson's guidelines to reduce the amount of care provided in order to save money and fail to disclose their use of the guidelines, thereby misleading patients about the amount of care they will cover. (Wall Street Journal, 9-14-2000)
A Department of Health and Human Services Office of Inspector General study found that Medicare risk plans earned $129 million in 1997, and $100 million in 1996, in interest from the float time between receiving the government's premium payments and reimbursing health care providers. Current federal rules do not require plans to report the interest earnings in financial proposals sent to Medicare. (WebMD, 9-15-2000)
Prompted by a recent federal report that linked quality of care problems in nursing homes to staffing shortages, the proposed grants would target 16,000 nursing homes nationwide. Clinton is also directing HCFA to establish minimum nursing home staffing requirements for Medicare and Medicaid eligibility within two years. (Associated Press, 9-16-2000)
According to a study prepared for HCFA by the Inspector General of the Health and Human Services Department, overestimates used to establish Medicare funding levels have led to health plans receiving 0.5 percent higher reimbursements this year than Congress originally intended. The study also said that, because Medicare HMO beneficiaries tend to be healthier than the Medicare population as a whole, those HMOs will run smaller bills that translate into an extra $1.8 billion in 2000 reimbursements. American Association of Health Plans spokesperson Susan Pisano countered that the study's figures did not reflect changes enacted in 1999 legislation and maintained that the government has never measured the health of the population in HMOs. (Associated Press, 9-20-2000)
HCFA is requiring Medicare+Choice plans to collect and submit patient encounter data so that it can factor in the health status of patients when setting payment rates. Hospital-based patient encounter data reporting has already begun, as per a new risk-adjusted Medicare HMO payment system required by the 1997 Balanced Budget Act, and full implementation of the payment adjustment system is expected by 2004. HCFA has not indicated whether physicians treating sicker Medicare HMO patients would receive enhanced capitation payments, but agreed that physicians should have access to health plans' risk adjustment data and recommended that they renegotiate their contracts with the plans to share in any future payment increases. (American Medical News, 9-25-2000)
Over 40 percent of the increase in retail drug spending stemmed from 25 of the most heavily advertised drugs, concluded a study by the National Institute for Health Care Management. As overall retail spending on prescription drugs rose to $111.1 billion in 1999, from $93.4 billion in 1998, the study said, consumers may have been persuaded to request newer and costlier medicines from their physician even if equally effective but less expensive drugs were available. The study noted other factors contributing to increased drug spending, including an increase in the number of FDA-approved drugs, an aging population and an increase in insurance coverage of drugs. (New York Times, 9-20-2000)
While Congress is considering a variety of options, including raising payment rates in urban areas, MedPAC members argued that increasing rates for plans in rural areas--where a large proportion of Medicare HMO departures have occurred--would not make up for business decisions made by plans to enter risky markets. Of the 39 million Medicare beneficiaries, 16 percent are in Medicare+Choice, 23 percent of beneficiaries who have plans available to them have opted for Medicare+Choice, and, while growth in Medicare+Choice participation has slowed, MedPAC noted that it is not below the growth in traditional fee-for-service Medicare. (Medical Data International, 9-21-2000)
The finding by the U.S. General Accounting Office represents a two percent increase since a federal crackdown initiative was launched two years ago against problem nursing homes and may stem partly from nursing shortages, as well as from better detection of deficiencies. The report also found that inspections in some states continue to be predictable, allowing facilities to mask deficiencies, and noted that the federal government's enhanced enforcement program won't be implemented for two or three more years. (Austin American-Statesman, 9-28-2000)
According to a new Census Bureau report, there were 42.6 million uninsured Americans in 1999, down from 44.3 million in 1998, the first drop in 12 years. The number of uninsured children fell by more than 1 million to 10 million, its lowest level since 1995. The turnaround was spurred by a high national employment rate and broader health care coverage offered by employees facing a tight labor pool. The American Medical Association attacked the health insurance industry's position that a federal HMO patients bill of rights would increase health insurance premiums and therefore lead to more uninsured Americans, noting that the census figures show there are fewer uninsured Americans today despite a two-year increase in premiums. (American Medical Association, 9-29-2000; Cox News Service, 9-28-2000)
Facing a competitive bidder looking to take over the contract, UNOS will continue to run the nation's transplant system and agreed to abide by HHS' final say over a new distribution policy targeting organs to the sickest recipients regardless of region. HHS has chosen a separate entity, the University Renal Research and Education Association of Ann Arbor, Michigan, to run the Scientific Registry of Transplant Recipients, which analyzes transplant patient recovery and will examine outcomes of the policy change. (Associated Press, 9-29-2000)
Sen. Diane Feinstein (D-California) and 59 other Senators sent a letter to President Clinton requesting that the deadline be extended by two years, rather than requiring states to forfeit the money to be redistributed to other states. Forty-five percent of the program's $4.2 billion allotment had been unspent and is slated to be reallocated to states that successfully spent their full allocation, including Pennsylvania, New York, Alaska, Indiana, Kentucky, Maine, Massachusetts, Missouri, North Carolina and South Carolina. Over $1 billion of the unspent money had been allocated to Texas and California. (CNN.com, 9-30-2000)
The former American Accreditation HealthCare Commission, now known as URAC, has appointed a 27-member advisory committee to begin developing standards for accrediting health web sites and plans to release draft standards for public comment in a few months, with final standards targeted for a Spring 2001 completion. URAC's advisory committee will consider issues such as privacy, professionalism, candor and accountability, and includes representatives from organizations such as Internet Healthcare Coalition, Hi-Ethics and the American Medical Association, which have already developed ethical or quality guidelines for health web sites. (Yahoo News, 9-29-2000)
Total HMO enrollment on January 1, 2000 fell to 80.9 million, down from 81.3 million the previous year, the first annual enrollment decrease since InterStudy began tracking HMO figures in 1973. The Health Insurance Association of America attributed the drop to greater consumer demand for health plans offering access to out-of-network physicians, such as PPOs and point-of-service plans. (Modern Healthcare, 10-2-2000)
The lawsuit accused Aetna of misleading investors about its financial status by failing to disclose problems in 1997 related to its purchase of U.S. Healthcare. Aetna admitted no wrongdoing in the agreement, which is subject to court approval. (Dallas Morning News, 9-27-2000)
The Department of Health and Human Services and the Association of Organ Procurement Organizations (AOPO) announced on September 12 that the number of organ donors increased nearly 4 percent during the first half of 2000, compared to the first six months of 1999. This increase is similar to the positive trend reported for the first five months of the year by the United Network for Organ Sharing, the HHS’ Health Resources and Services Administration’s contractor for the Organ Procurement and Transplantation Network and the Scientific Registry of Transplants Recipients. After rising 6 percent in 1998 - the first substantial increase since 1995 - organ donation remained essentially flat in 1999. AOPO’s organ donor data were generated from the 59 federally designated organ procurement organizations nationwide. For the first six months of 2000, the number of donors was 2,978, up from 2,875 in 1999 in the same time period. HHS also released “Roles and Training in the Donation Process: A Resource Guide,” a tool to help the transplant community, hospitals and OPOs implement a 1998 rule issued by HCFA to promote the best practices in organ donation. The rule requires hospitals to refer all deaths to OPOs and provide specialized training for hospital staff who talk with grieving families about donation. For a copy of “Roles and Training in the Donation Process: A Resource Guide,” visit www.organdonor.gov. (HHS news release, 9-12-2000)
Updated lists of designated primary medical care, mental and dental health professional shortage areas (HPSA) can be found in the September 15 “Federal Register.” Current HPSA data also can be found at http://www.bphc.hrsa.gov/databases/newhpsa/newhpsa.cfm on the World Wide Web. This site is updated weekly. The lists identify geographic areas or groups of people that are most in need of receiving primary health care services and assistance. The data is as of July 31, 2000, and includes 2,706 primary medical care, 661 mental health and 1,178 dental HPSAs. Federal programs use HPSA designations as prerequisites to applying for assistance, such as the National Health Service Corps’ Scholarship and Loan Repayment programs, administered by HRSA’s Bureau of Primary Health Care. Several projects managed by the Health Care Financing Administration also use HPSA designations, including the Rural Health Clinics and Medicare Incentive Payment programs. (HRSA News Brief, 9-25-2000)
The five-year contract between Aetna and the contracting organization for 1,700 Tarrant County physicians increases reimbursements to physicians by two to three percent annually and eliminates risk sharing requirements for pharmacy and hospital costs. Medical Select hopes to use the new Aetna deal as a template for future deals, including an upcoming one with Cigna Healthcare. (Fort Worth Star-Telegram, 9-30-2000)
The bill would roll back Medicare spending cuts under the Balanced Budget Act of 1997 beyond the $16 billion in Medicare reimbursement restoration approved by Congress last year, by an amount not yet finalized but expected to be below the $30 billion proposed by the White House. The bill would restore funding cuts to hospitals and nursing homes, raise payments to Medicare HMOs and extend Medicare to additional health screenings and treatments. (Boston Globe, 10-4-2000)
Rep. Tom Coburn (R-Okla.) and Sen. Tim Hutchinson (R-Ark.) introduced the legislation in response to approval of the drug by the FDA and its rules for prescribing the drug, which they regarded as inadequate to protect the health of pregnant women. The bills would require the prescribing physician to be legally empowered and trained to perform an abortion, properly trained in the drug's administration and have admitting privileges at a nearby hospital, adding to FDA requirements that physicians be able to pinpoint the date of the pregnancy, rule out women with ectopic pregnancy and be prepared to take surgical steps to complete the abortion or stop the bleeding in the case of problems. Coburn is a practicing physician claiming to have delivered 3,500 babies and to have performed abortions to save the lives of mothers. Abortion rights advocates criticized the bills as virtually negating the ability of physicians to prescribe RU-486 by narrowing the number of those who would be eligible to do so. (Associated Press, 10-5-2000)
HCFA recently issued a final National Coverage Decision (the “Coverage Decision”) which implements President Clinton’s June 7, 2000, executive memorandum directing the Secretary of the Department of Health and Human Services to authorize Medicare payment for routine patient care costs and costs due to medical complications associated with participation in clinical trials, as well as a Program Memorandum providing interim instructions on the identification and handling of claims. Thus, effective for items and services furnished on or after September 19, 2000, Medicare will cover the routine costs of qualifying clinical trials as well as reasonable and necessary items and services used to diagnose and treat complications arising from participation in all clinical trials. The routine costs of qualifying clinical trials are defined to include all items and services that are otherwise generally available to Medicare beneficiaries that are provided in either the experimental or the control arms of a clinical trial except for; 1) the investigational item or service itself; 2) items and services provided solely to satisfy data collection and analysis needs and that are not used in the direct clinical management of the patient; and 3) items and services customarily provided by the research sponsors free of charge for any enrollee in the trial. Routine costs of qualifying clinical trials do include: 1) items or services that are typically provided absent a clinical trial; 2) items or services required solely for the provision of the investigational item or service, the clinically appropriate monitoring of the effects of the item or service, or the prevention of complications; and 3) items or services needed for reasonable and necessary care arising from the provision of an investigation item or service, including the diagnosis or treatment of complications. To ensure the safety of Medicare beneficiaries, HCFA has established a process to determine which clinical trials are eligible for its participants to receive payments for routine medical costs. The Program Memorandum and the Coverage Decision may be found at: http://www.hcfa.gov/quality/8d3.htm and http://www.hcfa.gov/quality/8d.htm, respectively. (Vinson & Elkins Health Headlines, 9-25-2000)
Wyeth-Ayerst Updates and Recommendations for Norplant: Wyeth-Ayerst continues to conduct additional testing and analyses of the lots in question and continues to share the results of these analyses with the Food and Drug Administration. Until we can come to definitive conclusions, however, the contraceptive efficacy of Norplant Systems from specified lots cannot be assured. Any patient who has received a Norplant System from the lots listed below should use a back-up, barrier or other nonhormonal method of contraception, such as a condom, spermicide, a diaphragm, or IUD. We also continue to recommend that there should be no new insertions of Norplant Systems from these lots.
Specified Norplant System lot numbers and expiration dates:
A copy of the letter may be found at: http://www.fda.gov/medwatch/safety/2000/safety00.htm
FYI-- Revisions to the Precautions and Adverse Events sections of the labeling for Accolate. A copy of the letter may be found at: http://www.fda.gov/medwatch/safety/2000/safety00.htm
The leading article reports the August 14, 2000 release of the Food and Drug Administration's (FDA) final guidance on the reprocessing and reuse of devices intended for a single use (SUDs). The article describes the premarket and non-premarket requirements and the enforcement schedule for hospitals and third party processors, as well as where to go for FDA's help to comply with this new guidance.
"Medical Device Tracking: A Case Study" is the title of the second featured article. This article follows the discovery by a manufacturer of the malfunction of its implantable cardioverter defibrillator, its analysis of the problem, its creation of a software modification to minimize the problem, its tracking of the device and the difficulties associated with locating the implanted patients. With an aggressive tracking regimen, the manufacturer identified 99.8% of the patients. The authors were Ronald Kaczmarek, M.D. and Larry Kessler, Sc.D. from OSB. A third author is a biostatistician from private industry.
Two shorter articles follow. The first: "Safe Infusions", written by Audrey Morrison, R.N./OSB warns infusion pump users to carefully check and remove any tiny bubbles from warmed blood and replacement fluids before infusion. The second: "Protecting Your Patient's Eyes", by Eileen Woo, R.N./OSB, cautions contact lens users to follow a strict regimen when cleaning the lens, particularly to eliminate any confusion between cleaning and rewetting solutions.
The final article, "FDA Warns About EMI Risk With Telemetry Systems", was written by Nancy Pressly, and engineer in OSB. Ms. Pressly gives the background of probable electromagnetic interference (EMI) of medical telemetry systems from commercial broadcast TV bands and private land mobile radio service. EMI has in the past disrupted hospital telemetry systems, which are secondary users of the commercial broadcast bands. As the use of these bands is increased, there is an increased risk of EMI interference.
Almost two-thirds of children with uncomplicated acute otitis media (AOM) recover from pain and fever within 24 hours of diagnosis without treatment with antibiotics, and over 80 percent recover within 1-7 days. When treated with antibiotics, up to 93 percent of children will recover during the first week. These are the findings of an analysis of clinical studies conducted on children 4 weeks to 18 years of age from 1964 through 1998. The analysis was conducted by the Southern California/RAND Evidence-based Practice Center (EPC) sponsored by the Agency for Healthcare Research and Quality (AHRQ). The EPC found no evidence to conclude that children with AOM treated with amoxicillin fared any differently from those treated with more expensive antibiotics such as cefaclor, cefixime, azithromycin, or clarithromycin. Furthermore, amoxicillin caused fewer side effects. The EPC also found no evidence that short-duration (5 days or less) versus long-duration therapy (7-10 days) made a difference in the clinical outcome for children over 2 years of age. "Acute otitis media was chosen as an EPC topic because the lack of a standard definition and diagnosis criteria has created a great deal of uncertainty about whether, and which, antibiotics are an effective treatment," said Lisa Simpson, M.B., B.Ch., M.P.H., AHRQ deputy director. "This EPC report gives clinicians and policy makers information to address the controversy over the use of antibiotics in treating children with acute otitis media." AOM is one of the most common diagnoses in children. The EPC estimates that over 5 million episodes of AOM occur each year at a cost of approximately $3 billion. It is routine to use antibiotics for AOM in the United States, whereas in other countries, such as the Netherlands, the standard practice is to use "watchful waiting" for one to two days after the onset of an ear infection in children over 2 years of age, treating only if the infection fails to improve during that time. Although the EPC did not evaluate bacterial resistance to antibiotics, it has been reported that the rate of bacterial resistance in the Netherlands is about 1 percent, compared with the U.S. average of around 25 percent. The EPC suggests that future research examine the efficacy of antibiotics versus "watchful waiting" and a possible link to bacterial resistance. The EPC also pointed out other weaknesses and gaps in the literature that should be addressed in future research. These include the need for standard definitions of AOM and its outcomes and standard criteria for its diagnosis. In addition, the EPC encouraged rigorous study of factors that may influence AOM outcomes such as age and being prone to AOM. Summary of the EPC findings, Management of Acute Otitis Media Summary, Evidence Report/Technology Assessment 15, is available by calling the AHRQ Publications Clearinghouse at 1-800-358-9295. The full evidence report will be available later this year. (Clinical Evidence Shows Limited Effect of Antibiotic Treatment on Children With Acute Otitis Media. Press Release, August 9, 2000. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/press/pr2000/otitispr.htm)
(Which Conditions Treated in the Hospital Have the Highest Charges? Press Release, September 14, 2000. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/press/pr2000/hospcare.htm; statistics from Hospitalization in the United States 1997, HCUP Fact Book No. 1. AHRQ Publication No. 00-0031, May 2000. Agency for Healthcare Research and Quality)
The mifepristone pill, used by millions of women in 13 countries, could be available to physicians within a month and must be used within 49 days of the beginning of the woman's last menstrual period. The FDA will allow the pill be distributed only to physicians who are trained to accurately diagnose the duration of pregnancy and trained to screen women who cannot receive mifepristone--those with ectopic pregnancies--and to physicians who can operate or who have made arrangements for a surgeon to be available in case a surgical abortion is needed. (Associated Press, 9-28-2000)
Cardiac Care Provided at Teaching Hospitals is Superior to Care Provided at Non-teaching Hospitals, According to a Study Published in the Journal of the American Medical Association
The study found that 91.2 of heart attack patients in major teaching hospitals who were identified as ideal candidates for aspirin therapy received it, compared with 86.4 percent in minor teaching hospitals and 81.4 percent in non-teaching facilities; while nearly 50 percent of patients in major teaching hospitals appropriately received beta-blocker therapy and 63.7 percent appropriately received ACE inhibitors, compared to only 36.4 percent of patients appropriately receiving beta blockers and 58 percent appropriately receiving ACE inhibitors in non-teaching facilities. Mortality for heart attack patients was five percent lower for patients treated in teaching hospitals, with mortality differences seen consistently from 30 days after admission up until two years. (Journal of the American Medical Association, 9-13-2000; American Medical News, 10-9-2000)
The national survey of 3,288 adults found that:
(National Mental Health Association, 9-21-2000)
Advances Against Colorectal Cancer are ReportedResearchers at the Memorial Sloan-Kettering Cancer Center in New York have found that combining a new drug with the standard ones can more effectively slow colorectal cancer and prolong victims’ lives slightly. Colorectal cancer is the nation’s number two killer after lung cancer, claiming 56,000 lives annually. The drug irinotecan, also known as Camptosar, is already approved by the FDA for treating patients with advanced, Stage IV colorectal cancer after standard drugs fail. Researchers tested irinotecan together with the standard drugs, fluorouracil and leucovorin. The three-drug combination increased average survival from 13 months to 15 months, and the percentage of patients whose tumors temporarily shrank went from 28 percent to 50 percent, compared with the standard treatment. Additionally, far fewer patients suffered from serious side effects. The FDA called the three-drug combination the standard against which future treatments should be tested. Fluorouracil has been the standard drug for colorectal cancer since 1960, with leucovorin added since the 1970s to boost fluorouracil’s effectiveness. The study appears in the September 28 issue of the “New England Journal of Medicine.” (Fort Worth Star-Telegram, 9-28-2000)
A Medstat Group study of medical bills over six years for 46,000 employees of six large businesses concluded that $250 billion a year is spent in this country treating medical conditions stemming from unhealthy habits such as smoking and obesity. Among the study's findings were that people with stress-related illnesses cost the six employers nearly $6.2 million a year on total health care claims, former smokers cost $4.5 million annually in health claims, overweight employees cost $3.2 million and current smokers cost $2 million. (USA Today, 10-3-2000)
A national survey of emergency departments found that emergency physicians prescribed antibiotics to 25 percent of patients who had only colds or upper respiratory viral infections, and to 40 percent of patients with bronchitis. The study noted that medical residents were less likely than more experienced doctors to inappropriately give antibiotics, which the researchers attributed to increased awareness among younger physicians of the problem of antibiotic resistance. (Annals of Emergency Medicine, 10-2000; Yahoo News, 10-4-2000)
