Doctors Recommend Different Treatments for Patients Than for Themselves

A patient who can't decide between two available treatments asks his doctor: "What should I do?" Another patient, torn between the same two treatments, asks: "Doctor, what would you do if you were me?"

Will those two patients get the same answer? That question, posed by researchers from Duke University and the University of Michigan in a national survey of physicians, found doctors often recommend different treatments for patients than they would choose for themselves.

The study, from professor Peter Ubel and post-doctoral associate Andrea Angott of Duke University's Fuqua School of Business and professor Brian Zikmund-Fisher of the University of Michigan, appears in the April 11 edition of the Archives of Internal Medicine. Funding for the study was provided by the American Cancer Society, the National Science Foundation and the National Institutes of Health.

In the study, the researchers conducted a randomized experiment asking some physicians to make a recommendation to a patient seeking advice, while other physicians were asked what they themselves would choose as a patient facing the same health care decision.

Doctors frequently advised patients to pursue treatments with higher rates of side effects and lower mortality rates, while choosing treatments with lower rates of side effects and higher mortality rates for themselves.

"Our research found that people felt living with a colostomy or being paralyzed was better than dying. From that perspective, the ‘right' decision is to take the risk of side effects and reduce the chances of dying," Ubel said.

However, emotions brought on by potential significant side effects often push people away from the "right" decision. Doctors -- free from the side effects of treatment -- can make more objective treatment recommendations to their patients.

"When making recommendations to patients, physicians can push aside any emotions that would lead them astray," Ubel said. "But those emotions may loom large when a doctor is deciding for him or herself. In other words, the act of giving advice to others may reset the balance between emotion and reason."

Ubel noted, "Many physicians are biased by their own backgrounds, valuing things that patients don't necessarily value, or they can even be influenced by financial and professional conflicts of interest that can skew judgment."

As a result, you might not always get the objective advice you seek, Ubel said. "Instead, the advice you get could depend on whether your doctor is thinking about what you should do, or instead thinking about what he or she would do in your situation."

A detailed report on the research is available at http://archinte.ama-assn.org/.

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Oncologists Value Survival Over Quality of Life, Study Finds

For oncologists, drugs that help cancer patients live longer are worth more than drugs that help patients live well, according to research from Duke University's Fuqua School of Business and several health-related centers.

On average, oncologists were willing to prescribe treatments that cost about $245,000 to prolong life for one year, but the cost threshold dropped to about $119,000 per year for treatments that improve quality of life without prolonging patients' lives.

"Oncologists are understandably focused on survival, but they need to pay equal attention to the quality of life people experience during and after treatment," said senior author Peter Ubel, M.D., the John O. Blackburn professor of business administration at Fuqua.

The researchers found a wide range in what cancer doctors considered reasonable treatment costs. The threshold varied from $10,000 to $5 million per quality adjusted life year (QALY), a standard for assessing the cost-effectiveness of medical interventions. The spending thresholds assessed in the study were also measured in QALYs.

The research can be found on Medical Decision Making's website: http://bit.ly/fBIYBP.

The results highlight a critical problem in the struggle to control health care costs, Ubel said. Increasingly, doctors are being asked to consider whether very expensive cancer drugs -- some of which offer only small gains in survival -- are worth prescribing. But according to Ubel, the data on cost-effectiveness comes without guidelines for determining appropriate financial value in cancer care.

"Currently, individual oncologists are left to decide whether the benefits of expensive new drugs justify their costs," said Ubel. "Cancer care spending is unlikely to drop when there is such a broad range in what oncologists consider reasonable."

"The fact that these highly trained, wonderful doctors are confused about the issue suggests we as a society should discuss the cost of cancer care more explicitly. With health care spending emptying patients' pocketbooks, and bankrupting state and federal governments, we need to decide how much we should spend for small improvements in the quantity or quality of patients' lives."

The study results are based on a survey sent to members of the American Society of Clinical Oncology. The 768 physicians who responded considered two hypothetical scenarios involving a patient with metastatic cancer and a year to live.

The first scenario asked the doctor how much benefit, in months of survival gained, a new drug would need to provide for them to prescribe it. The new drug cost $75,000 more than standard treatment. The second scenario asked the doctor to indicate the highest cost at which they would prescribe a medication to improve the quality of life without prolonging survival.

The respondents consistently chose to spend more on life-prolonging treatments than on quality-enhancing treatments.

Additional authors of the study include Michael A. Kozminski and Aleksandra Jankovic of the Center for Behavioral and Decision Sciences in Medicine, University of Michigan Medical School in Ann Arbor, Mich.; Peter J. Neuman of the Institute for Clinical Research and Health Policy Studies, Tufts Medical Center in Boston; and Eric S. Nadler of the Charles Sammons Cancer Center, Baylor University Medical Center in Dallas.

The study was funded by grants from the California Healthcare Foundation and the Tufts Medical Center.

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AHIMA Files Response to HHS Privacy Rules

/PRNewswire/ -- The following statement was released today by Rita K. Bowen, President, AHIMA Board of Directors:

"While AHIMA (American Health Information Management Association ) continues to applaud federal government support for the ideal of protecting patients' health information rights, the proposed rule-making for HIPAA privacy, security and enforcement by HHS has a number of requirements that we do not believe the industry is ready to undertake; especially as it gears up for Meaningful Use. Today AHIMA is releasing its recommendations to the HHS Office of Civil Rights (OCR) that speak to the issues we believe are most critical to the patients of America, the healthcare industry and the best practice of health information management.

"As staunch supporters of patients' health information rights, AHIMA agrees the single most contentious issue in the proposed regulation is the ability of individuals to restrict the information held by their healthcare providers from being shared with their health plan. While AHIMA believes an individual's control over this data flow is valid, data flow restrictions in the HHS proposal creates unintended repercussions for data integrity, data processing and other elements within the current US reimbursement system.

"Many AHIMA members are engaged in providing patients' individual and aggregate data for a variety of approved uses. There is a continued discussion within the profession on how to best cover the costs of the retrieval, analysis and release of information within the context of the privacy and security regulations, patient restrictions; and the need to verify the requesting individual as a means of keeping released information available to a necessary minimum. Additionally, we remain concerned the charges permitted by states or HIPAA do not cover all costs and ultimately raise the cost of health care.

"AHIMA also questions the sale of patient health information when an organization is being absorbed by a second organization. The OCR's approach, while practical, raises the issue of whether consumers have the right to determine if their health information should be transferred with the ownership of a health organization.

"Finally, AHIMA feels strongly that the OCR needs to provide greater clarification regarding the definition of 'agents' as it relates to covered entities and who should be covered by HIPAA, including its hybrid organizations."

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CDC: Two-Thirds of Emergency Visits Occur During Non-Business Hours; Percentage of Non-Urgent Emergency Patients Drops To Less than 8 Percent

/PRNewswire/ -- A new report from the Centers for Disease Control and Prevention once again debunks the myth that emergency departments are crowded with non-urgent patients, a finding noted by the American College of Emergency Physicians (ACEP).

"The percentage of non-urgent patients dropped to only 7.9 percent in 2007 [from 12.1 percent in 2006]," said Dr. Angela Gardner, president of ACEP. "The report also makes the excellent point that non-urgent does not imply unnecessary. As we have said repeatedly, our patients are in the ER because that's where they need to be.

There were approximately 222 visits to U.S. emergency departments every minute in 2007 (http://bit.ly/9B5kHJ) and the number of visits increased by 23 percent between 1997 and 2007, according to the report. Preliminary data for 2008 indicate that emergency visits will increase to a record high of more than 123 million (http://bit.ly/ak6oRx).

The report, "National Hospital Ambulatory Medical Care Survey: 2007 Emergency Department Summary" offers far more detail than the data brief released by the Centers for Disease Control and Prevention (CDC) in May. The U.S. Department of Health and Human Services, of which the CDC is a part, has indicated that this is the last fully detailed report of its kind to be issued about emergency department visits.

Dr. Gardner is urging the CDC to reconsider:

"It is essential to know what is happening in our emergency departments as we implement health care reform. This report is rich in data about who our patients are, how old they are and why they are seeking care in the ER. From a planning perspective, this information is invaluable. It would be a mistake for the CDC to discontinue tracking what is happening on the front lines of healthcare, the nation's emergency departments."

Babies under 12 months old had the highest visit rate at 88.5 visits per 100 infants. The second highest visit rate was by adults age 75 and older, with 62 visits per 100 people.

Approximately one-quarter of all visits were by patients insured by either Medicaid or the State Children's Health Insurance Program. The uninsured represented about 15 percent of all visits.

"Most doctors' offices are open for around 45 hours a week, as opposed to the 168 hours a week emergency departments are open," said Dr. Gardner. "That nearly two-thirds of emergency patients came to the ER between 5 p.m. and 8 a.m. during the week or on weekends highlights the unpredictable nature of health emergencies. When you are the one who has a sick child, the last thing you want is a 'closed' sign or after-hours message."

The report also notes that only 0.1 percent of patients die in the emergency department.

"We do an excellent job of stabilizing and treating our patients, but the persistent problems of overcrowding, ambulance diversion and boarding admitted patients in the ER are not going away," said Dr. Gardner. "We know from the Massachusetts experience that visits will continue to rise with health care reform. We also know that as Baby Boomers age, a tsunami of patients in need of emergency care is just around the corner. We need help and we need it now."

The report says the main issue contributing to overcrowding has been delays in moving the sickest patients to inpatient beds. Admitted patients have often been boarded in the emergency departments or hospital hallways for hours to days, resulting in overcrowding and diversion of incoming ambulances to other hospitals.

ACEP is a national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.

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HHS Orders Intravenous Antiviral Flu Medication to Help Patients Hospitalized with 2009 H1N1

The U.S. Department of Health and Human Services (HHS) today (November 5) announced contract awards for up to 120,000 treatment courses of intravenous (IV) antiviral drugs to help treat hospitalized 2009 H1N1 influenza patients.

Patients hospitalized with 2009 H1N1 influenza are evaluated to determine if antiviral drugs will be useful; some patients are not able to take the drugs that are currently available as pills or liquid and may benefit from intravenous antiviral medications.

To help meet the potential need for IV medications to combat the H1N1 virus, HHS ordered 10,000 treatment courses each from BioCryst, Roche and GlaxoSmithKline, totaling $31.5 million. The contracts allow HHS to place additional orders of up to 30,000 treatment courses with each manufacturer over two years. Roche manufactures Tamiflu; GlaxoSmithKline, Relenza, and BioCryst manufactures Peramivir.

Because there are no Food and Drug Administration (FDA)-approved antiviral medications that can be administered intravenously to treat influenza, the FDA issued an emergency use authorization on Oct. 23 to allow use of intravenous peramivir, an investigational antiviral drug in the class of drugs known as neuraminidase inhibitors.

The HHS orders for intravenous oseltamivir (Tamiflu) and intravenous zanamivir (Relenza), also neuraminidase inhibitors, are predicated on FDA emergency use authorization for these medications.

FDA has not issued emergency use authorization authorizing the use of intravenous Tamiflu or Relenza. Orders for Tamiflu and Relenza are based on anticipated need of emergency use authorizations for additional IV drugs in the future. Tamiflu and Relenza) are FDA-approved in the form of pills or liquid, and studies are ongoing into the use of these two drugs intravenously for hospitalized H1N1 flu patients.

The emergency use authorization for IV peramivir allowed doctors to prescribe the drug to treat certain adults and children hospitalized with confirmed or suspected 2009 H1N1 infections. Specifically, IV peramivir is authorized only for hospitalized adult and pediatric patients for whom therapy with an IV drug is clinically appropriate.

To authorize emergency use of any product, the FDA commissioner must determine that in an emergency, based on the totality of scientific evidence available, it is reasonable to believe that the product may be effective in diagnosing, treating, or preventing the serious or life threatening disease or condition; that the known and potential benefits of the product outweigh the known and potential risks of the product in the emergency situation, and that there is no adequate, approved, and available alternative to the product for diagnosing, preventing, or treating such serious or life threatening disease or condition.

The Biomedical Advanced Research and Development Authority (BARDA) within the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR) will manage the contracts. BARDA supported the advanced development of IV peramivir beginning in 2007 as part of a larger HHS initiative to develop promising new influenza medications and vaccines.

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HHS Awards $17 Million in a New National Initiative to Fight Health Care-Associated Infections

/PRNewswire/ -- HHS Secretary Kathleen Sebelius today announced the award of $17 million to fund projects to fight costly and dangerous health care-associated infections, or HAIs.

"When patients go to the hospital, they expect to get better, not worse," Secretary Sebelius said. "Eliminating infections is critical to making care safer for patients and to improving the overall quality and safety of the health care system. We know that it can be done, and this new initiative will help us reach our goal."

HAIs are one of the most common complications of hospital care. Nearly 2 million patients develop HAIs, which contribute to 99,000 deaths each year and $28 billion to $33 billion in health care costs. HAIs are caused by different types of bacteria that infect patients being treated in a hospital or health care setting for other conditions. The most common HAI-causing bacteria is methicillin-resistant Staphylococcus aureus, or MRSA. The number of MRSA-associated hospital stays has more than tripled since 2000, reaching 368,600 in 2005, according to HHS' Agency for Healthcare Research and Quality's (AHRQ) Healthcare Cost and Utilization Project.

Of the $17 million, $8 million will fund a national expansion of the Keystone Project, which within 18 months successfully reduced the rate of central-line blood stream infections in more than 100 Michigan intensive care units and saved 1,500 lives and $200 million. The project was originally started by the Johns Hopkins University in Baltimore and the Michigan Health & Hospital Association to implement a comprehensive unit-based safety program. The program involves using a checklist of evidence-based safety practices; staff training and other tools for preventing infections that can be implemented in hospital units; standard and consistent measurement of infection rates; and tools to improve teamwork among doctors, nurses and hospital leaders.

Last year, AHRQ funded an expansion of this project to 10 states. With additional funding from AHRQ and a private foundation, the Keystone Project is now operating in all 50 states, Puerto Rico and the District of Columbia. The new funding announced today will expand the effort to more hospitals, extend it to other settings in addition to ICUs, and broaden the focus to address other types of infections. Specifically, the new $8 million in funding will provide:

-- $6 million to the Health Research & Educational Trust for national
efforts to expand the Comprehensive Unit-Based Patient Safety Program
to Reduce Central Line-Associated Blood Stream Infections. The funding
will allow more hospitals in all 50 states to participate in the
program and expand the program's reach into hospital settings outside
of the ICU. The Health Research & Educational Trust will also use $1
million to support a demonstration project that will help fight
catheter-associated urinary tract infections.

-- $1 million to Yale University to support a comprehensive plan to
prevent bloodstream infections in hemodialysis patients.


AHRQ, in collaboration with the Centers for Disease Control and Prevention (CDC), also identified several high-priority areas to apply the remaining $9 million toward reducing MRSA and other types of HAIs. These projects will focus on:

-- Reducing Clostridium difficile infections through a regional hospital
collaborative.
-- Reducing the overuse of antibiotics by primary care clinicians
treating patients in ambulatory and long-term care settings.
-- Evaluating two ways to eliminate MRSA in ICUs.
-- Improving the measurement of the risk of infections after surgery.
-- Identifying national-, regional- and state-level rates of HAIs that
are acquired in the acute care setting.
-- Reducing infections caused by Klebsiella pneumoniae
Carbapenemase-producing organisms by applying recently developed
recommendations from CDC's Healthcare Infection Control Practices
Advisory Committee.
-- Standardizing antibiotic use in long-term care settings (two
projects).
-- Implementing teamwork principles for frontline health care providers.

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'Doc Buy' Fails as Physician Support for Health Care Overhaul Wanes - Shadow Bill Concealing $247 Billion in Health Costs Defeated

'Doc Buy' Fails as Physician Support for Health Care Overhaul Wanes - Shadow Bill Concealing $247 Billion in Health Costs Defeated in Critical Senate Vote

/Standard Newswire/ -- Patients First, A Project of Americans for Prosperity(tm) is praising the U.S. Senate's bipartisan rejection of the $247 billion so-called "Doc Fix" bill (S.1776) by a 53-47 margin.

Senate Majority Leader Harry Reid had attempted to hastily force the bill through the Senate to
simultaneously purchase the support of doctors in the larger health care legislative battle, while concealing the full cost of the health overhaul in a shadow bill.

Leader Reid had abruptly scheduled today's failed cloture vote to increase Medicare payments to doctors by $247 billion. The tricky tactic, which would also have required a vote to waive Senate budget rules, raised criticism since it would conceal the total cost of the health care plan being considered in Congress by splitting the overhaul into two separate bills. The Senate Finance Committee recently voted for a $904 billion plan, but the addition of this $247 billion bill would have pushed the total cost of the overhaul to well over $1.1 trillion, violating the White House's
pledge to keep the health care plan deficit neutral.

"The 53 Senators that voted against this hastily-crafted backroom health care deal deserve credit," said Phil Kerpen, policy director of Patients First. "Leader Reid's attempt to use outright deception and trickery to conceal the true costs of the attempted Washington takeover of health care has failed. Americans have the right to know the details of how government-forced health care would impact their access to quality affordable health care. Transparency and open debate, not backroom deals and legislative gimmicks, offer us a way forward towards real health care
reform."

The "Doc Fix" bill's defeat spells further trouble for the Obama Administration and Congressional Democrats as they court critical support from doctors for the controversial health care overhaul. A recent IBD/TIPP Poll of nearly 1,400 doctors found that two-thirds of
physicians oppose the reforms proposed by Congress. 45 percent of doctors said that enactment
would force them to consider retiring or abandoning their practice, and 67 percent anticipated fewer medical school applicants. Meanwhile, 65 percent of doctors believed that the plan would lead to lower-quality care for seniors and 71 percent said that it was impossible for government to insure 47 million more Americans while cutting costs and providing better quality care.

"America's doctors cannot be bribed into supporting legislation that will restrict patient choice, increase bureaucracy, defund Medicare for seniors, and drive costs so high that middle class taxpayers suffer," said Phil Kerpen. "Our nation's physicians want to care for their patients, and government should not stand in the way of the sacred doctor-patient relationship."

Patients First, A Project of Americans for Prosperity(tm), is focused on real health care reform--reform that puts patients first. Patients First believes that Americans want and need more health insurance options--not just a costly, government-defined plan paid for by American taxpayers.

Patients First is a project of Americans for Prosperity® (AFP), a 501(c)(4) non-profit organization recognized by the IRS. AFP is the nation's premier grassroots organization committed to advancing every individual's right to economic freedom and opportunity. AFP has more than 700,000 members, including members in all 50 states, and 25 state chapters. Patients First is not affiliated in any way with Patient First health clinics. For more information on Patients First, go to www.JoinPatientsFirst.com (http://rs6.net/tn.jsp?et=1102780163328&s=13633e=001ZT5NIGsO3Sm71FnQxFM7c909urFNCe1BrHFUUxAchDovoi3PcvaYNpHK1T8
3srDskHtH9Wp_AWd5JxMhq2QGU6eumkYedekDD05_3N4yT1ANSouKAwNgOyU__ZtAVjIv).

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Cancer Community Alarmed at CMS Policy Lumping Life-Saving Cancer Therapy With Diagnostic Testing For Major Funding Cuts

/PRNewswire/ -- The following is being released by US Oncology:

Concerned members of the cancer community, including physicians, patient organizations and other care advocates, spoke out today in opposition to a proposed federal policy under consideration by the Centers for Medicare and Medicaid Services (CMS) that would lump life-saving radiation therapy in with diagnostic testing services in receiving major Medicare funding cuts. In support of their cause, a bipartisan letter led by Reps. Parker Griffith (D-AL), Sue Myrick (R-NC), Lois Capps (D-CA) and Mike Rogers (R-MI), was sent to Health and Human Services Secretary Kathleen Sebelius urging a reversal of this proposal.

"I am very alarmed at the prospect of these dangerous funding cuts being made to radiation therapy, which is a safe and effective treatment proven as a trusted tool in the fight against cancer," said Bernard W. Taylor, M.D., a radiation oncologist at Texas Oncology-Longview Cancer Center in Longview, Texas. "For vulnerable cancer patients like mine, this proposed policy would limit their access to vital radiation treatment through longer wait times and less time spent with their doctors. We must educate policymakers on the radical difference between life-saving, therapeutic radiation therapy and diagnostic testing, and the critical need to spare radiation therapy from these cuts."

At issue is a 19 percent funding cut in Medicare reimbursement to the radiation oncology specialty contained within the CY 2010 Physician Fee Schedule Proposed Rule, equating to cuts of up to 44 percent for certain codes critical to the provision of radiation therapy treatments. Of particular concern in the rule is a proposed policy that raises the utilization rate for medical equipment costing over one million dollars from 50 to 90 percent. The lawmakers and other experts in the industry warn that cuts of this size will result in the closing of many freestanding and community-based cancer centers, particularly in rural areas, harming patient access to care.

"As a radiation oncologist who practiced in the community setting, I am aware of how these severe cuts would limit access to life-saving radiation therapy for cancer patients," said Rep. Griffith. "I am proud to be working on healthcare reform to expand access to high quality, effective care for cancer patients and all Americans, and I look forward to working with both parties as well as the administration to find a solution that averts these cuts and protects patient access to care."

The Congressional letter submitted to Secretary Sebelius, signed by more than 60 Members of Congress, asked CMS to refrain from finalizing the proposed reductions in Medicare payment for radiation oncology services, and to refrain from applying a higher assumed equipment utilization rate to radiation oncology equipment. The letter states:

"We are writing you today to emphasize a clear distinction: Radiation therapy is not diagnostic imaging. . . The therapeutic use of radiation to treat cancer should not be the target of those concerned with volume growth in the area of diagnostic imaging."

The proposal to reduce rates for diagnostic imaging was made by the Medicare Payment Advisory Commission (MedPAC) in their March 2009 report. MedPAC has subsequently stated that it never intended to include radiation therapy in any Medicare reimbursement cuts and yet CMS proposed to extend the cuts to radiation oncology anyway.

According to the National Cancer Institute (NCI), radiation therapy has been found to be under-utilized, with a variety of barriers, including travel time to care, cited as standing between patients and treatment. Following a review of relevant literature, the Agency for Health Care Research and Quality (AHRQ) found evidence of disparities in radiation therapy use among older patients; women; and African Americans, with the exception of care provided in the Veterans' Administration system. In another study of more than 11,000 women in Florida who had undergone breast conserving surgery, the odds of receiving post-surgical radiation therapy decreased by 3 percent for every 5-mile increase in the distance to the nearest radiation therapy facility.

"We support using data to ensure that payment rates for medical procedure are appropriate," said Leonard Kalman, M.D., Chairman of US Oncology's Public Policy Steering Committee. "However, making cuts of this size to radiation therapy - a treatment modality that more than 1 million cancer patients rely upon each year for both curative intent and palliative treatment - without an expressed rationale backed by supporting data is unsound and frankly quite frightening. On behalf of our country's cancer patients, many of whom will rely on radiation therapy at some point in their illness, we must ensure that these cuts are not applied."

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