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Teaching Hospital Update - April 2-6, 2012


Email Alert

April 6, 2012

By Sarah Kitchell*

Many Common Tests and Procedures Unnecessary, Physician Groups Say

Nine leading physician specialty societies released lists on April 4 identifying specific tests or procedures that they say are commonly used but not always medically necessary, and urged patients to raise questions when those procedures are offered.

The lists were released as part of an initiative called Choosing Wisely, which is coordinated by the American Board of Internal Medicine (ABIM) Foundation. The lists, Five Things Physicians and Patients Should Question, represent specific, evidence-based recommendations physicians and patients should discuss to help make wise decisions about the most appropriate care for their individual situation, ABIM said. Each list provides information on when tests and procedures may be appropriate, as well as the methodology used in its creation.

The lists will be publicized by Consumer Reports, AARP, and other consumer groups, ABIM said. The lists include questions relating the appropriate use of medical imaging procedures recommended by groups such as the American College of Radiology, the American College of Cardiology, and the American College of Physicians. Other specialty groups will release additional lists this fall.

Nathaniel Weixel, Many Common Tests and Procedures Unnecessary, Physician Groups Say, BNA Health Care Daily Report (April 5, 2012) (note: registration is required to access this article).

Senate Drafts Plan to Speed Up FDA Drug Approval

A U.S. Senate committee on April 4 released proposed legislation involving U.S. Food and Drug Administration (FDA) approval processes that would expedite development of new, innovative medicines for serious and life-threatening diseases.

The draft bill was proposed by the Senate health committee as part of broader upcoming user fee legislation, a must-pass package that will authorize FDA to continue collecting user fees from the drug and device industries. The user fee package will also include goals FDA has agreed to meet, including reduced review times.

The plan aims to quicken patient access to new medical treatments by modernizing FDA's Accelerated Approval pathways. The draft says the plan may result in fewer, smaller, or shorter clinical trials for the intended patient population but won't compromise or alter FDA's standards for the approval of drugs.

It would also give FDA the ability to move toward more innovative clinical trials that may lower the number of patients enrolled with a placebo and shorten the duration of trials. The agency would have sixty days to determine whether a proposed drug meets the breakthrough standards after its manufacturers request the designation.

Maria Chutchian, Senate Drafts Plan to Speed Up FDA Drug Approval, Law360 (April 4, 2012) (note: registration is required to access this article).

Criminal Background Checks Provide Patchwork Protection Against Rogue Doctors

Driving under the influence, tax evasion, fraud, battery, and sexual assault. These are some of the charges that have been revealed in criminal background checks of physicians by medical boards around the country. Often the doctors in question try to hide their criminal past, but that has become increasingly difficult.

Physicians with criminal records may be denied a license, have restrictions placed on their practice, or face no repercussions, depending on the will of the board in a particular state.

Of the nation's seventy medical boards, forty-six boards in thirty-six states can conduct a criminal background check as a condition of licensure. Of those, forty boards in thirty-one states have access to the Federal Bureau of Investigation database, according to the Federation of State Medical Boards. Medical boards in fourteen states lack the authority to conduct the searches on physicians. At least one of those statesMinnesotais considering legislation to mandate such checks.

The Association of American Medical Colleges (AAMC) has recommended such checks for all medical school applicants since 2006. Of the nation's 137 accredited allopathic medical schools, 102 had the checks run through AAMC's American Medical College Application Service for students who will begin classes in Fall 2012.

Carolyne Krupa, Criminal Background Checks Provide Patchwork Protection Against Rogue Doctors, American Medical News (April 2, 2012).

FSMB Overview: Federation of State Medical Boards, Authority to Run Criminal Background Checks: Board-by-Board Overview (Feb. 24, 2012).

Prescription Drug Spending Ticked Up to $320 Billion in 2011

Spending on prescription drugs in the United States ticked up to $320 billion in 2011, as new medications entered the market and younger patients increased their usage after the Patient Protection and Affordable Care Act of 2010 helped them stay on their parents' insurance plans, research firm IMS Health Inc. said Wednesday.

The spending, which rose roughly 3.7% from 2010's $308.6 billion, increased a modest 0.5% on a per-capita basis even as more new medicines were launched than in previous years, in part because overall per-capita use of medications took a slight dip last year, when doctor's office visits and non-emergency-room hospital admissions decreased and senior Americans used fewer retail drugs, according to the report, The Use of Medicines in the United States: Review of 2011.

People above the age of sixty-five cut their use of prescription drugs by 3.1% last year, with young people between the ages of nineteen and twenty-fivethe only group that increased its use of medications last yearincreasing their medicine use by 2%, particularly for treatments for attention deficit hyperactivity disorder and depression, the report found.

Sindhu Sundar, Prescription Drug Spending Ticked Up to $320 Billion in 2011 Law360 (April 4, 2012) (note: registration is required to access this article).

Study: IMS Institute for Health Informatics, The Use of Medicines in the United States: Review of 2011 (April 2012) (note: registration is required to access this article).

Study IDs Hospital Frequent Flyers

Patients with psychiatric disorders and those with chronic pain used a disproportionally high amount of healthcare resources because of frequent hospital readmission, a study reports.

In a chart review of twenty-nine patients who had an index admission during 2011 and six or more readmissions, 55% had psychiatric conditions and 52% had chronic pain, reported Michael Hwa, MD, of the University of California San Francisco, and colleagues, at the Society of Hospital Medicine annual meeting.

Little is known about this population because most data on frequent use have focused on emergency departments and have been disease specific, such as patients with asthma. Other common diagnoses included pneumonia, chronic obstructive pulmonary disease, end-stage renal disease, and persistent vomiting.

To better characterize patients who are high users of inpatient services, the researchers looked at administrative data from their 600-bed academic medical center and found that their high-using cohort represented only 1% of all admissions to the medical service, yet accounted for 13% of readmissions.

Among the 55% of patients with psychiatric diagnoses, mostly depression, only 10% were actively seeing a psychiatrist. And few of the chronic pain patients were seeing a specialist for their condition, he added. This study implied that a more-individualized, multidisciplinary approach may be necessary, more closely involving nurses, social workers, and emergency department staff.

Nancy Walsh, Study IDs Hospital Frequent Flyers, MedPage Today (April 5, 2012).

*We would like to thank Sarah Kitchell, Esquire (McDermott Will & Emery LLP, Boston, MA), for providing this week's update.

AHLA Teaching Hospital Updates are intended to provide quick summaries of cutting-edge issues of interest to teaching hospitals and their counsel. Additional information and more in-depth coverage on these topics may be available from AHLA Health Lawyers Weekly and appropriate AHLA Practice Groups.

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