Texas doctors fed up with Medicare's declining reimbursements dropped out of the government-funded program for the elderly in record numbers in 2010, according to new data. One hundred and seventy-two doctors formally ended involvement with Medicare last year, the most yet in a surge of "opt-outs" that has claimed more than 450 Texas doctors since 2008. Before 2007, the number averaged a handful a year. Since 2001, Medicare reimbursement has been cut about 20% in inflation-adjusted dollars. TMA officials contend those cuts are forcing doctors out of the system. The 172 opt-outs follow totals of 135 in 2009 and 151 in 2008, according to data compiled by the Houston Chronicle from the website of Trailblazer Health Enterprises, Texas' Medicare carrier. The trend started in 2007, when 70 doctors opted out.
Doctors call it "PSA velocity," the change in the level of a chemical in the blood called prostate-specific antigen. In recent years, many doctors have come to rely on it as the best indicator for when it's time for an initial biopsy to check for prostate cancer. But PSA velocity has come under challenge. A recent article in the Journal of the National Cancer Institute concludes that a rising PSA is no better sign of incipient prostate cancer than the old signal --- a PSA level over a specific threshold. That's often 4 nanograms of PSA in a thousandth of a liter of blood. (A healthy man's PSA level can range from zero to 10 and beyond.) "We found out that in many cases, to our complete surprise, [PSA velocity] didn't really tell us very much at all," says Andrew Vickers, a biostatistician at Memorial Sloan-Kettering Cancer Center in New York and lead author of the study. "Once you knew what somebody's PSA level was, their change in PSA, or PSA velocity, was essentially uninformative," Vickers says of his results, "particularly for the aggressive cancers, the ones we should really be worrying about."
A large West Virginia hospital seriously overradiated patients suspected of having strokes with CT scans for more than a year after similar episodes prompted federal officials to alert hospitals nationwide to be especially careful when using those types of scans, interviews and documents show. The patients, at Cabell Huntington Hospital in Huntington, WV were overdosed with radiation until late November, records show, even after the Food and Drug Administration had publicly issued its final report on hundreds of overdoses involving brain scans at other hospitals and the errors had been discussed publicly in Congress and by state officials and professional organizations. Federal records indicate that Cabell knew of some of the overdoses for three months, but it did not disclose them publicly until The New York Times called the hospital for comment late last week. Within hours, the hospital issued a news release that was picked up by the local media.
The question seemed simple enough: Should women in their 40s be advised to get routine mammograms in the hopes of catching breast cancers while they are still small and, presumably, easier to treat? But the more an expert panel of doctors, nurses and preventive health specialists studied the data, the harder it was to come up with an answer. Without screening, 3.5 out of every 1,000 women ages 40 to 49 will die of breast cancer in the next 10 years; regular mammography can reduce that number to 3. The panel calculated that to save one life among women in this age group, 1,900 women must be screened annually for 10 years. The other 1,899 women will receive no benefit from mammography over that period.
A change in Medicare reimbursement for a prosthetic device that allows people who have had their voice box removed to speak has led some providers to stop offering the device or reducing the number of patients they see. The change has to do with how Medicare reimburses for a device called tracheo-esophageal voice prosthesis, or TEP. The device facilitates speech for laryngectomy patients who have had surgery to remove their voice box, usually because of cancer. It must be replaced roughly two to four times a year. In the past, Medicare partially reimbursed patients who purchased TEP devices at full price from the manufacturer before having them inserted by a doctor. Now, since Oct. 1, Medicare covers only devices that have been purchased by healthcare providers. Providers say the problem is that the amount Medicare reimburses them per device is far less than the invoice price they pay.
When White House drug czar Gil Kerlikowske recently toured Appalachia, he met with 14 imprisoned women who were in drug treatment, 13 of whom were being treated for prescription-drug use. Kerlikowske asked the women how many had been to Florida to get their drugs. "Thirteen of the 14 raised their hand," Kerlikowske said. So it may be no surprise that Kerlikowske has an interest in what Florida --- considered a key supply source for prescription drugs--- does to help combat the epidemic. The debate over how to tackle the prescription-drug problem in Florida was renewed last month when Gov. Rick Scott proposed eliminating the Prescription Drug Monitoring Program, a stalled, yet much-anticipated database touted as one of the best tools for fighting the crisis. Kerlikowske recently requested a meeting with Scott, but as of Friday, the governor had not obliged.