Dozing Doctors Endure
Residents and medical students are still suffering from fatigue, despite the shorter work hours established in 2003 by the Accreditation Council for Graduate Medical Education. In a survey of 1,126 medical students and 1,010 residents, the American Medical Association found that 44% of residents and 39% of medical students said they've experienced sleep deprivation about once a week or more often during their most recently completed rotation. The ACGME work limit is 80 hours per week, but 11%–12% of the respondents said their workweek exceeded those hours on their most recent rotation. Nearly half of the respondents thought that sleep deprivation or fatigue may have had a negative impact on the quality of patient care they delivered.
More Options Versus Saving Costs
Elderly patients aren't willing to sacrifice physician/hospital choice to save on out-of-pocket costs, the Center for Studying Health System Change reported. In a 2003 survey of 36,000 adults, including 6,700 aged 65 years and older, only 45% of the seniors were willing to trade broad provider choice to save money, compared with 70% of people aged 18–34 years. “The findings suggest that Medicare managed-care plans will face a tough sell in convincing seniors to switch from fee-for-service Medicare where they have unfettered choice of doctors and hospitals to private plans that limit provider choice but offer cost savings,” said HSC president Paul B. Ginsburg, Ph.D. Given these concerns, it's clear that Medicare Advantage Plans will need to offer broad provider networks to attract more seniors.
Medicare Drug Benefit Explained
The Centers for Medicare and Medicaid Services is requiring all health plans serving Medicare patients to include all drugs in six categories on their formularies starting in 2006, when the Part D drug benefit begins. The agency noted that in earlier guidance on the Medicare drug plan, it stated that “a majority” of drugs in these categories—antidepressants, antipsychotics, anticonvulsants, anticancer drugs, immunosuppressants, and HIV/AIDS drugs—would have to be on plan formularies and that beneficiaries should have uninterrupted access to drugs in those classes. But in training sessions and in answering user calls, “CMS has consistently explained that this meant that access to 'all or substantially all' drugs in these categories needed to be addressed by plan formularies,” the agency said. “This is because the factors described in our formulary guidance indicated that interruption of therapy in these categories could cause significant negative outcomes to beneficiaries in a short timeframe.”
Underinsured Statistics
A little insurance isn't necessarily better than none, according to a study from the Commonwealth Fund. Drawing from a survey of 3,293 adults, the study found that 16 million adults were underinsured in 2003, meaning their insurance did not adequately protect them against catastrophic health care expenses. Underinsured adults are almost as likely as the uninsured to go without needed medical care and to incur medical debt. For example, more than half of the underinsured (54%) went without needed care during the year, failed to fill a prescription, or failed to visit a physician for a medical problem. “An increase in the numbers of underinsured could undermine effective care, health, and financial security—making it harder to distinguish the uninsured from the insured,” according to the report. The study appeared as a Web-exclusive article in Health Affairs, June 14, 2005.
The Ongoing OxyContin Wars
The federal Drug Enforcement Administration's efforts to stop illegal use of the prescription painkiller OxyContin have “cast a chill over the doctor-patient candor necessary for successful treatment,” Ronald T. Libby, Ph.D., a political science professor at the University of North Florida in Jacksonville, wrote in a policy analysis for the Cato Institute, a libertarian think tank. The DEA's campaign includes elevating OxyContin to the status of other schedule II substances and using “aggressive undercover investigation, asset forfeiture, and informers,” he noted. “By demonizing physicians as drug dealers and exaggerating the health risks of pain management, the federal government has made physicians scapegoats for the failed drug war,” Dr. Libby wrote. When asked for comment, a DEA spokeswoman referred to a recent statement by DEA Administrator Karen Tandy. “We employ a balanced approach that recognizes both the unquestioned need for responsible pain medication, and the possibility … of criminal drug trafficking,” Ms. Tandy said, noting that physicians “are an extremely small part of the problem.”
Weight Loss Surgery Coverage
The American Society for Bariatric Surgery (ASBS) is asking Medicare to provide coverage for bariatric surgery in an effort to improve access for Medicare beneficiaries. Medicare currently covers gastric bypass surgery if it is medically appropriate and if the surgery is used to correct an illness that caused the obesity or was aggravated by it. ASBS is asking Medicare to expand its coverage to include laparoscopic procedures. In addition, the group would like to see coverage made more uniform around the country since Medicare coverage decisions for weight-loss surgery are generally decided regionally. “The current coverage policy has become outdated as new surgical procedures have become available and as evidence mounts as to their safety and effectiveness,” ASBS President Harvey Sugerman, M.D., said in a statement.