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Physician's First Watch: Archives
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Did You Pay Retail for That Pneumonia? Hospitals' Prices Revealed
By Joe Elia
The government has published what 3300 U.S. hospitals charge Medicare for the top 100 diagnosis-related groups, and what Medicare pays in return.
The charges vary widely, even between neighboring hospitals. For example, the New York Times reports that while one Dallas hospital charged an average of about $15,000 for treating simple pneumonia, another charged over $38,000; the government actually pays about $9000 for such treatments.
For their part, private insurers pay roughly 30% above Medicare rates. So who is actually paying the higher amounts? According to the Times, it is "those with little or no insurance" who are receiving bills "that may bear little connection to the cost of treatment."
The Washington Post has taken the data and assembled an interactive state-by-state map of 10 representative diagnoses and the state's average billings.
LINK(S):
Medicare Provider Charge Data (Free)
New York Times story (Free)
Washington Post interactive feature (Free)
Background: Physician's First Watch coverage of Time magazine's issue on costs (Free)
Published in Physician's First Watch May 9, 2013
Hepatitis C RNA Testing Recommended for All Positive HCV Antibody Tests
By Kelly Young
After a positive antibody test for hepatitis C virus (HCV), the CDC recommends that clinicians perform an RNA HCV test to better identify patients with current infections.
In guidelines published in MMWR, the CDC advises that if the RNA test comes back negative, it indicates either past HCV infection or a false-positive antibody test. However, if the person has had suspected HCV exposure within the prior 6 months or has clinical evidence of HCV, then repeat RNA testing and appropriate counseling are indicated.
The guidelines are published jointly with a CDC analysis that found, between 2005 and 2011, about half of people with HCV infection at eight surveillance sites didn't have an HCV RNA test, making it difficult to discern whose infections were current. People born between 1945 and 1965 accounted for 63% of all newly reported HCV infections.
LINK(S):
MMWR guidance for clinicians (Free)
MMWR article (Free)
Published in Physician's First Watch May 8, 2013
Chest Physicians Recommend CT Lung Cancer Screening for High-Risk Patients
By Amy Orciari Herman
Smokers and former smokers aged 55 to 74 who have accumulated 30 or more pack-years of smoking should be screened annually for lung cancer with low-dose computed tomography (CT), according to new guidelines from the American College of Chest Physicians.
Published in Chest, the guidelines specify that to lower the risk for death, screening must be performed at a center with "multidisciplinary coordinated care and a comprehensive process for screening, image interpretation, management of findings, and evaluation and treatment of potential cancers."
CT screening is not recommend for younger or older smokers, those who've smoked for less than 30 pack-years, those who quit more than 15 years earlier, or those with significant comorbidities that limit life expectancy.
LINK(S):
Chest executive summary (Free)
Published in Physician's First Watch May 8, 2013
Economists Wonder Why Health Costs Continue to Stabilize
By Joe Elia
Policy wonks are scratching their heads over continued good news about U.S. health costs. National health spending increased at a stable rate from 2009 to 2011, at about 4% per year. That's in contrast to increases of 6% to almost 10% between 2000 and 2007.
What has them most puzzled, according to a report in the New York Times and blogs in Health Affairs, is that the spending slowdown doesn't seem to be entirely attributable to the last recession.
Commentators point to "fundamental structural changes in the health system" as playing a role. Among those changes is the increasing likelihood that physicians are salaried and not practicing under fee-for-service incentives. Also at play is the fact that patients' out-of-pocket costs have increased substantially, by some 140% over the past 10 years, according to the New York Times.
LINK(S):
New York Times story (Free)
Health Affairs blog #1 (Free)
Health Affairs blog #2 (Free)
Published in Physician's First Watch May 8, 2013
Featured in Journal Watch: Benefits of Sequentially Offering CRC Screening Tests
By The Journal Watch Editors
In a population-based screening program, 19% of people who refused sigmoidoscopy took a fecal immunochemical test, which detected 8% of all advanced adenomas and 20% of all cancers, according to a study in Gut.
LINK(S):
Journal Watch Gastroenterology summary (Free)
Published in Physician's First Watch May 8, 2013
FDA: Women Should Not Take Valproate for Migraine While Pregnant
By Kelly Young
Pregnant women should not take drugs containing valproate for migraine prevention, the FDA warned on Monday, citing the potential for decreased IQ in offspring. The warning includes valproate sodium (Depacon), divalproex sodium (Depakote, Depakote CP, and Depakote ER), and valproic acid (Depakene and Stavzor).
The drug is now in the FDA's pregnancy category X (drugs whose risks clearly outweigh their benefits).
The Neurodevelopmental Effects of Antiepileptic Drugs (NEAD) study found that children exposed to valproate in utero had lower IQs (between 8 and 11 points lower) at age 6, compared with children exposed to other antiepileptic medications. It is unknown at what point in pregnancy valproate exposure can affect cognition.
Women taking valproate during childbearing years should use effective birth control, the FDA says. Pregnant women taking valproate should consult a clinician before stopping. Women with epilepsy and bipolar disorder may continue taking valproate during pregnancy, but only if symptoms are uncontrolled with other drugs or if other treatments are unacceptable.
LINK(S):
FDA MedWatch safety alert (Free)
Background: Journal Watch Neurology summary on NEAD study (Your Journal Watch subscription required)
Published in Physician's First Watch May 7, 2013
Pfizer to Sell Viagra Directly from Its Website
By Joe Elia
Pfizer says it will make its most-counterfeited product, the erectile dysfunction drug Viagra (sildenafil), directly available on its website, making it the first major drugmaker to try this approach.
A prescription is still required, and the pills will sell for $25 each, according to the Associated Press. Three pills in the first order are free.
LINK(S):
Pfizer announcement (Free)
Associated Press story (Free)
Viagra label (Free PDF)
Published in Physician's First Watch May 7, 2013
FDA Warns Against Confusing Herceptin with Kadcyla in Electronic Systems
By Joe Elia
Two drugs used against breast cancer have "quite different" dosing and treatment schedules, but share similar generic names that may confuse electronic ordering systems, the FDA warns.
One drug is Herceptin, whose generic name is trastuzumab; the other is Kadcyla, with the generic name ado-trastuzumab emtansine.
The FDA says that some health information systems and pharmacy ordering systems are incorrectly dropping the "ado-" prefix, which can lead to confusing the two drugs. There have been no reported mix-ups yet. However, Kadcyla was only approved in February, and some confusion did occur during clinical trials.
The agency is recommending use of both the proprietary and generic names on prescriptions.
LINK(S):
FDA MedWatch safety alert (Free)
Published in Physician's First Watch May 7, 2013
Featured in Journal Watch: Acetaminophen as Anxiolytic?
By The Journal Watch Editors
In experiments reported in Psychological Science, acetaminophen modified how people responded to angst, "possibly by taking the edge off feelings of unsettling uncertainty," Joel Yager writes.
LINK(S):
Journal Watch Psychiatry summary (Free)
Published in Physician's First Watch May 7, 2013
Pediatrics Group Updates Policy Statement on Caring for Immigrant Children
By Amy Orciari Herman
Pediatricians should advocate for health insurance for all children living in the U.S., according to a new policy statement from the American Academy of Pediatrics on caring for immigrant, migrant, and border children.
Published in Pediatrics, the statement notes that roughly 25% of U.S. children live in immigrant families. Among the other recommendations for pediatricians caring for this patient population:
- Children's immunization status should be carefully assessed.
- Newly arrived, foreign-born children should be evaluated for infectious diseases; lead, vision, and hearing screening should also be considered.
- Beliefs around traditional healing practices and medication use should be discussed.
- Information on culturally relevant federal, state, and community resources should be made readily available for families.
LINK(S):
Pediatrics article (Free PDF)
AAP's Bright Futures toolkit for well-child care (Free)
Published in Physician's First Watch May 7, 2013
