Ads Influence Prescribing
Direct-to-consumer advertisements appear to have an impact on physician prescribing practices, a study by Richard L. Kravitz, M.D., of the University of California, Davis, found. A total of 152 general internists and family physicians were recruited from solo and group practices and health maintenance organizations to participate in the study, which focused on advertising for prescription antidepressants (JAMA 2005;293:1995–2002). Standardized patients were randomly assigned to make 298 unannounced visits, presenting either with major depression or adjustment disorder with depressed mood. When the patients with depression made a general request for an antidepressant, only 3% of the physicians prescribed paroxetine (Paxil). However, when they asked for the prescription by name, 27% were given a prescription for Paxil. In addition, patients with adjustment disorder symptoms were more likely to receive a prescription for an antidepressant if they made a brand specific request (55%) versus a general request (39%).
E-Prescribing Standards
Medicare should adopt a program-wide system of uniform national electronic prescribing standards for its new prescription drug benefit, according to the Pharmaceutical Care Management Association (PCMA). A uniform national standard is key to maximizing the participation of private plans in the Part D benefit and in helping to reduce regional variations in health care delivery and outcomes, PCMA said in comments sent to the Centers for Medicare and Medicaid Services on its proposed rule for Medicare e-prescribing standards. “PCMA believes that Medicare e-prescribing holds the potential to transform the health care delivery system,” PCMA President Mark Merritt said in a statement. “Regrettably, a 50-state patchwork approach would increase costs, decrease efficiency, and severely undermine the promise of e-prescribing.” The organization also urged CMS officials to pre-empt duplicative and conflicting state laws that could result in increased costs.
CMS: Pay for Performance Works
Preliminary data indicate that pay-for-performance is improving quality of care in hospitals. A 3-year demonstration project sponsored by the Centers for Medicare and Medicaid Services is tracking hospital performance on a set of 34 measures of processes and outcomes of care for five common clinical conditions. Reports from more than 270 participating hospitals on their experiences during the project's first year show that median quality scores improved in all of the clinical areas. For example, scores increased from 90% to 93% for patients with acute myocardial infarction; from 64% to 76% for patients with heart failure; and from 70% to 80% for patients with pneumonia. These early findings demonstrate that using financial incentives works to promote delivery of better patient care and to avoid costly complications for patients, said CMS Administrator Mark B. McClellan, M.D.
New Medicare Wheelchair Policy
Ability to function is the primary criteria in the new national coverage policy issued by CMS for power wheelchairs and scooters. The criteria look at how well the beneficiary can accomplish activities of daily living such as toileting, grooming, and eating with and without using a wheelchair or other mobility device. The criteria are “part of our efforts to ensure that seniors who need mobility help will get it promptly, and that we are paying appropriately for mobility assistive equipment,” Dr. McClellan said in a statement. The coverage policy is one element in Medicare's year-old effort to improve the coverage, payment, and quality of suppliers for wheelchairs and scooters. That effort was launched after Medicare spending on mobility equipment rose to $1.2 billion annually.
Uninsured Rates Among the States
Minnesota has the lowest uninsured rate among employed adults (7%), followed by Hawaii, the District of Columbia, and Delaware, each with uninsured rates of 9%. The states with the highest rates of uninsured residents include Texas (27%), New Mexico (23%), and Florida (22%). The report was compiled by the Robert Wood Johnson Foundation, which analyzed 2003 data from the Centers for Disease Control and Prevention. Although some states fare better than others, the problem is pervasive among workers in every state. More than 20 million working adults do not have health insurance. In eight states, at least 1 in 5 working adults is uninsured, and in 39 other states at least 1 working adult in every 10 does not have health coverage.
Unhealthy Habits
Very few Americans are doing all they can to maintain a healthy life, according to a nationally representative survey of 153,805 adults (Arch. Intern. Med. 2005;165:854–7). Mathew Reeves, Ph.D., of Michigan State University, East Lansing, found that only 3% followed four steps that define a healthy lifestyle: not smoking, holding weight down, eating adequate amounts of fruits and vegetables, and exercising. Women tended to follow these steps more than men, as did whites compared with minority populations. But no one group came close to what is necessary to lead a healthy life, Dr. Reeves said. When assessed individually, these health statistics didn't look as grim: Of the respondents, 76% said they didn't smoke, 23% included at least five fruits and vegetables in their diets, and 40% maintained a healthy weight.