Physicians News » News Briefs http://www.physiciansnews.com Tue, 07 Feb 2012 16:44:06 +0000 en hourly 1 http://wordpress.org/?v=3.2.1 Experts Divided Over Recommendation To Screen Children For Cholesterol http://www.physiciansnews.com/2012/02/07/experts-divided-over-recommendation-to-screen-children-for-cholesterol/ http://www.physiciansnews.com/2012/02/07/experts-divided-over-recommendation-to-screen-children-for-cholesterol/#comments Tue, 07 Feb 2012 16:15:56 +0000 Physicians News http://www.physiciansnews.com/?p=4592 One in 500 kids has an inherited disorder that causes high levels of LDL ("bad") cholesterol that may require medication to control. However, since the problem doesn't create observable symptoms, as many as half of these kids don't know they have the condition. To help identify these children, late last year an expert panel convened by the National Heart, Lung, and Blood Institute recommended that all children be screened for high cholesterol, once between the ages of 9 and 11 and again between ages 17 and 21. Reaction to the guidelines, which were included as part of a larger NHLBI report on improving cardiovascular health in children and adolescents, has been mixed. Some clinicians and researchers say universal screening is an important tool not only to help identify children who are genetically predisposed to high cholesterol, a condition called familial hypercholesterolemia, but also to pinpoint others who could benefit from treatment, including those with high LDL related to being overweight or obese. Working with these kids to eat more healthfully and to exercise more may reduce the cumulative negative effect of high cholesterol on their cardiovascular systems and lead to fewer heart attacks and strokes later in life, the experts say. Others, including clinicians who authored a pair of articles in the Journal of the American Medical Association last month, express concerns that screening may do more harm than good. To identify the relatively small number of kids who really need medical treatment, doctors cast a wide and expensive net that identifies many children as at risk who will never develop  premature cardiovascular disease, says Matthew Gillman, director of the obesity prevention program at Harvard Medical School, who co-authored one of the articles. Some of those children will probably be needlessly put on cholesterol-lowering medications, he says. The U.S. Preventive Services Task Force, an independent group of primary-care providers that evaluates the evidence for clinical care, concluded in 2007 that there isn't enough evidence to recommend for or against routine lipid screening in children and adolescents. Research has shown that 10 to 13 percent of children have elevated cholesterol levels. Treatment for the vast majority should focus on lifestyle interventions, says Stephen Daniels, chairman of the Department of Pediatrics at the University of Colorado School of Medicine, who led the NHLBI panel. A much smaller number of those children, the ones with a genetic predisposition to high cholesterol, may need to take a statin, he says. Until the new guidelines were released, the American Academy of Pediatrics recommended cholesterol screening in children primarily based on family history. If a child had a father who had heart disease or a heart attack before age 55, for example, screening would be indicated. Children who had risk factors such as obesity or diabetes were also candidates for screening. The AAP has since endorsed the new NHLBI guidelines. "Family history doesn't really catch everybody" with familial hypercholesterolemia, says Sarah de Ferranti, a member of the AAP committee on nutrition and the director of preventive cardiology at Children's Hospital Boston. In addition, she says, "Anecdotally, I can tell you that when someone comes to my office and they know they have high cholesterol values, they're much more focused." That's the case with the McFeeley family. Bill and Carolyn McFeeley, of Mullica Hill, N.J., had always considered themselves very healthy - until Bill had a heart attack two years ago at age 47. The pediatrician for their three children checked the kids' cholesterol and found that while levels for the two girls - Chelsea, now 17, and Chandler, 13 - were normal, Chase, 10, had slightly higher values: His total cholesterol was roughly 210. (In general, anything over 200 is considered high.)
The McFeeley family, from left to right: Chandler, Carolyn, Chase, Bill, and Chelsea.
Now Chase has replaced his beloved egg salad sandwiches with turkey and fat-free cheese ones. "If we can get ahead of it and keep Chase healthy, it means a lot to us," says Bill. Julie Brothers, medical director of the lipid heart clinic at Children's Hospital of Philadelphia, sees Chase once a year now and says she hopes they can manage his cholesterol without medication. "None of us wants to slap medication on anyone," she says. Maybe not. "But if you're going to test every child, it's a sure bet you're going to be medicating more kids," says H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, who has written extensively on the problems created by aggressive screening. Research on the safety and effectiveness of statins in children is scant; studies that have looked at statin use haven't enrolled more than a few hundred kids, and none has followed them for more than two years, say experts. "We don't know what taking a 10- to 11-year-old kid and putting them on statins long term will do," says Frederick Rivara, division chief of general pediatrics at Seattle Children's Hospital and co-author of one of the JAMA articles. Gillman says that while early intervention to prevent heart disease is critical, screening all children may not be the best way to do it. As an example, he cites a study that he co-authored last year examining the cost-effectiveness of blood pressure screening in adolescents. "The bottom line of that study is that population approaches like taking the salt out of food are more effective and less costly than any screening program," he says. ### This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente. ]]> http://www.physiciansnews.com/2012/02/07/experts-divided-over-recommendation-to-screen-children-for-cholesterol/feed/ 0 The Treatment of Solid Tumors: Some Recent Approaches http://www.physiciansnews.com/2012/02/07/the-treatment-of-solid-tumors-some-recent-approaches/ http://www.physiciansnews.com/2012/02/07/the-treatment-of-solid-tumors-some-recent-approaches/#comments Tue, 07 Feb 2012 16:14:45 +0000 Physicians News http://www.physiciansnews.com/?p=4595 By Punit Dhillon At some point in their lives, one in five people will suffer from skin cancer, and the fraction is steadily rising.  In spite of innovation in sunscreen technology and public attention to the need to be shielded from the sun, data reported recently by Dermatology Times show a rise in the average American lifetime risk of one skin cancer variety—invasive melanoma—from 1/600 in 1960 to 1/50 in 2008.  Despite previous diagnosis and innovations in approaches to treatment, the age-adjusted number of annual deaths per 100,000 population is rising.  Additionally, the expense to the healthcare system and society continues to increase.  As U.S. and European populations age, the incidence of skin cancer and other solid tumor cancers will grow.  According to the latest United States Cancer Statistics, published by the Centers for Disease Control and Prevention in 2007, the top 10 cancer types (based on incidence rate) are in the solid tumor category; today the priority is probably even higher.  Thus, there are clear medical needs going unmet and the creation of novel, cost-efficient and patient-friendly treatments remain a top priority for both the healthcare community and patients. Various challenges of traditional treatments The treatment of solid tumor cancers, which range from melanoma and Merkel cell carcinoma to cutaneous T-cell lymphoma, continues to be a substantial challenge for physicians.  For example, in spite of innovations in drug discovery and development, it is still challenging to simply deliver efficient drugs into cancer cells in a safe and effective manner.  Meanwhile, today’s therapeutic approaches—involving surgery, radiation therapy and chemotherapy—each have characteristic and major drawbacks. Surgery, the current first-line treatment for localized and operable tumors or lesions, requires resecting the tumor mass and a surrounding boundary of healthy tissue to make sure that no cancer cells remain at the tumor site.  Surgery can potentially cause physical disfigurement and/or debilitating effects on organ function, and the patient quality of life has been demonstrated to be negatively impacted.  Also, surgery can require an expensive and long hospital stay. Radiation therapy is occasionally used in conjunction with surgery to shrink a tumor prior to surgical removal, or afterward to destroy any cancer cells that might remain.  Yet surgery plus radiation can damage important normal tissues like nerves, blood vessels, or vital organs such as the heart that are within the designated zone of treatment.  Radiation is also a costly therapeutic approach, and demands substantial expertise, precautionary measures and infrastructure to administer.  Radiation entails major complications, such as nausea, diarrhea, dry mouth, taste alterations, loss of appetite, and the potential for the formation of new cancerous lesions. Those who get radiation to the heart often suffer from various types of heart failure in subsequent years. Typically, chemotherapy is a secondary or palliative treatment to help mitigate systemic or metastatic tumor growth, whereas surgery and radiation may be considered local treatments.  In response to cancer’s spread, physicians will administer chemotherapeutic agents that circulate throughout the body, systemically and in high concentrations, to counter the challenge that some chemotherapeutic agents have in reaching and penetrating the cell membrane to trigger cell death.  Yet the system-wide use of chemotherapeutics frequently has major side effects by killing healthy as well as cancerous cells.  This systemic and non-targeted administration of anticancer agents can trigger alopecia; nausea; vomiting; myelosuppression; and drug resistance.  Chemotherapy is curative for only a few tumor types. Additionally, all of these conventional treatments are only minimally effective on aggressive types of cutaneous cancers, especially in later stages of the disease. Some potential approaches We now offer an abbreviated look at some current approaches to override these challenges in treating solid tumors. One possible strategy for solid tumor treatment involves a new class of small-molecule drug candidates called vascular disrupting agents.  Via interaction with vascular endothelial cytoskeletal proteins, these agents may selectively target and collapse tumor vasculature, thereby depriving the tumor of oxygen and causing death of the tumor cells. Another approach involves the use of new therapeutic monoclonal antibody candidates that target CD27, a member of the tumor necrosis factor (TNF) receptor superfamily.  Anti-CD27 monoclonal antibodies have been demonstrated to effectively promote anticancer immunity in mouse models when combined with T cell receptor stimulation.  In addition, CD27 is overexpressed in various lymphomas and leukemias and can be targeted for direct activity by anti-CD27 monoclonal antibodies with effector function against those cancers.  There are many other antibody drugs on the market, some also with linked toxins or radiation. A third tactic involves the creation of an orally available nucleoside analogue for various cancers including solid tumors.  This agent could act through a novel DNA single-strand breaking mechanism, leading to the production of DNA double strand breaks (DSBs) and/or DNA repair checkpoint activation; unrepaired DSBs go on to cause apoptosis or programmed cell death. Alternatively, solid tumors could be treated using a technique called tumor ablation, which involves destroying the tumor inside the body via various approaches.  Radioactive pellets, shorter than an inch and approximately the width of a pin, can be inserted into the tumor; the pellet subsequently emits lethal radioactive atoms that irradiate the tumor from the inside out.  As the tumor breaks down, it starts to release antigens that trigger an immune response against the cancer cells.  Sometimes, the body also develops an immune memory against the future return of tumor cells.  Another proposed ablation technique, called “pulsed electric current ablation,” involves the insertion of electrodes into tumors, which subsequently emit very high-energy electrical currents; these currents create a physical reaction that destroys the tumor cells. A separate approach involves applying local heating to the tumor using radio frequency techniques.  In this instance, a thermal energy delivery device can be focused and targeted according to the shape, size and position of a specific tumor.  Adjusting the frequency, phase, and amplitude of the radio waves, combined with different applicators and adjustment of the patient’s position, could conceivably permit a doctor to optimize the delivery of damaging energy into the tumor. Cancer scientists are also interested in attacking solid tumors by delivering drugs specifically into diseased tissues. Such a targeted approach can result in more efficient therapy while using smaller drug doses with fewer negative side effects.  For example, in animal studies, immune-deficient mice carrying human forms of various cancers have been simultaneously injected with a range of anticancer agents and a peptide known as iRGD.  iRGD can find and attach itself to receptors on solid tumor cancer cells and later activate their internal transport systems so that the peptide is essentially passed through cell after cell, moving progressively deeper into the tumor structure.  Anticancer drugs lingering near the peptide molecules may also get pulled into and through the tumor mass by this transport mechanism, enabling them to attack cancer cells previously beyond their reach. By their nature and cellular architecture, solid tumors are equipped to limit the efficacy of most anticancer drugs.  Tumors have poor vascular systems, which reduces exposure to drugs that have been administered into the circulation.  The lesions are densely fibrous, which serves as a physical barrier against transport.  Also, the tumors have high internal pressures, causing further physical challenges to any molecule attempting to enter the lesion.  The iRGD peptide is designed to act like a key, switching on the internal transport mechanism of the cells so that they absorb anything that is proximal to certain cell surface receptors.  Researchers believe the iRGD peptide could penetrate many tumor types and might be useful in treating most solid tumor cancers.  An encouraging aspect of this approach is that both the peptide and anticancer drugs are effective together without being chemically attached. Yet another promising strategy for treating solid tumor cancers involves targeting the tumor itself without affecting any of the surrounding healthy tissue.  This ensures that the drug or therapeutic agent is absorbed at once by the cancer cells and not normal tissues.  One such targeted therapy could harness a physiologic process known as “electroporation.”  Derived from the words “electric” and “pore,” this involves applying a brief electric field to the cancerous cell.  The electrical pulse triggers the temporary creation of pores in the cell’s outer membrane—pores that close again within seconds once the electric field is discontinued.  These transient pores can improve uptake of various drugs more than a thousand-fold. Several electroporation systems have been manufactured that consist of a generator that creates the pulsed electric field, and various handheld applicators with electrode needles at their proximal ends.  The applicator delivers a controlled electric pulse to the cancer cells, thus causing any cancer cells within the affected region to undergo electroporation.  The cell takes up therapeutic agents within the region of electroporation. This technology platform is being developed for use in two varieties of anticancer therapies:  electrochemotherapy and electroimmunotherapy.  In the former, an anticancer drug is injected into a targeted tumor; the lesion is then electroporated and the drug carries out its planned mechanism of action in killing the cell.  As a result of the targeted, local therapy, the amount of drug needed to kill the cells is substantially less than that required in traditional, non-targeted chemotherapy.  The lower quantity of systemic drug (cytotoxic agent) reduces harmful side effects linked to traditional chemotherapy. Electroimmunotherapy, the second application of electroporation, involves the use of a gene encoding a specific cytokine, a substance known to boost the human immune system against cancer cells.  An immune response can have both a local and a distant effect against cancerous cells.  These therapeutic approaches have been shown to be safe and effective across various types of tumors.  Both patient outcomes and pharmacoeconomic benefits are substantial.  This technology is in clinical testing in North America and is available for commercial sale in some European countries. Therapies such as those discussed here may provide a compelling set of novel approaches to the treatment of solid tumor cancers. ### Punit Dhillon is President and CEO of OncoSec Medical Inc., a biotechnology company developing its advanced-stage Oncology Medical System (OMS) ElectroOncology therapies to treat skin cancer and other solid tumor cancers. He can be reached at pdhillon@oncosec.com.]]> http://www.physiciansnews.com/2012/02/07/the-treatment-of-solid-tumors-some-recent-approaches/feed/ 0 Dream Of A Medical ‘Price List’ Dies In Florida Legislature http://www.physiciansnews.com/2012/01/31/dream-of-a-medical-%e2%80%98price-list%e2%80%99-dies-in-florida-legislature/ http://www.physiciansnews.com/2012/01/31/dream-of-a-medical-%e2%80%98price-list%e2%80%99-dies-in-florida-legislature/#comments Tue, 31 Jan 2012 16:30:32 +0000 Physicians News http://www.physiciansnews.com/?p=4579 approved legislation that would expand the state’s requirement that certain providers post the out-of-pocket prices of common health care services, a state Senate committee shot down a similar measure after an aggressive lobbying push by health care provider groups. Organizations representing the state’s doctors weren’t wild about the idea that certain facilities would have to display bulletin-board sized postings of their prices. Jeff Scott, general counsel for the Florida Medical Association, said that providers are all for transparency, but they don’t need the government telling them exactly how they should do it. “Next thing you know they’re going to say it has to be neon or include pictures,” he said. But providers’ most strenuous objections were to provisions in the legislation that would require providers to disclose prices to out-of-network patients and limit so-called balance billing, which happens in health care settings when providers bill patients the difference between what they charge for a service and what insurers pay it. Meanwhile, the state already requires urgent care centers to post in their reception area the prices of their 50 most frequently used services, and the posting must be at least 15 square feet.  Physicians are not required to do so, but they must follow the same rules if they post prices voluntarily. Under the proposed legislation, ambulatory care centers and diagnostic-imaging centers would have had to follow the same rules as urgent care centers, and the original bills also would have expanded the requirement to physicians. The House committee-approved bill softened this language to maintain the voluntary status quo for doctors. Both bills would have required physicians to provide patients with a written statement of prices at each visit. Richard Polangin, health care policy coordinator for the Florida Public Interest Research Group, said the legislation would have been a boon for consumers, many of whom are unaware that prices can vary among doctors and facilities. The bills would “enable persons who must pay for doctor visits, diagnostic images such as CT scans and MRIs, and for care at ambulatory surgery centers, to know the cost in advance,” he said. “The uninsured and persons with insurance deductibles would be able to make more informed health care decisions.” Insurers and business groups also supported the legislation. And, though the measure’s future is uncertain, at least one person involved in the lobbying effort said work would continue. ### This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.]]> http://www.physiciansnews.com/2012/01/31/dream-of-a-medical-%e2%80%98price-list%e2%80%99-dies-in-florida-legislature/feed/ 0 Twins Born in Different Years: What About Insurance? http://www.physiciansnews.com/2012/01/04/twins-born-in-different-years-what-about-insurance/ http://www.physiciansnews.com/2012/01/04/twins-born-in-different-years-what-about-insurance/#comments Wed, 04 Jan 2012 21:02:55 +0000 Physicians News http://www.physiciansnews.com/?p=4525 By Sarah Barr By the time newborn Freya Humenny joined her twin brother Beckett this past weekend, the calendar already had turned from 2011 to 2012. That means the twins always will have their own birthdays—but will they share an insurance statement? The twin’s mother, Stephanie Peterson, gave birth to Beckett at 6:40 p.m. on Dec. 31, 2011,  at the Hennepin County Medical Center in Minneapolis, but Freya did not follow until 12:26 a.m on Jan. 1. And so after we ooh-ed and ahh-ed over the adorable pair, we had to ask: What could a case like this mean for a family’s insurance? Paul Fronstin, director of the health research and education program at the Employee Benefit Research Institute, said that every case would vary based on the terms of a family’s policy. But, as an example, if a family had a high-deductible private insurance plan, a number of factors would be in play, according to Fronstin. For one, there is the question of the family’s deductible.  Lots of prenatal services are covered as preventive care, but some are not.  If the family had not yet met their 2011 deductible, then the first of the births would be applied to that year’s deductible, while the second could apply to the next year. There’s also the question of whether the second birth would even be considered an expense for the new year or whether it would be tied to the mother’s original admission. And as for the twins themselves, the second child’s expenses likely would be billed as new year expenses, but services for the first child, such as nights spent in a nursery, could span the two years—raising another set of questions about how to bill. Fronstin said that while a hypothetical case brings up a number of questions, an insurer’s response won’t necessarily be complicated. “It could be as simple as it was so close to midnight that it doesn’t really matter,” he said. Recommence the oohs and ahhs. ### This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.]]> http://www.physiciansnews.com/2012/01/04/twins-born-in-different-years-what-about-insurance/feed/ 0 Fox Chase Cancer Center Merges with Temple University http://www.physiciansnews.com/2011/12/17/fox-chase-cancer-center-merges-with-temple-university/ http://www.physiciansnews.com/2011/12/17/fox-chase-cancer-center-merges-with-temple-university/#comments Sat, 17 Dec 2011 16:05:33 +0000 Physicians News http://www.physiciansnews.com/?p=4493 Temple University Health System and Fox Chase Cancer Center this week signed an Affiliation Agreement that moves both institutions closer to bringing Fox Chase Cancer Center into the Temple family – marking a major milestone for two celebrated Philadelphia institutions that will enhance cancer research and patient care in the region, both immediately and for years to come. "Temple is proud and privileged to welcome Fox Chase Cancer Center into its family of academic researchers and clinicians," said Ann Weaver Hart, PhD, President of Temple University. "This bold, visionary relationship immediately establishes Temple's position as a leader in cancer care and translational research at the local, regional and national levels," said Larry R. Kaiser, MD, FACS, Senior Executive Vice President for Health Sciences of Temple University, Dean of Temple University School of Medicine, and President and CEO of Temple University Health System. "It sets the stage for many exciting opportunities to grow and enhance the cancer-related patient-care, research and educational programs of Temple’s healthcare enterprise. "The pursuit of excellence is the driving force for today's action – which offers a preview of what tomorrow represents. Indeed, this affiliation marks a fresh direction in cancer research and treatment in Philadelphia," continued Dr. Kaiser. "Sustained by the converging action of two highly respected medical institutions, it will draw on both established knowledge and original insights to pave the way for what all cancer patients and their families want and deserve – hope." "Fox Chase is proud to be the professional home to some of the most talented and compassionate scientists, doctors, and nurses working on the cancer problem anywhere in the world," said Michael V. Seiden, MD, PhD, President and CEO of Fox Chase Cancer Center. "But we're always working to strengthen the Center's ability to more vigorously pursue our mission to prevail over cancer, and we believe that this affiliation with Temple University Health System will do just that, enabling us to begin recruiting new researchers and clinicians almost immediately and to expand our clinical services significantly in coming years to serve the region's cancer-care needs well into the future."   Fox Chase Cancer Center is one of only two National Cancer Institute (NCI)-designated comprehensive cancer centers in Philadelphia, and one of only 40 in the U.S. Its addition to Temple creates collaborative synergies between and among physician-scientists at Temple University School of Medicine, Fox Chase Cancer Center, and Temple Cancer Center that will accelerate the pace of further discovery and development of the most effective approaches to cancer prevention, diagnosis, and treatment. By becoming an affiliate of Temple University Health System, Fox Chase will be able to significantly expand its outpatient and surgical-care services – within its existing facilities and through the use of leased space in Jeanes Hospital, an affiliate of Temple University Health System since 1996. Given the geographic proximity of Fox Chase to Jeanes Hospital (home to TUH's highly-regarded Bone Marrow Transplant Program), a natural byproduct of the agreement is the creation of a contiguous, 47.5-acre site to serve as Temple's "cancer hub" for the development of future innovations in cancer-care and research. The affiliation also gives Jeanes Hospital the opportunity to meet the associated health care needs of cancer patients by providing a broad array of services on its premises in areas such as outpatient diagnostic testing, interventional radiology, breast care, general surgery, thoracic surgery, endocrine surgery, urology and diagnostic GI. Temple University Health System will invest in cancer research at Fox Chase – providing new resources to recruit additional physician-scientists who will further advance the collaborative efforts of Temple and Fox Chase researchers in creating new knowledge and pathways for the prevention, treatment, and, ultimately, cures for cancer and cancer-related conditions. "The affiliation of Fox Chase Cancer Center with Temple University Health System signifies an important step in the transformation of Temple’s healthcare enterprise," said Jane Scaccetti, Chair of Temple University Health System's Board and a Temple University Trustee. "The combined strength of both highly regarded institutions will fuel innovations in cancer research and patient care," added Patrick J. O'Connor, Esq., Chair of the Board of Trustees of Temple University. "We at Fox Chase Cancer Center have long understood the potential value of joining forces with Temple University Health System, particularly with Jeanes Hospital as our immediate neighbor," said David G. Marshall, Chair of the Board of Directors of Fox Chase Cancer Center. "Thanks to the committed leadership of Dr. Michael Seiden and Dr. Larry Kaiser, we're proud to announce today an affiliation agreement that will meet Fox Chase's growth needs for the foreseeable future while bringing a National Cancer Institute-designated comprehensive cancer center into Temple's vibrant academic medical community." Finally, the affiliation will bring efficiencies and savings, as economies-of-scale are recognized and leveraged across TUHS, Fox Chase Cancer Center, and Jeanes Hospital. The ability to demonstrate collaborative efficiencies is particularly important in a time when the ability to demonstrate both excellence and value matters more than ever before… to patients, payors, and grant-funding agencies. Temple's newly-consolidated cancer hub will serve as a vital source of discovery, development, and delivery of the most effective approaches to cancer prevention, diagnosis, and treatment that will give patients the best of both worlds: access to the comprehensive treatments and innovative clinical-trials available at both Temple Cancer Center and Fox Chase Cancer Center. Fold in the full array of academic and clinical expertise of Temple University School of Medicine faculty, and the most advanced diagnostic and therapeutic technologies available at Temple University Hospital, and it becomes clear that this affiliation will benefit all cancer patients and their families throughout the Delaware Valley… and beyond.
]]> http://www.physiciansnews.com/2011/12/17/fox-chase-cancer-center-merges-with-temple-university/feed/ 0 Physicians Pessimistic on Benefits of Health Care Reform http://www.physiciansnews.com/2011/12/13/physicians-pessimistic-on-benefits-of-health-care-reform/ http://www.physiciansnews.com/2011/12/13/physicians-pessimistic-on-benefits-of-health-care-reform/#comments Tue, 13 Dec 2011 15:47:24 +0000 Physicians News http://www.physiciansnews.com/?p=4488 A new Deloitte study reveals physicians are skeptical about core promises associated with the Patient Protection and Affordable Care Act.  Only 27 percent of physicians surveyed believe the PPACA is likely to reduce costs by increasing efficiency, and only 33 percent feel it is likely to decrease disparities.  Moreover, half say access to health care will decrease because of hospital closures that result from the law. The report, “Physician Perspectives about Health Care Reform and the Future of the Medical Profession,” also shows that the majority of doctors (73 percent) are not excited about the future of medicine and believe (69 percent) the “best and brightest” who might consider a career in medicine will think otherwise. “The data confirms that physicians are resistant to reform and are frustrated with the direction of the profession,” says Paul Keckley, Ph.D., executive director of the Deloitte Center for Health Solutions and lead author of the report.  “Understanding the view of the physician is fundamental to any attempt to change the health care model – this is the person prescribing the medicine, ordering the test and performing the surgery." The negativity is driven in part by concern over the pressure primary doctors will face from millions of newly-insured consumers seeking care and the reverberations this sudden impact could create on the larger system. Another stumbling block for physicians is the view that reform will mean a loss of autonomy and more costs and administrative burdens in adopting processes and technologies.  For decades this sense of autonomy has been sacrosanct to the profession, and it’s difficult to uproot that overnight, continues Keckley. “Effective reform has to consider the physician’s view as a starting point,” says Keckley.  “We not only have to design the right model, but we have to create the right incentives and processes for implementing that model.  The concept of change management is just as important for doctors in the health care system as it is for employees in a corporation.” Additional key findings from the study include:
  • Nearly three-quarters of respondents think that emergency rooms could get overwhelmed if primary care physician appointments are full as a result of the Patient Protection and Affordable Care Act.
  • More than 80 percent believe it is likely that wait times for primary care appointments will increase because of a lack of providers.  More than half indicate that other medical professionals (physician assistants, nurse practitioners) will deliver primary care both independently and as an adjunct to physician services.
  • Surgical specialists (57 percent) are much more likely to support the law’s repeal compared to primary-care providers (38 percent) and non-surgical specialists (34 percent).  They are also more likely to say the legislation is a step in the wrong direction and believe their net income will decrease as a result of reform.
  • There is a disparity among generations, as 59 percent of physicians 50 to 59 years old feel PPACA is a step in the wrong direction while only 36 percent of those ages 25 to 39 share this sentiment. Younger physicians (ages 25 to 39) are also more likely than older doctors (ages 40 to 59) to think the transition to evidence-based medicine will improve care.
For more information about Physician Perspectives about Health Care Reform and the Future of the Medical Profession, visit www.deloitte.com/us/physiciansurvey.]]> http://www.physiciansnews.com/2011/12/13/physicians-pessimistic-on-benefits-of-health-care-reform/feed/ 0 Five Issues To Impact Docs in 2012 http://www.physiciansnews.com/2011/12/08/five-issues-to-impact-docs-in-2012/ http://www.physiciansnews.com/2011/12/08/five-issues-to-impact-docs-in-2012/#comments Thu, 08 Dec 2011 15:40:50 +0000 Physicians News http://www.physiciansnews.com/?p=4473 As the New Year approaches and the future of health reform hangs in the balance, The Physicians Foundation – a nonprofit organization that seeks to advance the work of practicing physicians and improve the quality of healthcare for all Americans – has identified five key areas that will impact the practice of medicine in the year ahead. The Physicians Watch List for 2012 is based on research the Foundation released earlier this year, including the 2010 Health Reform Research Study and 2011 Roadmap for Physicians to Healthcare Reform Paper.

  1. Changing nature of medical practices. Many physicians are choosing hospital and group settings versus private practice due to the perceived security employed settings offer. Only one quarter of physicians surveyed said they plan to continue practicing as they are; half said they would adopt a style of practice different from the traditional full-time independent private practice model. In 2012, physicians will need to carefully assess their individual circumstances and determine the practice configuration that best meets their needs and those of their patients.
  2.  Decreased return on increased burden. The added regulations and administrative responsibilities based on the Patient Protection and Affordable Care Act (PPACA) have caused physicians to focus less on the patient and more on administrating their practices. Sixty-three percent of physicians surveyed said that non-clinical paperwork has caused them to spend less time with their patients and 94 percent said time they devote to non-clinical paperwork in the last three years has increased. In 2012, physicians will need to vigilantly monitor their administrative burdens and take steps to minimize any further impact on their relationship with patients.
  3. Acute shortages of primary care physicians. A growing shortage of physicians threatens the medical profession’s ability to serve patients across key specialties and geographies. Physicians will need to redefine their roles and rethink delivery models in order to meet rising demand. The majority of physicians (60 percent) said health reform will compel them to close or significantly limit their practices to certain categories of patients. Of these, 93 percent said they will close or significantly limit their practices to Medicaid patients and 87 percent said they would close or significantly restrict their practices to Medicare patients. In 2012, physicians will need to evaluate how they can optimize their time to accommodate the current and future needs of their patients.
  4. Critical need for physician leadership tools / skills. In the healthcare environment of tomorrow, many physicians will assume greater business and people management responsibilities within practice groups and hospital settings.  In 2012, physicians will need to acquire new types of non-medical leadership skills to be effective in these expanded roles, while still maintaining their trusted relationships with patients.
  5. Impact on patients. The need to provide higher quality in an environment characterized by increased reporting, problematic reimbursement and high potential liability, will place extraordinary stress on physicians, particularly those in private practice. Only one physician in ten believes that health reform will enhance the quality of care they are able to provide to their patients, compared to 56 percent who believe reform will diminish the quality of care they are able to provide.  In 2012, physicians will increasingly need to balance these competing factors in ways that do not compromise the care they provide to patients.

“Proposed changes to our healthcare system have already significantly impacted physicians and patients,” said Lou Goodman, Ph.D., president of The Physicians Foundation and chief executive officer of the Texas Medical Association. “We hope the physician watch list helps to address the core issues under the new legislation and offers doctors and the healthcare community guidance on how to deliver the best care possible to patients in 2012.”

]]> http://www.physiciansnews.com/2011/12/08/five-issues-to-impact-docs-in-2012/feed/ 2 Both Patients And Physicians Can Suffer When Test Results Aren’t Reported http://www.physiciansnews.com/2011/11/29/both-patients-and-physicians-can-suffer-when-test-results-aren%e2%80%99t-reported/ http://www.physiciansnews.com/2011/11/29/both-patients-and-physicians-can-suffer-when-test-results-aren%e2%80%99t-reported/#comments Tue, 29 Nov 2011 16:01:38 +0000 Physicians News http://www.physiciansnews.com/?p=4438 Medical tests can reveal critical information about a person's health, but only if the results are communicated to clinicians and patients. Sometimes, the ball gets dropped somewhere between the lab or the radiology department and the clinician who ordered the test and the patient. In Peggy Kidwell's case, a mix-up over doctors' names led to a year-long delay in a breast cancer diagnosis.

After her annual gynecological exam and mammogram several years ago at a medical center near her Virginia Beach home, she got a letter from her doctor saying the results of her Pap test were normal. She assumed that she would hear from her doctor if anything untoward showed up on her mammogram exam and thought no more about it.

A year later, when Kidwell went back for her annual exam at age 59, her doctor, finding no mammogram results in her chart, asked why she hadn't gotten a screening exam the previous year. When Kidwell said she had, the doctor investigated. Five hours later, the doctor called Kidwell to tell her she had found the results and it looked as though she had breast cancer.The test results had been sent to an orthopedic surgeon at the medical center who had the same last name as Kidwell's gynecologist. The folder had been sitting on his desk for a year, according to her gynecologist. By that time her cancer had spread to her chest wall. Kidwell had a lumpectomy, chemotherapy and radiation. The following year, the cancer came back and Kidwell had a mastectomy. She filed a lawsuit and eventually settled the case. (A confidentiality agreement prohibits her from discussing specifics.) No one, she says, ever said that an earlier diagnosis might have made a difference in the course of her disease, but she believes it may have. Kidwell, who now lives in Silver Spring, blames the medical system for the mix-up, but also herself. "To this day, I don't let myself off the hook for not picking up the phone," she says. Financial Consequences There are also financial consequences for providers when tests aren't promptly reported: A recent study in the Journal of the American College of Radiology found that annual medical malpractice payouts for communication breakdowns, including failing to share test results, more than quadrupled nationally between 1991 and 2010, to million. For patients, the missteps and mistakes can be life-altering. Patient follow-up could make a difference in many instances. The study examined medical malpractice claims from 425 hospitals and 52,000 providers. Of the 306 cases in which test results were specifically cited as a factor in a malpractice case, the most common problem — it occurred almost half the time — was that the patient didn't receive the test results, cited in 143 cases. The second-most-common problem was that the clinician didn't receive the results, cited in 110 cases. Other problems included delays and slow turnaround in reporting findings and test results that were filed before the clinician reviewed them. The study examined a different database as well, the National Practitioner Data Bank, to arrive at a dollar value for malpractice claims payouts related to communications problems, examining categories that would include getting test result information to practitioners and patients alike, for the period from 1991 to 2010. That analysis showed that payouts increased from million to million during that time, a more than four-fold increase. Patient advocates and policy experts say the push for better coordination of patient care, including the adoption of electronic medical records, should help improve the delivery of test results to patients from doctors and to doctors from those who perform the tests. "Health reform and payment reform are moving us toward integrating care to a degree that we don't do right now," says Diane Pinakiewicz, president of the National Patient Safety Foundation, a Boston-based consumer group. "The one constant is the patient. The best chance is for the patient to be part of the process." A Multilayered Approach Patient involvement is important, but the burden of following up on test results shouldn't fall on their shoulders, experts agree. But doctors need a helping hand. In a given week, a primary-care doctor might need to review 360 chemistry test results, 460 hematology results, 12 pathology reports and 40 radiology reports, according to researchers at Partners HealthCare system in Boston. More than half of physicians surveyed some years ago said they weren't satisfied with the way they handled test results, which typically took more than an hour each day. Now many practices affiliated with Partners use a multilayered system that helps them manage test results. The Web-based system lets them log in and see all the tests they've ordered and the results that have come in, with those that are problematic listed first. If a test result requires urgent attention, the system generates an e-mail alerting doctors; if they ignore this warning and subsequent messages, the system alerts the practice manager, who contacts the physician directly. The system also generates letters that notify patients of their test results and has a tickler function that can alert doctors when patients haven't had follow-up tests as ordered. Even so, "nothing is foolproof," says Eric Poon, director of clinical informatics at Brigham and Women's Hospital, part of the Partners system. "No news is not good news," he says. "If a patient gets a test done and doesn't get a result, he should follow up." ### This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente. ]]> http://www.physiciansnews.com/2011/11/29/both-patients-and-physicians-can-suffer-when-test-results-aren%e2%80%99t-reported/feed/ 1 Win ,000: Essay Contest Challenges Docs To Offer Solutions To Healthcare Costs http://www.physiciansnews.com/2011/10/27/win-1000-essay-contest-challenges-docs-to-offer-solutions-to-healthcare-costs/ http://www.physiciansnews.com/2011/10/27/win-1000-essay-contest-challenges-docs-to-offer-solutions-to-healthcare-costs/#comments Thu, 27 Oct 2011 13:00:54 +0000 Physicians News http://www.physiciansnews.com/?p=4350 Costs of Care, a physician-run nonprofit based in Boston, has launched its second annual national healthcare essay contest, with the goal of expanding the public discourse on the role of doctors, nurses, and other care providers in controlling healthcare costs. Executive Director Neel Shah, who is also a third-year obstetrics and gynecology resident at the Harvard Medical School, founded Costs of Care after he began thinking, as a med student, that physicians had a good deal of power over healthcare costs but rarely thought about them. "There's a lot of talk about insurers and patients, but at the end of the day doctors decide what's on the bill," he told the LA Times. Last year, Costs of Care launched an innovative essay contest that emphasized the importance of price transparency in everyday medicine by gathering more than 100 personal stories from patients, nurses, and doctors across the nation. A vascular surgeon in Arizona, for example, wrote about a time a hospital assigned an out-of-network anesthesiologist to a surgery, sending a patient's bill skyrocketing, according to the LA Times. "There was no mechanism to make sure all of the providers a patient uses were in network," Shah said.  "That's a simple check." This year, Costs of Care is looking for more stories, and will award 00 prizes for stories about the importance of price transparency as well as solution-oriented stories that illustrate ways to reduce harmful healthcare spending and save patients’ money. As the economy struggles to recover, the spiraling costs of healthcare in the United States have become a contentious political focal point without an obvious solution. Traditionally, health care providers have been reluctant to discuss their own role in healthcare spending. However, Dr. Shah, “Ultimately, no amount of regulating, reorganizing, or otherwise reforming the healthcare system will successfully contain costs unless healthcare providers are invested in fixing the problem.” To help mobilize healthcare providers to examine their own role in spending, Costs of Care is launching an essay contest that will collect and widely disseminate stories from the front lines of medicine. Costs of Care will award 00 in prizes to top submissions. Two 00 prizes will be reserved for patients, and two 00 prizes will be reserved for care providers. Preference will be given to stories that best demonstrate the importance of cost-awareness in medicine. Examples may include a time a patient tried to find out what a test or treatment would cost but was unable to do so, a time that caring for a patient generated an unexpectedly a high medical bill, or a time a patient and care provider figured out a way to save money while still delivering high-value care. To help select the winning entries, Costs of Care has partnered with five health luminaries who will serve as judges:
  • Peter Orzsag, former Director of the White House Office of Management and Budget
  • Dr. C. Everett Koop, former United States Surgeon General
  • Hon. Jennifer Granholm, former Governor of Michigan
  • Dr. Susan Love, women’s health and cancer research advocate
  • Dr. Alan Garber, health economist and Harvard University Provost
All submissions will be due on November 15th, 2011. Finalists will be announced on December 15th, 2011 and the ,000 prize winners will be announced on January 15th, 2012. All qualifying submissions will be published biweekly at http://www.costsofcare.org during the 2012 calendar year.  ]]> http://www.physiciansnews.com/2011/10/27/win-1000-essay-contest-challenges-docs-to-offer-solutions-to-healthcare-costs/feed/ 0 ER Docs Focus On Medical Liability Reforms http://www.physiciansnews.com Tue, 07 Feb 2012 16:44:06 +0000 en hourly 1 http://wordpress.org/?v=3.2.1 Physicians News » News Briefs http://www.physiciansnews.com Tue, 07 Feb 2012 16:44:06 +0000 en hourly 1 http://wordpress.org/?v=3.2.1 Experts Divided Over Recommendation To Screen Children For Cholesterol http://www.physiciansnews.com/2012/02/07/experts-divided-over-recommendation-to-screen-children-for-cholesterol/ http://www.physiciansnews.com/2012/02/07/experts-divided-over-recommendation-to-screen-children-for-cholesterol/#comments Tue, 07 Feb 2012 16:15:56 +0000 Physicians News http://www.physiciansnews.com/?p=4592 One in 500 kids has an inherited disorder that causes high levels of LDL ("bad") cholesterol that may require medication to control. However, since the problem doesn't create observable symptoms, as many as half of these kids don't know they have the condition. To help identify these children, late last year an expert panel convened by the National Heart, Lung, and Blood Institute recommended that all children be screened for high cholesterol, once between the ages of 9 and 11 and again between ages 17 and 21. Reaction to the guidelines, which were included as part of a larger NHLBI report on improving cardiovascular health in children and adolescents, has been mixed. Some clinicians and researchers say universal screening is an important tool not only to help identify children who are genetically predisposed to high cholesterol, a condition called familial hypercholesterolemia, but also to pinpoint others who could benefit from treatment, including those with high LDL related to being overweight or obese. Working with these kids to eat more healthfully and to exercise more may reduce the cumulative negative effect of high cholesterol on their cardiovascular systems and lead to fewer heart attacks and strokes later in life, the experts say. Others, including clinicians who authored a pair of articles in the Journal of the American Medical Association last month, express concerns that screening may do more harm than good. To identify the relatively small number of kids who really need medical treatment, doctors cast a wide and expensive net that identifies many children as at risk who will never develop  premature cardiovascular disease, says Matthew Gillman, director of the obesity prevention program at Harvard Medical School, who co-authored one of the articles. Some of those children will probably be needlessly put on cholesterol-lowering medications, he says. The U.S. Preventive Services Task Force, an independent group of primary-care providers that evaluates the evidence for clinical care, concluded in 2007 that there isn't enough evidence to recommend for or against routine lipid screening in children and adolescents. Research has shown that 10 to 13 percent of children have elevated cholesterol levels. Treatment for the vast majority should focus on lifestyle interventions, says Stephen Daniels, chairman of the Department of Pediatrics at the University of Colorado School of Medicine, who led the NHLBI panel. A much smaller number of those children, the ones with a genetic predisposition to high cholesterol, may need to take a statin, he says. Until the new guidelines were released, the American Academy of Pediatrics recommended cholesterol screening in children primarily based on family history. If a child had a father who had heart disease or a heart attack before age 55, for example, screening would be indicated. Children who had risk factors such as obesity or diabetes were also candidates for screening. The AAP has since endorsed the new NHLBI guidelines. "Family history doesn't really catch everybody" with familial hypercholesterolemia, says Sarah de Ferranti, a member of the AAP committee on nutrition and the director of preventive cardiology at Children's Hospital Boston. In addition, she says, "Anecdotally, I can tell you that when someone comes to my office and they know they have high cholesterol values, they're much more focused." That's the case with the McFeeley family. Bill and Carolyn McFeeley, of Mullica Hill, N.J., had always considered themselves very healthy - until Bill had a heart attack two years ago at age 47. The pediatrician for their three children checked the kids' cholesterol and found that while levels for the two girls - Chelsea, now 17, and Chandler, 13 - were normal, Chase, 10, had slightly higher values: His total cholesterol was roughly 210. (In general, anything over 200 is considered high.)
The McFeeley family, from left to right: Chandler, Carolyn, Chase, Bill, and Chelsea.
Now Chase has replaced his beloved egg salad sandwiches with turkey and fat-free cheese ones. "If we can get ahead of it and keep Chase healthy, it means a lot to us," says Bill. Julie Brothers, medical director of the lipid heart clinic at Children's Hospital of Philadelphia, sees Chase once a year now and says she hopes they can manage his cholesterol without medication. "None of us wants to slap medication on anyone," she says. Maybe not. "But if you're going to test every child, it's a sure bet you're going to be medicating more kids," says H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, who has written extensively on the problems created by aggressive screening. Research on the safety and effectiveness of statins in children is scant; studies that have looked at statin use haven't enrolled more than a few hundred kids, and none has followed them for more than two years, say experts. "We don't know what taking a 10- to 11-year-old kid and putting them on statins long term will do," says Frederick Rivara, division chief of general pediatrics at Seattle Children's Hospital and co-author of one of the JAMA articles. Gillman says that while early intervention to prevent heart disease is critical, screening all children may not be the best way to do it. As an example, he cites a study that he co-authored last year examining the cost-effectiveness of blood pressure screening in adolescents. "The bottom line of that study is that population approaches like taking the salt out of food are more effective and less costly than any screening program," he says. ### This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente. ]]> http://www.physiciansnews.com/2012/02/07/experts-divided-over-recommendation-to-screen-children-for-cholesterol/feed/ 0 The Treatment of Solid Tumors: Some Recent Approaches http://www.physiciansnews.com/2012/02/07/the-treatment-of-solid-tumors-some-recent-approaches/ http://www.physiciansnews.com/2012/02/07/the-treatment-of-solid-tumors-some-recent-approaches/#comments Tue, 07 Feb 2012 16:14:45 +0000 Physicians News http://www.physiciansnews.com/?p=4595 By Punit Dhillon At some point in their lives, one in five people will suffer from skin cancer, and the fraction is steadily rising.  In spite of innovation in sunscreen technology and public attention to the need to be shielded from the sun, data reported recently by Dermatology Times show a rise in the average American lifetime risk of one skin cancer variety—invasive melanoma—from 1/600 in 1960 to 1/50 in 2008.  Despite previous diagnosis and innovations in approaches to treatment, the age-adjusted number of annual deaths per 100,000 population is rising.  Additionally, the expense to the healthcare system and society continues to increase.  As U.S. and European populations age, the incidence of skin cancer and other solid tumor cancers will grow.  According to the latest United States Cancer Statistics, published by the Centers for Disease Control and Prevention in 2007, the top 10 cancer types (based on incidence rate) are in the solid tumor category; today the priority is probably even higher.  Thus, there are clear medical needs going unmet and the creation of novel, cost-efficient and patient-friendly treatments remain a top priority for both the healthcare community and patients. Various challenges of traditional treatments The treatment of solid tumor cancers, which range from melanoma and Merkel cell carcinoma to cutaneous T-cell lymphoma, continues to be a substantial challenge for physicians.  For example, in spite of innovations in drug discovery and development, it is still challenging to simply deliver efficient drugs into cancer cells in a safe and effective manner.  Meanwhile, today’s therapeutic approaches—involving surgery, radiation therapy and chemotherapy—each have characteristic and major drawbacks. Surgery, the current first-line treatment for localized and operable tumors or lesions, requires resecting the tumor mass and a surrounding boundary of healthy tissue to make sure that no cancer cells remain at the tumor site.  Surgery can potentially cause physical disfigurement and/or debilitating effects on organ function, and the patient quality of life has been demonstrated to be negatively impacted.  Also, surgery can require an expensive and long hospital stay. Radiation therapy is occasionally used in conjunction with surgery to shrink a tumor prior to surgical removal, or afterward to destroy any cancer cells that might remain.  Yet surgery plus radiation can damage important normal tissues like nerves, blood vessels, or vital organs such as the heart that are within the designated zone of treatment.  Radiation is also a costly therapeutic approach, and demands substantial expertise, precautionary measures and infrastructure to administer.  Radiation entails major complications, such as nausea, diarrhea, dry mouth, taste alterations, loss of appetite, and the potential for the formation of new cancerous lesions. Those who get radiation to the heart often suffer from various types of heart failure in subsequent years. Typically, chemotherapy is a secondary or palliative treatment to help mitigate systemic or metastatic tumor growth, whereas surgery and radiation may be considered local treatments.  In response to cancer’s spread, physicians will administer chemotherapeutic agents that circulate throughout the body, systemically and in high concentrations, to counter the challenge that some chemotherapeutic agents have in reaching and penetrating the cell membrane to trigger cell death.  Yet the system-wide use of chemotherapeutics frequently has major side effects by killing healthy as well as cancerous cells.  This systemic and non-targeted administration of anticancer agents can trigger alopecia; nausea; vomiting; myelosuppression; and drug resistance.  Chemotherapy is curative for only a few tumor types. Additionally, all of these conventional treatments are only minimally effective on aggressive types of cutaneous cancers, especially in later stages of the disease. Some potential approaches We now offer an abbreviated look at some current approaches to override these challenges in treating solid tumors. One possible strategy for solid tumor treatment involves a new class of small-molecule drug candidates called vascular disrupting agents.  Via interaction with vascular endothelial cytoskeletal proteins, these agents may selectively target and collapse tumor vasculature, thereby depriving the tumor of oxygen and causing death of the tumor cells. Another approach involves the use of new therapeutic monoclonal antibody candidates that target CD27, a member of the tumor necrosis factor (TNF) receptor superfamily.  Anti-CD27 monoclonal antibodies have been demonstrated to effectively promote anticancer immunity in mouse models when combined with T cell receptor stimulation.  In addition, CD27 is overexpressed in various lymphomas and leukemias and can be targeted for direct activity by anti-CD27 monoclonal antibodies with effector function against those cancers.  There are many other antibody drugs on the market, some also with linked toxins or radiation. A third tactic involves the creation of an orally available nucleoside analogue for various cancers including solid tumors.  This agent could act through a novel DNA single-strand breaking mechanism, leading to the production of DNA double strand breaks (DSBs) and/or DNA repair checkpoint activation; unrepaired DSBs go on to cause apoptosis or programmed cell death. Alternatively, solid tumors could be treated using a technique called tumor ablation, which involves destroying the tumor inside the body via various approaches.  Radioactive pellets, shorter than an inch and approximately the width of a pin, can be inserted into the tumor; the pellet subsequently emits lethal radioactive atoms that irradiate the tumor from the inside out.  As the tumor breaks down, it starts to release antigens that trigger an immune response against the cancer cells.  Sometimes, the body also develops an immune memory against the future return of tumor cells.  Another proposed ablation technique, called “pulsed electric current ablation,” involves the insertion of electrodes into tumors, which subsequently emit very high-energy electrical currents; these currents create a physical reaction that destroys the tumor cells. A separate approach involves applying local heating to the tumor using radio frequency techniques.  In this instance, a thermal energy delivery device can be focused and targeted according to the shape, size and position of a specific tumor.  Adjusting the frequency, phase, and amplitude of the radio waves, combined with different applicators and adjustment of the patient’s position, could conceivably permit a doctor to optimize the delivery of damaging energy into the tumor. Cancer scientists are also interested in attacking solid tumors by delivering drugs specifically into diseased tissues. Such a targeted approach can result in more efficient therapy while using smaller drug doses with fewer negative side effects.  For example, in animal studies, immune-deficient mice carrying human forms of various cancers have been simultaneously injected with a range of anticancer agents and a peptide known as iRGD.  iRGD can find and attach itself to receptors on solid tumor cancer cells and later activate their internal transport systems so that the peptide is essentially passed through cell after cell, moving progressively deeper into the tumor structure.  Anticancer drugs lingering near the peptide molecules may also get pulled into and through the tumor mass by this transport mechanism, enabling them to attack cancer cells previously beyond their reach. By their nature and cellular architecture, solid tumors are equipped to limit the efficacy of most anticancer drugs.  Tumors have poor vascular systems, which reduces exposure to drugs that have been administered into the circulation.  The lesions are densely fibrous, which serves as a physical barrier against transport.  Also, the tumors have high internal pressures, causing further physical challenges to any molecule attempting to enter the lesion.  The iRGD peptide is designed to act like a key, switching on the internal transport mechanism of the cells so that they absorb anything that is proximal to certain cell surface receptors.  Researchers believe the iRGD peptide could penetrate many tumor types and might be useful in treating most solid tumor cancers.  An encouraging aspect of this approach is that both the peptide and anticancer drugs are effective together without being chemically attached. Yet another promising strategy for treating solid tumor cancers involves targeting the tumor itself without affecting any of the surrounding healthy tissue.  This ensures that the drug or therapeutic agent is absorbed at once by the cancer cells and not normal tissues.  One such targeted therapy could harness a physiologic process known as “electroporation.”  Derived from the words “electric” and “pore,” this involves applying a brief electric field to the cancerous cell.  The electrical pulse triggers the temporary creation of pores in the cell’s outer membrane—pores that close again within seconds once the electric field is discontinued.  These transient pores can improve uptake of various drugs more than a thousand-fold. Several electroporation systems have been manufactured that consist of a generator that creates the pulsed electric field, and various handheld applicators with electrode needles at their proximal ends.  The applicator delivers a controlled electric pulse to the cancer cells, thus causing any cancer cells within the affected region to undergo electroporation.  The cell takes up therapeutic agents within the region of electroporation. This technology platform is being developed for use in two varieties of anticancer therapies:  electrochemotherapy and electroimmunotherapy.  In the former, an anticancer drug is injected into a targeted tumor; the lesion is then electroporated and the drug carries out its planned mechanism of action in killing the cell.  As a result of the targeted, local therapy, the amount of drug needed to kill the cells is substantially less than that required in traditional, non-targeted chemotherapy.  The lower quantity of systemic drug (cytotoxic agent) reduces harmful side effects linked to traditional chemotherapy. Electroimmunotherapy, the second application of electroporation, involves the use of a gene encoding a specific cytokine, a substance known to boost the human immune system against cancer cells.  An immune response can have both a local and a distant effect against cancerous cells.  These therapeutic approaches have been shown to be safe and effective across various types of tumors.  Both patient outcomes and pharmacoeconomic benefits are substantial.  This technology is in clinical testing in North America and is available for commercial sale in some European countries. Therapies such as those discussed here may provide a compelling set of novel approaches to the treatment of solid tumor cancers. ### Punit Dhillon is President and CEO of OncoSec Medical Inc., a biotechnology company developing its advanced-stage Oncology Medical System (OMS) ElectroOncology therapies to treat skin cancer and other solid tumor cancers. He can be reached at pdhillon@oncosec.com.]]> http://www.physiciansnews.com/2012/02/07/the-treatment-of-solid-tumors-some-recent-approaches/feed/ 0 Dream Of A Medical ‘Price List’ Dies In Florida Legislature http://www.physiciansnews.com/2012/01/31/dream-of-a-medical-%e2%80%98price-list%e2%80%99-dies-in-florida-legislature/ http://www.physiciansnews.com/2012/01/31/dream-of-a-medical-%e2%80%98price-list%e2%80%99-dies-in-florida-legislature/#comments Tue, 31 Jan 2012 16:30:32 +0000 Physicians News http://www.physiciansnews.com/?p=4579 approved legislation that would expand the state’s requirement that certain providers post the out-of-pocket prices of common health care services, a state Senate committee shot down a similar measure after an aggressive lobbying push by health care provider groups. Organizations representing the state’s doctors weren’t wild about the idea that certain facilities would have to display bulletin-board sized postings of their prices. Jeff Scott, general counsel for the Florida Medical Association, said that providers are all for transparency, but they don’t need the government telling them exactly how they should do it. “Next thing you know they’re going to say it has to be neon or include pictures,” he said. But providers’ most strenuous objections were to provisions in the legislation that would require providers to disclose prices to out-of-network patients and limit so-called balance billing, which happens in health care settings when providers bill patients the difference between what they charge for a service and what insurers pay it. Meanwhile, the state already requires urgent care centers to post in their reception area the prices of their 50 most frequently used services, and the posting must be at least 15 square feet.  Physicians are not required to do so, but they must follow the same rules if they post prices voluntarily. Under the proposed legislation, ambulatory care centers and diagnostic-imaging centers would have had to follow the same rules as urgent care centers, and the original bills also would have expanded the requirement to physicians. The House committee-approved bill softened this language to maintain the voluntary status quo for doctors. Both bills would have required physicians to provide patients with a written statement of prices at each visit. Richard Polangin, health care policy coordinator for the Florida Public Interest Research Group, said the legislation would have been a boon for consumers, many of whom are unaware that prices can vary among doctors and facilities. The bills would “enable persons who must pay for doctor visits, diagnostic images such as CT scans and MRIs, and for care at ambulatory surgery centers, to know the cost in advance,” he said. “The uninsured and persons with insurance deductibles would be able to make more informed health care decisions.” Insurers and business groups also supported the legislation. And, though the measure’s future is uncertain, at least one person involved in the lobbying effort said work would continue. ### This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.]]> http://www.physiciansnews.com/2012/01/31/dream-of-a-medical-%e2%80%98price-list%e2%80%99-dies-in-florida-legislature/feed/ 0 Twins Born in Different Years: What About Insurance? http://www.physiciansnews.com/2012/01/04/twins-born-in-different-years-what-about-insurance/ http://www.physiciansnews.com/2012/01/04/twins-born-in-different-years-what-about-insurance/#comments Wed, 04 Jan 2012 21:02:55 +0000 Physicians News http://www.physiciansnews.com/?p=4525 By Sarah Barr By the time newborn Freya Humenny joined her twin brother Beckett this past weekend, the calendar already had turned from 2011 to 2012. That means the twins always will have their own birthdays—but will they share an insurance statement? The twin’s mother, Stephanie Peterson, gave birth to Beckett at 6:40 p.m. on Dec. 31, 2011,  at the Hennepin County Medical Center in Minneapolis, but Freya did not follow until 12:26 a.m on Jan. 1. And so after we ooh-ed and ahh-ed over the adorable pair, we had to ask: What could a case like this mean for a family’s insurance? Paul Fronstin, director of the health research and education program at the Employee Benefit Research Institute, said that every case would vary based on the terms of a family’s policy. But, as an example, if a family had a high-deductible private insurance plan, a number of factors would be in play, according to Fronstin. For one, there is the question of the family’s deductible.  Lots of prenatal services are covered as preventive care, but some are not.  If the family had not yet met their 2011 deductible, then the first of the births would be applied to that year’s deductible, while the second could apply to the next year. There’s also the question of whether the second birth would even be considered an expense for the new year or whether it would be tied to the mother’s original admission. And as for the twins themselves, the second child’s expenses likely would be billed as new year expenses, but services for the first child, such as nights spent in a nursery, could span the two years—raising another set of questions about how to bill. Fronstin said that while a hypothetical case brings up a number of questions, an insurer’s response won’t necessarily be complicated. “It could be as simple as it was so close to midnight that it doesn’t really matter,” he said. Recommence the oohs and ahhs. ### This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.]]> http://www.physiciansnews.com/2012/01/04/twins-born-in-different-years-what-about-insurance/feed/ 0 Fox Chase Cancer Center Merges with Temple University http://www.physiciansnews.com/2011/12/17/fox-chase-cancer-center-merges-with-temple-university/ http://www.physiciansnews.com/2011/12/17/fox-chase-cancer-center-merges-with-temple-university/#comments Sat, 17 Dec 2011 16:05:33 +0000 Physicians News http://www.physiciansnews.com/?p=4493 Temple University Health System and Fox Chase Cancer Center this week signed an Affiliation Agreement that moves both institutions closer to bringing Fox Chase Cancer Center into the Temple family – marking a major milestone for two celebrated Philadelphia institutions that will enhance cancer research and patient care in the region, both immediately and for years to come. "Temple is proud and privileged to welcome Fox Chase Cancer Center into its family of academic researchers and clinicians," said Ann Weaver Hart, PhD, President of Temple University. "This bold, visionary relationship immediately establishes Temple's position as a leader in cancer care and translational research at the local, regional and national levels," said Larry R. Kaiser, MD, FACS, Senior Executive Vice President for Health Sciences of Temple University, Dean of Temple University School of Medicine, and President and CEO of Temple University Health System. "It sets the stage for many exciting opportunities to grow and enhance the cancer-related patient-care, research and educational programs of Temple’s healthcare enterprise. "The pursuit of excellence is the driving force for today's action – which offers a preview of what tomorrow represents. Indeed, this affiliation marks a fresh direction in cancer research and treatment in Philadelphia," continued Dr. Kaiser. "Sustained by the converging action of two highly respected medical institutions, it will draw on both established knowledge and original insights to pave the way for what all cancer patients and their families want and deserve – hope." "Fox Chase is proud to be the professional home to some of the most talented and compassionate scientists, doctors, and nurses working on the cancer problem anywhere in the world," said Michael V. Seiden, MD, PhD, President and CEO of Fox Chase Cancer Center. "But we're always working to strengthen the Center's ability to more vigorously pursue our mission to prevail over cancer, and we believe that this affiliation with Temple University Health System will do just that, enabling us to begin recruiting new researchers and clinicians almost immediately and to expand our clinical services significantly in coming years to serve the region's cancer-care needs well into the future."   Fox Chase Cancer Center is one of only two National Cancer Institute (NCI)-designated comprehensive cancer centers in Philadelphia, and one of only 40 in the U.S. Its addition to Temple creates collaborative synergies between and among physician-scientists at Temple University School of Medicine, Fox Chase Cancer Center, and Temple Cancer Center that will accelerate the pace of further discovery and development of the most effective approaches to cancer prevention, diagnosis, and treatment. By becoming an affiliate of Temple University Health System, Fox Chase will be able to significantly expand its outpatient and surgical-care services – within its existing facilities and through the use of leased space in Jeanes Hospital, an affiliate of Temple University Health System since 1996. Given the geographic proximity of Fox Chase to Jeanes Hospital (home to TUH's highly-regarded Bone Marrow Transplant Program), a natural byproduct of the agreement is the creation of a contiguous, 47.5-acre site to serve as Temple's "cancer hub" for the development of future innovations in cancer-care and research. The affiliation also gives Jeanes Hospital the opportunity to meet the associated health care needs of cancer patients by providing a broad array of services on its premises in areas such as outpatient diagnostic testing, interventional radiology, breast care, general surgery, thoracic surgery, endocrine surgery, urology and diagnostic GI. Temple University Health System will invest in cancer research at Fox Chase – providing new resources to recruit additional physician-scientists who will further advance the collaborative efforts of Temple and Fox Chase researchers in creating new knowledge and pathways for the prevention, treatment, and, ultimately, cures for cancer and cancer-related conditions. "The affiliation of Fox Chase Cancer Center with Temple University Health System signifies an important step in the transformation of Temple’s healthcare enterprise," said Jane Scaccetti, Chair of Temple University Health System's Board and a Temple University Trustee. "The combined strength of both highly regarded institutions will fuel innovations in cancer research and patient care," added Patrick J. O'Connor, Esq., Chair of the Board of Trustees of Temple University. "We at Fox Chase Cancer Center have long understood the potential value of joining forces with Temple University Health System, particularly with Jeanes Hospital as our immediate neighbor," said David G. Marshall, Chair of the Board of Directors of Fox Chase Cancer Center. "Thanks to the committed leadership of Dr. Michael Seiden and Dr. Larry Kaiser, we're proud to announce today an affiliation agreement that will meet Fox Chase's growth needs for the foreseeable future while bringing a National Cancer Institute-designated comprehensive cancer center into Temple's vibrant academic medical community." Finally, the affiliation will bring efficiencies and savings, as economies-of-scale are recognized and leveraged across TUHS, Fox Chase Cancer Center, and Jeanes Hospital. The ability to demonstrate collaborative efficiencies is particularly important in a time when the ability to demonstrate both excellence and value matters more than ever before… to patients, payors, and grant-funding agencies. Temple's newly-consolidated cancer hub will serve as a vital source of discovery, development, and delivery of the most effective approaches to cancer prevention, diagnosis, and treatment that will give patients the best of both worlds: access to the comprehensive treatments and innovative clinical-trials available at both Temple Cancer Center and Fox Chase Cancer Center. Fold in the full array of academic and clinical expertise of Temple University School of Medicine faculty, and the most advanced diagnostic and therapeutic technologies available at Temple University Hospital, and it becomes clear that this affiliation will benefit all cancer patients and their families throughout the Delaware Valley… and beyond.
]]> http://www.physiciansnews.com/2011/12/17/fox-chase-cancer-center-merges-with-temple-university/feed/ 0 Physicians Pessimistic on Benefits of Health Care Reform http://www.physiciansnews.com/2011/12/13/physicians-pessimistic-on-benefits-of-health-care-reform/ http://www.physiciansnews.com/2011/12/13/physicians-pessimistic-on-benefits-of-health-care-reform/#comments Tue, 13 Dec 2011 15:47:24 +0000 Physicians News http://www.physiciansnews.com/?p=4488 A new Deloitte study reveals physicians are skeptical about core promises associated with the Patient Protection and Affordable Care Act.  Only 27 percent of physicians surveyed believe the PPACA is likely to reduce costs by increasing efficiency, and only 33 percent feel it is likely to decrease disparities.  Moreover, half say access to health care will decrease because of hospital closures that result from the law. The report, “Physician Perspectives about Health Care Reform and the Future of the Medical Profession,” also shows that the majority of doctors (73 percent) are not excited about the future of medicine and believe (69 percent) the “best and brightest” who might consider a career in medicine will think otherwise. “The data confirms that physicians are resistant to reform and are frustrated with the direction of the profession,” says Paul Keckley, Ph.D., executive director of the Deloitte Center for Health Solutions and lead author of the report.  “Understanding the view of the physician is fundamental to any attempt to change the health care model – this is the person prescribing the medicine, ordering the test and performing the surgery." The negativity is driven in part by concern over the pressure primary doctors will face from millions of newly-insured consumers seeking care and the reverberations this sudden impact could create on the larger system. Another stumbling block for physicians is the view that reform will mean a loss of autonomy and more costs and administrative burdens in adopting processes and technologies.  For decades this sense of autonomy has been sacrosanct to the profession, and it’s difficult to uproot that overnight, continues Keckley. “Effective reform has to consider the physician’s view as a starting point,” says Keckley.  “We not only have to design the right model, but we have to create the right incentives and processes for implementing that model.  The concept of change management is just as important for doctors in the health care system as it is for employees in a corporation.” Additional key findings from the study include:
  • Nearly three-quarters of respondents think that emergency rooms could get overwhelmed if primary care physician appointments are full as a result of the Patient Protection and Affordable Care Act.
  • More than 80 percent believe it is likely that wait times for primary care appointments will increase because of a lack of providers.  More than half indicate that other medical professionals (physician assistants, nurse practitioners) will deliver primary care both independently and as an adjunct to physician services.
  • Surgical specialists (57 percent) are much more likely to support the law’s repeal compared to primary-care providers (38 percent) and non-surgical specialists (34 percent).  They are also more likely to say the legislation is a step in the wrong direction and believe their net income will decrease as a result of reform.
  • There is a disparity among generations, as 59 percent of physicians 50 to 59 years old feel PPACA is a step in the wrong direction while only 36 percent of those ages 25 to 39 share this sentiment. Younger physicians (ages 25 to 39) are also more likely than older doctors (ages 40 to 59) to think the transition to evidence-based medicine will improve care.
For more information about Physician Perspectives about Health Care Reform and the Future of the Medical Profession, visit www.deloitte.com/us/physiciansurvey.]]> http://www.physiciansnews.com/2011/12/13/physicians-pessimistic-on-benefits-of-health-care-reform/feed/ 0 Five Issues To Impact Docs in 2012 http://www.physiciansnews.com/2011/12/08/five-issues-to-impact-docs-in-2012/ http://www.physiciansnews.com/2011/12/08/five-issues-to-impact-docs-in-2012/#comments Thu, 08 Dec 2011 15:40:50 +0000 Physicians News http://www.physiciansnews.com/?p=4473 As the New Year approaches and the future of health reform hangs in the balance, The Physicians Foundation – a nonprofit organization that seeks to advance the work of practicing physicians and improve the quality of healthcare for all Americans – has identified five key areas that will impact the practice of medicine in the year ahead. The Physicians Watch List for 2012 is based on research the Foundation released earlier this year, including the 2010 Health Reform Research Study and 2011 Roadmap for Physicians to Healthcare Reform Paper.

  1. Changing nature of medical practices. Many physicians are choosing hospital and group settings versus private practice due to the perceived security employed settings offer. Only one quarter of physicians surveyed said they plan to continue practicing as they are; half said they would adopt a style of practice different from the traditional full-time independent private practice model. In 2012, physicians will need to carefully assess their individual circumstances and determine the practice configuration that best meets their needs and those of their patients.
  2.  Decreased return on increased burden. The added regulations and administrative responsibilities based on the Patient Protection and Affordable Care Act (PPACA) have caused physicians to focus less on the patient and more on administrating their practices. Sixty-three percent of physicians surveyed said that non-clinical paperwork has caused them to spend less time with their patients and 94 percent said time they devote to non-clinical paperwork in the last three years has increased. In 2012, physicians will need to vigilantly monitor their administrative burdens and take steps to minimize any further impact on their relationship with patients.
  3. Acute shortages of primary care physicians. A growing shortage of physicians threatens the medical profession’s ability to serve patients across key specialties and geographies. Physicians will need to redefine their roles and rethink delivery models in order to meet rising demand. The majority of physicians (60 percent) said health reform will compel them to close or significantly limit their practices to certain categories of patients. Of these, 93 percent said they will close or significantly limit their practices to Medicaid patients and 87 percent said they would close or significantly restrict their practices to Medicare patients. In 2012, physicians will need to evaluate how they can optimize their time to accommodate the current and future needs of their patients.
  4. Critical need for physician leadership tools / skills. In the healthcare environment of tomorrow, many physicians will assume greater business and people management responsibilities within practice groups and hospital settings.  In 2012, physicians will need to acquire new types of non-medical leadership skills to be effective in these expanded roles, while still maintaining their trusted relationships with patients.
  5. Impact on patients. The need to provide higher quality in an environment characterized by increased reporting, problematic reimbursement and high potential liability, will place extraordinary stress on physicians, particularly those in private practice. Only one physician in ten believes that health reform will enhance the quality of care they are able to provide to their patients, compared to 56 percent who believe reform will diminish the quality of care they are able to provide.  In 2012, physicians will increasingly need to balance these competing factors in ways that do not compromise the care they provide to patients.

“Proposed changes to our healthcare system have already significantly impacted physicians and patients,” said Lou Goodman, Ph.D., president of The Physicians Foundation and chief executive officer of the Texas Medical Association. “We hope the physician watch list helps to address the core issues under the new legislation and offers doctors and the healthcare community guidance on how to deliver the best care possible to patients in 2012.”

]]> http://www.physiciansnews.com/2011/12/08/five-issues-to-impact-docs-in-2012/feed/ 2 Both Patients And Physicians Can Suffer When Test Results Aren’t Reported http://www.physiciansnews.com/2011/11/29/both-patients-and-physicians-can-suffer-when-test-results-aren%e2%80%99t-reported/ http://www.physiciansnews.com/2011/11/29/both-patients-and-physicians-can-suffer-when-test-results-aren%e2%80%99t-reported/#comments Tue, 29 Nov 2011 16:01:38 +0000 Physicians News http://www.physiciansnews.com/?p=4438 Medical tests can reveal critical information about a person's health, but only if the results are communicated to clinicians and patients. Sometimes, the ball gets dropped somewhere between the lab or the radiology department and the clinician who ordered the test and the patient. In Peggy Kidwell's case, a mix-up over doctors' names led to a year-long delay in a breast cancer diagnosis.

After her annual gynecological exam and mammogram several years ago at a medical center near her Virginia Beach home, she got a letter from her doctor saying the results of her Pap test were normal. She assumed that she would hear from her doctor if anything untoward showed up on her mammogram exam and thought no more about it.

A year later, when Kidwell went back for her annual exam at age 59, her doctor, finding no mammogram results in her chart, asked why she hadn't gotten a screening exam the previous year. When Kidwell said she had, the doctor investigated. Five hours later, the doctor called Kidwell to tell her she had found the results and it looked as though she had breast cancer.The test results had been sent to an orthopedic surgeon at the medical center who had the same last name as Kidwell's gynecologist. The folder had been sitting on his desk for a year, according to her gynecologist. By that time her cancer had spread to her chest wall. Kidwell had a lumpectomy, chemotherapy and radiation. The following year, the cancer came back and Kidwell had a mastectomy. She filed a lawsuit and eventually settled the case. (A confidentiality agreement prohibits her from discussing specifics.) No one, she says, ever said that an earlier diagnosis might have made a difference in the course of her disease, but she believes it may have. Kidwell, who now lives in Silver Spring, blames the medical system for the mix-up, but also herself. "To this day, I don't let myself off the hook for not picking up the phone," she says. Financial Consequences There are also financial consequences for providers when tests aren't promptly reported: A recent study in the Journal of the American College of Radiology found that annual medical malpractice payouts for communication breakdowns, including failing to share test results, more than quadrupled nationally between 1991 and 2010, to million. For patients, the missteps and mistakes can be life-altering. Patient follow-up could make a difference in many instances. The study examined medical malpractice claims from 425 hospitals and 52,000 providers. Of the 306 cases in which test results were specifically cited as a factor in a malpractice case, the most common problem — it occurred almost half the time — was that the patient didn't receive the test results, cited in 143 cases. The second-most-common problem was that the clinician didn't receive the results, cited in 110 cases. Other problems included delays and slow turnaround in reporting findings and test results that were filed before the clinician reviewed them. The study examined a different database as well, the National Practitioner Data Bank, to arrive at a dollar value for malpractice claims payouts related to communications problems, examining categories that would include getting test result information to practitioners and patients alike, for the period from 1991 to 2010. That analysis showed that payouts increased from million to million during that time, a more than four-fold increase. Patient advocates and policy experts say the push for better coordination of patient care, including the adoption of electronic medical records, should help improve the delivery of test results to patients from doctors and to doctors from those who perform the tests. "Health reform and payment reform are moving us toward integrating care to a degree that we don't do right now," says Diane Pinakiewicz, president of the National Patient Safety Foundation, a Boston-based consumer group. "The one constant is the patient. The best chance is for the patient to be part of the process." A Multilayered Approach Patient involvement is important, but the burden of following up on test results shouldn't fall on their shoulders, experts agree. But doctors need a helping hand. In a given week, a primary-care doctor might need to review 360 chemistry test results, 460 hematology results, 12 pathology reports and 40 radiology reports, according to researchers at Partners HealthCare system in Boston. More than half of physicians surveyed some years ago said they weren't satisfied with the way they handled test results, which typically took more than an hour each day. Now many practices affiliated with Partners use a multilayered system that helps them manage test results. The Web-based system lets them log in and see all the tests they've ordered and the results that have come in, with those that are problematic listed first. If a test result requires urgent attention, the system generates an e-mail alerting doctors; if they ignore this warning and subsequent messages, the system alerts the practice manager, who contacts the physician directly. The system also generates letters that notify patients of their test results and has a tickler function that can alert doctors when patients haven't had follow-up tests as ordered. Even so, "nothing is foolproof," says Eric Poon, director of clinical informatics at Brigham and Women's Hospital, part of the Partners system. "No news is not good news," he says. "If a patient gets a test done and doesn't get a result, he should follow up." ### This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente. ]]> http://www.physiciansnews.com/2011/11/29/both-patients-and-physicians-can-suffer-when-test-results-aren%e2%80%99t-reported/feed/ 1 Win ,000: Essay Contest Challenges Docs To Offer Solutions To Healthcare Costs http://www.physiciansnews.com/2011/10/27/win-1000-essay-contest-challenges-docs-to-offer-solutions-to-healthcare-costs/ http://www.physiciansnews.com/2011/10/27/win-1000-essay-contest-challenges-docs-to-offer-solutions-to-healthcare-costs/#comments Thu, 27 Oct 2011 13:00:54 +0000 Physicians News http://www.physiciansnews.com/?p=4350 Costs of Care, a physician-run nonprofit based in Boston, has launched its second annual national healthcare essay contest, with the goal of expanding the public discourse on the role of doctors, nurses, and other care providers in controlling healthcare costs. Executive Director Neel Shah, who is also a third-year obstetrics and gynecology resident at the Harvard Medical School, founded Costs of Care after he began thinking, as a med student, that physicians had a good deal of power over healthcare costs but rarely thought about them. "There's a lot of talk about insurers and patients, but at the end of the day doctors decide what's on the bill," he told the LA Times. Last year, Costs of Care launched an innovative essay contest that emphasized the importance of price transparency in everyday medicine by gathering more than 100 personal stories from patients, nurses, and doctors across the nation. A vascular surgeon in Arizona, for example, wrote about a time a hospital assigned an out-of-network anesthesiologist to a surgery, sending a patient's bill skyrocketing, according to the LA Times. "There was no mechanism to make sure all of the providers a patient uses were in network," Shah said.  "That's a simple check." This year, Costs of Care is looking for more stories, and will award 00 prizes for stories about the importance of price transparency as well as solution-oriented stories that illustrate ways to reduce harmful healthcare spending and save patients’ money. As the economy struggles to recover, the spiraling costs of healthcare in the United States have become a contentious political focal point without an obvious solution. Traditionally, health care providers have been reluctant to discuss their own role in healthcare spending. However, Dr. Shah, “Ultimately, no amount of regulating, reorganizing, or otherwise reforming the healthcare system will successfully contain costs unless healthcare providers are invested in fixing the problem.” To help mobilize healthcare providers to examine their own role in spending, Costs of Care is launching an essay contest that will collect and widely disseminate stories from the front lines of medicine. Costs of Care will award 00 in prizes to top submissions. Two 00 prizes will be reserved for patients, and two 00 prizes will be reserved for care providers. Preference will be given to stories that best demonstrate the importance of cost-awareness in medicine. Examples may include a time a patient tried to find out what a test or treatment would cost but was unable to do so, a time that caring for a patient generated an unexpectedly a high medical bill, or a time a patient and care provider figured out a way to save money while still delivering high-value care. To help select the winning entries, Costs of Care has partnered with five health luminaries who will serve as judges:
  • Peter Orzsag, former Director of the White House Office of Management and Budget
  • Dr. C. Everett Koop, former United States Surgeon General
  • Hon. Jennifer Granholm, former Governor of Michigan
  • Dr. Susan Love, women’s health and cancer research advocate
  • Dr. Alan Garber, health economist and Harvard University Provost
All submissions will be due on November 15th, 2011. Finalists will be announced on December 15th, 2011 and the ,000 prize winners will be announced on January 15th, 2012. All qualifying submissions will be published biweekly at http://www.costsofcare.org during the 2012 calendar year.  ]]> http://www.physiciansnews.com/2011/10/27/win-1000-essay-contest-challenges-docs-to-offer-solutions-to-healthcare-costs/feed/ 0 ER Docs Focus On Medical Liability Reforms http://www.physiciansnews.com/2012/02/07/experts-divided-over-recommendation-to-screen-children-for-cholesterol/ http://www.physiciansnews.com/2012/02/07/experts-divided-over-recommendation-to-screen-children-for-cholesterol/#comments Tue, 07 Feb 2012 16:15:56 +0000 Physicians News http://www.physiciansnews.com/?p=4592 One in 500 kids has an inherited disorder that causes high levels of LDL ("bad") cholesterol that may require medication to control. However, since the problem doesn't create observable symptoms, as many as half of these kids don't know they have the condition. To help identify these children, late last year an expert panel convened by the National Heart, Lung, and Blood Institute recommended that all children be screened for high cholesterol, once between the ages of 9 and 11 and again between ages 17 and 21. Reaction to the guidelines, which were included as part of a larger NHLBI report on improving cardiovascular health in children and adolescents, has been mixed. Some clinicians and researchers say universal screening is an important tool not only to help identify children who are genetically predisposed to high cholesterol, a condition called familial hypercholesterolemia, but also to pinpoint others who could benefit from treatment, including those with high LDL related to being overweight or obese. Working with these kids to eat more healthfully and to exercise more may reduce the cumulative negative effect of high cholesterol on their cardiovascular systems and lead to fewer heart attacks and strokes later in life, the experts say. Others, including clinicians who authored a pair of articles in the Journal of the American Medical Association last month, express concerns that screening may do more harm than good. To identify the relatively small number of kids who really need medical treatment, doctors cast a wide and expensive net that identifies many children as at risk who will never develop  premature cardiovascular disease, says Matthew Gillman, director of the obesity prevention program at Harvard Medical School, who co-authored one of the articles. Some of those children will probably be needlessly put on cholesterol-lowering medications, he says. The U.S. Preventive Services Task Force, an independent group of primary-care providers that evaluates the evidence for clinical care, concluded in 2007 that there isn't enough evidence to recommend for or against routine lipid screening in children and adolescents. Research has shown that 10 to 13 percent of children have elevated cholesterol levels. Treatment for the vast majority should focus on lifestyle interventions, says Stephen Daniels, chairman of the Department of Pediatrics at the University of Colorado School of Medicine, who led the NHLBI panel. A much smaller number of those children, the ones with a genetic predisposition to high cholesterol, may need to take a statin, he says. Until the new guidelines were released, the American Academy of Pediatrics recommended cholesterol screening in children primarily based on family history. If a child had a father who had heart disease or a heart attack before age 55, for example, screening would be indicated. Children who had risk factors such as obesity or diabetes were also candidates for screening. The AAP has since endorsed the new NHLBI guidelines. "Family history doesn't really catch everybody" with familial hypercholesterolemia, says Sarah de Ferranti, a member of the AAP committee on nutrition and the director of preventive cardiology at Children's Hospital Boston. In addition, she says, "Anecdotally, I can tell you that when someone comes to my office and they know they have high cholesterol values, they're much more focused." That's the case with the McFeeley family. Bill and Carolyn McFeeley, of Mullica Hill, N.J., had always considered themselves very healthy - until Bill had a heart attack two years ago at age 47. The pediatrician for their three children checked the kids' cholesterol and found that while levels for the two girls - Chelsea, now 17, and Chandler, 13 - were normal, Chase, 10, had slightly higher values: His total cholesterol was roughly 210. (In general, anything over 200 is considered high.)
The McFeeley family, from left to right: Chandler, Carolyn, Chase, Bill, and Chelsea.
Now Chase has replaced his beloved egg salad sandwiches with turkey and fat-free cheese ones. "If we can get ahead of it and keep Chase healthy, it means a lot to us," says Bill. Julie Brothers, medical director of the lipid heart clinic at Children's Hospital of Philadelphia, sees Chase once a year now and says she hopes they can manage his cholesterol without medication. "None of us wants to slap medication on anyone," she says. Maybe not. "But if you're going to test every child, it's a sure bet you're going to be medicating more kids," says H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, who has written extensively on the problems created by aggressive screening. Research on the safety and effectiveness of statins in children is scant; studies that have looked at statin use haven't enrolled more than a few hundred kids, and none has followed them for more than two years, say experts. "We don't know what taking a 10- to 11-year-old kid and putting them on statins long term will do," says Frederick Rivara, division chief of general pediatrics at Seattle Children's Hospital and co-author of one of the JAMA articles. Gillman says that while early intervention to prevent heart disease is critical, screening all children may not be the best way to do it. As an example, he cites a study that he co-authored last year examining the cost-effectiveness of blood pressure screening in adolescents. "The bottom line of that study is that population approaches like taking the salt out of food are more effective and less costly than any screening program," he says. ### This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente. ]]> http://www.physiciansnews.com/2012/02/07/experts-divided-over-recommendation-to-screen-children-for-cholesterol/feed/ 0 Physicians News » News Briefs http://www.physiciansnews.com Tue, 07 Feb 2012 16:44:06 +0000 en hourly 1 http://wordpress.org/?v=3.2.1 Experts Divided Over Recommendation To Screen Children For Cholesterol http://www.physiciansnews.com/2012/02/07/experts-divided-over-recommendation-to-screen-children-for-cholesterol/ http://www.physiciansnews.com/2012/02/07/experts-divided-over-recommendation-to-screen-children-for-cholesterol/#comments Tue, 07 Feb 2012 16:15:56 +0000 Physicians News http://www.physiciansnews.com/?p=4592 One in 500 kids has an inherited disorder that causes high levels of LDL ("bad") cholesterol that may require medication to control. However, since the problem doesn't create observable symptoms, as many as half of these kids don't know they have the condition. To help identify these children, late last year an expert panel convened by the National Heart, Lung, and Blood Institute recommended that all children be screened for high cholesterol, once between the ages of 9 and 11 and again between ages 17 and 21. Reaction to the guidelines, which were included as part of a larger NHLBI report on improving cardiovascular health in children and adolescents, has been mixed. Some clinicians and researchers say universal screening is an important tool not only to help identify children who are genetically predisposed to high cholesterol, a condition called familial hypercholesterolemia, but also to pinpoint others who could benefit from treatment, including those with high LDL related to being overweight or obese. Working with these kids to eat more healthfully and to exercise more may reduce the cumulative negative effect of high cholesterol on their cardiovascular systems and lead to fewer heart attacks and strokes later in life, the experts say. Others, including clinicians who authored a pair of articles in the Journal of the American Medical Association last month, express concerns that screening may do more harm than good. To identify the relatively small number of kids who really need medical treatment, doctors cast a wide and expensive net that identifies many children as at risk who will never develop  premature cardiovascular disease, says Matthew Gillman, director of the obesity prevention program at Harvard Medical School, who co-authored one of the articles. Some of those children will probably be needlessly put on cholesterol-lowering medications, he says. The U.S. Preventive Services Task Force, an independent group of primary-care providers that evaluates the evidence for clinical care, concluded in 2007 that there isn't enough evidence to recommend for or against routine lipid screening in children and adolescents. Research has shown that 10 to 13 percent of children have elevated cholesterol levels. Treatment for the vast majority should focus on lifestyle interventions, says Stephen Daniels, chairman of the Department of Pediatrics at the University of Colorado School of Medicine, who led the NHLBI panel. A much smaller number of those children, the ones with a genetic predisposition to high cholesterol, may need to take a statin, he says. Until the new guidelines were released, the American Academy of Pediatrics recommended cholesterol screening in children primarily based on family history. If a child had a father who had heart disease or a heart attack before age 55, for example, screening would be indicated. Children who had risk factors such as obesity or diabetes were also candidates for screening. The AAP has since endorsed the new NHLBI guidelines. "Family history doesn't really catch everybody" with familial hypercholesterolemia, says Sarah de Ferranti, a member of the AAP committee on nutrition and the director of preventive cardiology at Children's Hospital Boston. In addition, she says, "Anecdotally, I can tell you that when someone comes to my office and they know they have high cholesterol values, they're much more focused." That's the case with the McFeeley family. Bill and Carolyn McFeeley, of Mullica Hill, N.J., had always considered themselves very healthy - until Bill had a heart attack two years ago at age 47. The pediatrician for their three children checked the kids' cholesterol and found that while levels for the two girls - Chelsea, now 17, and Chandler, 13 - were normal, Chase, 10, had slightly higher values: His total cholesterol was roughly 210. (In general, anything over 200 is considered high.)
The McFeeley family, from left to right: Chandler, Carolyn, Chase, Bill, and Chelsea.
Now Chase has replaced his beloved egg salad sandwiches with turkey and fat-free cheese ones. "If we can get ahead of it and keep Chase healthy, it means a lot to us," says Bill. Julie Brothers, medical director of the lipid heart clinic at Children's Hospital of Philadelphia, sees Chase once a year now and says she hopes they can manage his cholesterol without medication. "None of us wants to slap medication on anyone," she says. Maybe not. "But if you're going to test every child, it's a sure bet you're going to be medicating more kids," says H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, who has written extensively on the problems created by aggressive screening. Research on the safety and effectiveness of statins in children is scant; studies that have looked at statin use haven't enrolled more than a few hundred kids, and none has followed them for more than two years, say experts. "We don't know what taking a 10- to 11-year-old kid and putting them on statins long term will do," says Frederick Rivara, division chief of general pediatrics at Seattle Children's Hospital and co-author of one of the JAMA articles. Gillman says that while early intervention to prevent heart disease is critical, screening all children may not be the best way to do it. As an example, he cites a study that he co-authored last year examining the cost-effectiveness of blood pressure screening in adolescents. "The bottom line of that study is that population approaches like taking the salt out of food are more effective and less costly than any screening program," he says. ### This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente. ]]> http://www.physiciansnews.com/2012/02/07/experts-divided-over-recommendation-to-screen-children-for-cholesterol/feed/ 0 The Treatment of Solid Tumors: Some Recent Approaches http://www.physiciansnews.com/2012/02/07/the-treatment-of-solid-tumors-some-recent-approaches/ http://www.physiciansnews.com/2012/02/07/the-treatment-of-solid-tumors-some-recent-approaches/#comments Tue, 07 Feb 2012 16:14:45 +0000 Physicians News http://www.physiciansnews.com/?p=4595 By Punit Dhillon At some point in their lives, one in five people will suffer from skin cancer, and the fraction is steadily rising.  In spite of innovation in sunscreen technology and public attention to the need to be shielded from the sun, data reported recently by Dermatology Times show a rise in the average American lifetime risk of one skin cancer variety—invasive melanoma—from 1/600 in 1960 to 1/50 in 2008.  Despite previous diagnosis and innovations in approaches to treatment, the age-adjusted number of annual deaths per 100,000 population is rising.  Additionally, the expense to the healthcare system and society continues to increase.  As U.S. and European populations age, the incidence of skin cancer and other solid tumor cancers will grow.  According to the latest United States Cancer Statistics, published by the Centers for Disease Control and Prevention in 2007, the top 10 cancer types (based on incidence rate) are in the solid tumor category; today the priority is probably even higher.  Thus, there are clear medical needs going unmet and the creation of novel, cost-efficient and patient-friendly treatments remain a top priority for both the healthcare community and patients. Various challenges of traditional treatments The treatment of solid tumor cancers, which range from melanoma and Merkel cell carcinoma to cutaneous T-cell lymphoma, continues to be a substantial challenge for physicians.  For example, in spite of innovations in drug discovery and development, it is still challenging to simply deliver efficient drugs into cancer cells in a safe and effective manner.  Meanwhile, today’s therapeutic approaches—involving surgery, radiation therapy and chemotherapy—each have characteristic and major drawbacks. Surgery, the current first-line treatment for localized and operable tumors or lesions, requires resecting the tumor mass and a surrounding boundary of healthy tissue to make sure that no cancer cells remain at the tumor site.  Surgery can potentially cause physical disfigurement and/or debilitating effects on organ function, and the patient quality of life has been demonstrated to be negatively impacted.  Also, surgery can require an expensive and long hospital stay. Radiation therapy is occasionally used in conjunction with surgery to shrink a tumor prior to surgical removal, or afterward to destroy any cancer cells that might remain.  Yet surgery plus radiation can damage important normal tissues like nerves, blood vessels, or vital organs such as the heart that are within the designated zone of treatment.  Radiation is also a costly therapeutic approach, and demands substantial expertise, precautionary measures and infrastructure to administer.  Radiation entails major complications, such as nausea, diarrhea, dry mouth, taste alterations, loss of appetite, and the potential for the formation of new cancerous lesions. Those who get radiation to the heart often suffer from various types of heart failure in subsequent years. Typically, chemotherapy is a secondary or palliative treatment to help mitigate systemic or metastatic tumor growth, whereas surgery and radiation may be considered local treatments.  In response to cancer’s spread, physicians will administer chemotherapeutic agents that circulate throughout the body, systemically and in high concentrations, to counter the challenge that some chemotherapeutic agents have in reaching and penetrating the cell membrane to trigger cell death.  Yet the system-wide use of chemotherapeutics frequently has major side effects by killing healthy as well as cancerous cells.  This systemic and non-targeted administration of anticancer agents can trigger alopecia; nausea; vomiting; myelosuppression; and drug resistance.  Chemotherapy is curative for only a few tumor types. Additionally, all of these conventional treatments are only minimally effective on aggressive types of cutaneous cancers, especially in later stages of the disease. Some potential approaches We now offer an abbreviated look at some current approaches to override these challenges in treating solid tumors. One possible strategy for solid tumor treatment involves a new class of small-molecule drug candidates called vascular disrupting agents.  Via interaction with vascular endothelial cytoskeletal proteins, these agents may selectively target and collapse tumor vasculature, thereby depriving the tumor of oxygen and causing death of the tumor cells. Another approach involves the use of new therapeutic monoclonal antibody candidates that target CD27, a member of the tumor necrosis factor (TNF) receptor superfamily.  Anti-CD27 monoclonal antibodies have been demonstrated to effectively promote anticancer immunity in mouse models when combined with T cell receptor stimulation.  In addition, CD27 is overexpressed in various lymphomas and leukemias and can be targeted for direct activity by anti-CD27 monoclonal antibodies with effector function against those cancers.  There are many other antibody drugs on the market, some also with linked toxins or radiation. A third tactic involves the creation of an orally available nucleoside analogue for various cancers including solid tumors.  This agent could act through a novel DNA single-strand breaking mechanism, leading to the production of DNA double strand breaks (DSBs) and/or DNA repair checkpoint activation; unrepaired DSBs go on to cause apoptosis or programmed cell death. Alternatively, solid tumors could be treated using a technique called tumor ablation, which involves destroying the tumor inside the body via various approaches.  Radioactive pellets, shorter than an inch and approximately the width of a pin, can be inserted into the tumor; the pellet subsequently emits lethal radioactive atoms that irradiate the tumor from the inside out.  As the tumor breaks down, it starts to release antigens that trigger an immune response against the cancer cells.  Sometimes, the body also develops an immune memory against the future return of tumor cells.  Another proposed ablation technique, called “pulsed electric current ablation,” involves the insertion of electrodes into tumors, which subsequently emit very high-energy electrical currents; these currents create a physical reaction that destroys the tumor cells. A separate approach involves applying local heating to the tumor using radio frequency techniques.  In this instance, a thermal energy delivery device can be focused and targeted according to the shape, size and position of a specific tumor.  Adjusting the frequency, phase, and amplitude of the radio waves, combined with different applicators and adjustment of the patient’s position, could conceivably permit a doctor to optimize the delivery of damaging energy into the tumor. Cancer scientists are also interested in attacking solid tumors by delivering drugs specifically into diseased tissues. Such a targeted approach can result in more efficient therapy while using smaller drug doses with fewer negative side effects.  For example, in animal studies, immune-deficient mice carrying human forms of various cancers have been simultaneously injected with a range of anticancer agents and a peptide known as iRGD.  iRGD can find and attach itself to receptors on solid tumor cancer cells and later activate their internal transport systems so that the peptide is essentially passed through cell after cell, moving progressively deeper into the tumor structure.  Anticancer drugs lingering near the peptide molecules may also get pulled into and through the tumor mass by this transport mechanism, enabling them to attack cancer cells previously beyond their reach. By their nature and cellular architecture, solid tumors are equipped to limit the efficacy of most anticancer drugs.  Tumors have poor vascular systems, which reduces exposure to drugs that have been administered into the circulation.  The lesions are densely fibrous, which serves as a physical barrier against transport.  Also, the tumors have high internal pressures, causing further physical challenges to any molecule attempting to enter the lesion.  The iRGD peptide is designed to act like a key, switching on the internal transport mechanism of the cells so that they absorb anything that is proximal to certain cell surface receptors.  Researchers believe the iRGD peptide could penetrate many tumor types and might be useful in treating most solid tumor cancers.  An encouraging aspect of this approach is that both the peptide and anticancer drugs are effective together without being chemically attached. Yet another promising strategy for treating solid tumor cancers involves targeting the tumor itself without affecting any of the surrounding healthy tissue.  This ensures that the drug or therapeutic agent is absorbed at once by the cancer cells and not normal tissues.  One such targeted therapy could harness a physiologic process known as “electroporation.”  Derived from the words “electric” and “pore,” this involves applying a brief electric field to the cancerous cell.  The electrical pulse triggers the temporary creation of pores in the cell’s outer membrane—pores that close again within seconds once the electric field is discontinued.  These transient pores can improve uptake of various drugs more than a thousand-fold. Several electroporation systems have been manufactured that consist of a generator that creates the pulsed electric field, and various handheld applicators with electrode needles at their proximal ends.  The applicator delivers a controlled electric pulse to the cancer cells, thus causing any cancer cells within the affected region to undergo electroporation.  The cell takes up therapeutic agents within the region of electroporation. This technology platform is being developed for use in two varieties of anticancer therapies:  electrochemotherapy and electroimmunotherapy.  In the former, an anticancer drug is injected into a targeted tumor; the lesion is then electroporated and the drug carries out its planned mechanism of action in killing the cell.  As a result of the targeted, local therapy, the amount of drug needed to kill the cells is substantially less than that required in traditional, non-targeted chemotherapy.  The lower quantity of systemic drug (cytotoxic agent) reduces harmful side effects linked to traditional chemotherapy. Electroimmunotherapy, the second application of electroporation, involves the use of a gene encoding a specific cytokine, a substance known to boost the human immune system against cancer cells.  An immune response can have both a local and a distant effect against cancerous cells.  These therapeutic approaches have been shown to be safe and effective across various types of tumors.  Both patient outcomes and pharmacoeconomic benefits are substantial.  This technology is in clinical testing in North America and is available for commercial sale in some European countries. Therapies such as those discussed here may provide a compelling set of novel approaches to the treatment of solid tumor cancers. ### Punit Dhillon is President and CEO of OncoSec Medical Inc., a biotechnology company developing its advanced-stage Oncology Medical System (OMS) ElectroOncology therapies to treat skin cancer and other solid tumor cancers. He can be reached at pdhillon@oncosec.com.]]> http://www.physiciansnews.com/2012/02/07/the-treatment-of-solid-tumors-some-recent-approaches/feed/ 0 Dream Of A Medical ‘Price List’ Dies In Florida Legislature http://www.physiciansnews.com/2012/01/31/dream-of-a-medical-%e2%80%98price-list%e2%80%99-dies-in-florida-legislature/ http://www.physiciansnews.com/2012/01/31/dream-of-a-medical-%e2%80%98price-list%e2%80%99-dies-in-florida-legislature/#comments Tue, 31 Jan 2012 16:30:32 +0000 Physicians News http://www.physiciansnews.com/?p=4579 approved legislation that would expand the state’s requirement that certain providers post the out-of-pocket prices of common health care services, a state Senate committee shot down a similar measure after an aggressive lobbying push by health care provider groups. Organizations representing the state’s doctors weren’t wild about the idea that certain facilities would have to display bulletin-board sized postings of their prices. Jeff Scott, general counsel for the Florida Medical Association, said that providers are all for transparency, but they don’t need the government telling them exactly how they should do it. “Next thing you know they’re going to say it has to be neon or include pictures,” he said. But providers’ most strenuous objections were to provisions in the legislation that would require providers to disclose prices to out-of-network patients and limit so-called balance billing, which happens in health care settings when providers bill patients the difference between what they charge for a service and what insurers pay it. Meanwhile, the state already requires urgent care centers to post in their reception area the prices of their 50 most frequently used services, and the posting must be at least 15 square feet.  Physicians are not required to do so, but they must follow the same rules if they post prices voluntarily. Under the proposed legislation, ambulatory care centers and diagnostic-imaging centers would have had to follow the same rules as urgent care centers, and the original bills also would have expanded the requirement to physicians. The House committee-approved bill softened this language to maintain the voluntary status quo for doctors. Both bills would have required physicians to provide patients with a written statement of prices at each visit. Richard Polangin, health care policy coordinator for the Florida Public Interest Research Group, said the legislation would have been a boon for consumers, many of whom are unaware that prices can vary among doctors and facilities. The bills would “enable persons who must pay for doctor visits, diagnostic images such as CT scans and MRIs, and for care at ambulatory surgery centers, to know the cost in advance,” he said. “The uninsured and persons with insurance deductibles would be able to make more informed health care decisions.” Insurers and business groups also supported the legislation. And, though the measure’s future is uncertain, at least one person involved in the lobbying effort said work would continue. ### This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.]]> http://www.physiciansnews.com/2012/01/31/dream-of-a-medical-%e2%80%98price-list%e2%80%99-dies-in-florida-legislature/feed/ 0 Twins Born in Different Years: What About Insurance? http://www.physiciansnews.com/2012/01/04/twins-born-in-different-years-what-about-insurance/ http://www.physiciansnews.com/2012/01/04/twins-born-in-different-years-what-about-insurance/#comments Wed, 04 Jan 2012 21:02:55 +0000 Physicians News http://www.physiciansnews.com/?p=4525 By Sarah Barr By the time newborn Freya Humenny joined her twin brother Beckett this past weekend, the calendar already had turned from 2011 to 2012. That means the twins always will have their own birthdays—but will they share an insurance statement? The twin’s mother, Stephanie Peterson, gave birth to Beckett at 6:40 p.m. on Dec. 31, 2011,  at the Hennepin County Medical Center in Minneapolis, but Freya did not follow until 12:26 a.m on Jan. 1. And so after we ooh-ed and ahh-ed over the adorable pair, we had to ask: What could a case like this mean for a family’s insurance? Paul Fronstin, director of the health research and education program at the Employee Benefit Research Institute, said that every case would vary based on the terms of a family’s policy. But, as an example, if a family had a high-deductible private insurance plan, a number of factors would be in play, according to Fronstin. For one, there is the question of the family’s deductible.  Lots of prenatal services are covered as preventive care, but some are not.  If the family had not yet met their 2011 deductible, then the first of the births would be applied to that year’s deductible, while the second could apply to the next year. There’s also the question of whether the second birth would even be considered an expense for the new year or whether it would be tied to the mother’s original admission. And as for the twins themselves, the second child’s expenses likely would be billed as new year expenses, but services for the first child, such as nights spent in a nursery, could span the two years—raising another set of questions about how to bill. Fronstin said that while a hypothetical case brings up a number of questions, an insurer’s response won’t necessarily be complicated. “It could be as simple as it was so close to midnight that it doesn’t really matter,” he said. Recommence the oohs and ahhs. ### This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.]]> http://www.physiciansnews.com/2012/01/04/twins-born-in-different-years-what-about-insurance/feed/ 0 Fox Chase Cancer Center Merges with Temple University http://www.physiciansnews.com/2011/12/17/fox-chase-cancer-center-merges-with-temple-university/ http://www.physiciansnews.com/2011/12/17/fox-chase-cancer-center-merges-with-temple-university/#comments Sat, 17 Dec 2011 16:05:33 +0000 Physicians News http://www.physiciansnews.com/?p=4493 Temple University Health System and Fox Chase Cancer Center this week signed an Affiliation Agreement that moves both institutions closer to bringing Fox Chase Cancer Center into the Temple family – marking a major milestone for two celebrated Philadelphia institutions that will enhance cancer research and patient care in the region, both immediately and for years to come. "Temple is proud and privileged to welcome Fox Chase Cancer Center into its family of academic researchers and clinicians," said Ann Weaver Hart, PhD, President of Temple University. "This bold, visionary relationship immediately establishes Temple's position as a leader in cancer care and translational research at the local, regional and national levels," said Larry R. Kaiser, MD, FACS, Senior Executive Vice President for Health Sciences of Temple University, Dean of Temple University School of Medicine, and President and CEO of Temple University Health System. "It sets the stage for many exciting opportunities to grow and enhance the cancer-related patient-care, research and educational programs of Temple’s healthcare enterprise. "The pursuit of excellence is the driving force for today's action – which offers a preview of what tomorrow represents. Indeed, this affiliation marks a fresh direction in cancer research and treatment in Philadelphia," continued Dr. Kaiser. "Sustained by the converging action of two highly respected medical institutions, it will draw on both established knowledge and original insights to pave the way for what all cancer patients and their families want and deserve – hope." "Fox Chase is proud to be the professional home to some of the most talented and compassionate scientists, doctors, and nurses working on the cancer problem anywhere in the world," said Michael V. Seiden, MD, PhD, President and CEO of Fox Chase Cancer Center. "But we're always working to strengthen the Center's ability to more vigorously pursue our mission to prevail over cancer, and we believe that this affiliation with Temple University Health System will do just that, enabling us to begin recruiting new researchers and clinicians almost immediately and to expand our clinical services significantly in coming years to serve the region's cancer-care needs well into the future."   Fox Chase Cancer Center is one of only two National Cancer Institute (NCI)-designated comprehensive cancer centers in Philadelphia, and one of only 40 in the U.S. Its addition to Temple creates collaborative synergies between and among physician-scientists at Temple University School of Medicine, Fox Chase Cancer Center, and Temple Cancer Center that will accelerate the pace of further discovery and development of the most effective approaches to cancer prevention, diagnosis, and treatment. By becoming an affiliate of Temple University Health System, Fox Chase will be able to significantly expand its outpatient and surgical-care services – within its existing facilities and through the use of leased space in Jeanes Hospital, an affiliate of Temple University Health System since 1996. Given the geographic proximity of Fox Chase to Jeanes Hospital (home to TUH's highly-regarded Bone Marrow Transplant Program), a natural byproduct of the agreement is the creation of a contiguous, 47.5-acre site to serve as Temple's "cancer hub" for the development of future innovations in cancer-care and research. The affiliation also gives Jeanes Hospital the opportunity to meet the associated health care needs of cancer patients by providing a broad array of services on its premises in areas such as outpatient diagnostic testing, interventional radiology, breast care, general surgery, thoracic surgery, endocrine surgery, urology and diagnostic GI. Temple University Health System will invest in cancer research at Fox Chase – providing new resources to recruit additional physician-scientists who will further advance the collaborative efforts of Temple and Fox Chase researchers in creating new knowledge and pathways for the prevention, treatment, and, ultimately, cures for cancer and cancer-related conditions. "The affiliation of Fox Chase Cancer Center with Temple University Health System signifies an important step in the transformation of Temple’s healthcare enterprise," said Jane Scaccetti, Chair of Temple University Health System's Board and a Temple University Trustee. "The combined strength of both highly regarded institutions will fuel innovations in cancer research and patient care," added Patrick J. O'Connor, Esq., Chair of the Board of Trustees of Temple University. "We at Fox Chase Cancer Center have long understood the potential value of joining forces with Temple University Health System, particularly with Jeanes Hospital as our immediate neighbor," said David G. Marshall, Chair of the Board of Directors of Fox Chase Cancer Center. "Thanks to the committed leadership of Dr. Michael Seiden and Dr. Larry Kaiser, we're proud to announce today an affiliation agreement that will meet Fox Chase's growth needs for the foreseeable future while bringing a National Cancer Institute-designated comprehensive cancer center into Temple's vibrant academic medical community." Finally, the affiliation will bring efficiencies and savings, as economies-of-scale are recognized and leveraged across TUHS, Fox Chase Cancer Center, and Jeanes Hospital. The ability to demonstrate collaborative efficiencies is particularly important in a time when the ability to demonstrate both excellence and value matters more than ever before… to patients, payors, and grant-funding agencies. Temple's newly-consolidated cancer hub will serve as a vital source of discovery, development, and delivery of the most effective approaches to cancer prevention, diagnosis, and treatment that will give patients the best of both worlds: access to the comprehensive treatments and innovative clinical-trials available at both Temple Cancer Center and Fox Chase Cancer Center. Fold in the full array of academic and clinical expertise of Temple University School of Medicine faculty, and the most advanced diagnostic and therapeutic technologies available at Temple University Hospital, and it becomes clear that this affiliation will benefit all cancer patients and their families throughout the Delaware Valley… and beyond.
]]> http://www.physiciansnews.com/2011/12/17/fox-chase-cancer-center-merges-with-temple-university/feed/ 0 Physicians Pessimistic on Benefits of Health Care Reform http://www.physiciansnews.com/2011/12/13/physicians-pessimistic-on-benefits-of-health-care-reform/ http://www.physiciansnews.com/2011/12/13/physicians-pessimistic-on-benefits-of-health-care-reform/#comments Tue, 13 Dec 2011 15:47:24 +0000 Physicians News http://www.physiciansnews.com/?p=4488 A new Deloitte study reveals physicians are skeptical about core promises associated with the Patient Protection and Affordable Care Act.  Only 27 percent of physicians surveyed believe the PPACA is likely to reduce costs by increasing efficiency, and only 33 percent feel it is likely to decrease disparities.  Moreover, half say access to health care will decrease because of hospital closures that result from the law. The report, “Physician Perspectives about Health Care Reform and the Future of the Medical Profession,” also shows that the majority of doctors (73 percent) are not excited about the future of medicine and believe (69 percent) the “best and brightest” who might consider a career in medicine will think otherwise. “The data confirms that physicians are resistant to reform and are frustrated with the direction of the profession,” says Paul Keckley, Ph.D., executive director of the Deloitte Center for Health Solutions and lead author of the report.  “Understanding the view of the physician is fundamental to any attempt to change the health care model – this is the person prescribing the medicine, ordering the test and performing the surgery." The negativity is driven in part by concern over the pressure primary doctors will face from millions of newly-insured consumers seeking care and the reverberations this sudden impact could create on the larger system. Another stumbling block for physicians is the view that reform will mean a loss of autonomy and more costs and administrative burdens in adopting processes and technologies.  For decades this sense of autonomy has been sacrosanct to the profession, and it’s difficult to uproot that overnight, continues Keckley. “Effective reform has to consider the physician’s view as a starting point,” says Keckley.  “We not only have to design the right model, but we have to create the right incentives and processes for implementing that model.  The concept of change management is just as important for doctors in the health care system as it is for employees in a corporation.” Additional key findings from the study include:
  • Nearly three-quarters of respondents think that emergency rooms could get overwhelmed if primary care physician appointments are full as a result of the Patient Protection and Affordable Care Act.
  • More than 80 percent believe it is likely that wait times for primary care appointments will increase because of a lack of providers.  More than half indicate that other medical professionals (physician assistants, nurse practitioners) will deliver primary care both independently and as an adjunct to physician services.
  • Surgical specialists (57 percent) are much more likely to support the law’s repeal compared to primary-care providers (38 percent) and non-surgical specialists (34 percent).  They are also more likely to say the legislation is a step in the wrong direction and believe their net income will decrease as a result of reform.
  • There is a disparity among generations, as 59 percent of physicians 50 to 59 years old feel PPACA is a step in the wrong direction while only 36 percent of those ages 25 to 39 share this sentiment. Younger physicians (ages 25 to 39) are also more likely than older doctors (ages 40 to 59) to think the transition to evidence-based medicine will improve care.
For more information about Physician Perspectives about Health Care Reform and the Future of the Medical Profession, visit www.deloitte.com/us/physiciansurvey.]]> http://www.physiciansnews.com/2011/12/13/physicians-pessimistic-on-benefits-of-health-care-reform/feed/ 0 Five Issues To Impact Docs in 2012 http://www.physiciansnews.com/2011/12/08/five-issues-to-impact-docs-in-2012/ http://www.physiciansnews.com/2011/12/08/five-issues-to-impact-docs-in-2012/#comments Thu, 08 Dec 2011 15:40:50 +0000 Physicians News http://www.physiciansnews.com/?p=4473 As the New Year approaches and the future of health reform hangs in the balance, The Physicians Foundation – a nonprofit organization that seeks to advance the work of practicing physicians and improve the quality of healthcare for all Americans – has identified five key areas that will impact the practice of medicine in the year ahead. The Physicians Watch List for 2012 is based on research the Foundation released earlier this year, including the 2010 Health Reform Research Study and 2011 Roadmap for Physicians to Healthcare Reform Paper.

  1. Changing nature of medical practices. Many physicians are choosing hospital and group settings versus private practice due to the perceived security employed settings offer. Only one quarter of physicians surveyed said they plan to continue practicing as they are; half said they would adopt a style of practice different from the traditional full-time independent private practice model. In 2012, physicians will need to carefully assess their individual circumstances and determine the practice configuration that best meets their needs and those of their patients.
  2.  Decreased return on increased burden. The added regulations and administrative responsibilities based on the Patient Protection and Affordable Care Act (PPACA) have caused physicians to focus less on the patient and more on administrating their practices. Sixty-three percent of physicians surveyed said that non-clinical paperwork has caused them to spend less time with their patients and 94 percent said time they devote to non-clinical paperwork in the last three years has increased. In 2012, physicians will need to vigilantly monitor their administrative burdens and take steps to minimize any further impact on their relationship with patients.
  3. Acute shortages of primary care physicians. A growing shortage of physicians threatens the medical profession’s ability to serve patients across key specialties and geographies. Physicians will need to redefine their roles and rethink delivery models in order to meet rising demand. The majority of physicians (60 percent) said health reform will compel them to close or significantly limit their practices to certain categories of patients. Of these, 93 percent said they will close or significantly limit their practices to Medicaid patients and 87 percent said they would close or significantly restrict their practices to Medicare patients. In 2012, physicians will need to evaluate how they can optimize their time to accommodate the current and future needs of their patients.
  4. Critical need for physician leadership tools / skills. In the healthcare environment of tomorrow, many physicians will assume greater business and people management responsibilities within practice groups and hospital settings.  In 2012, physicians will need to acquire new types of non-medical leadership skills to be effective in these expanded roles, while still maintaining their trusted relationships with patients.
  5. Impact on patients. The need to provide higher quality in an environment characterized by increased reporting, problematic reimbursement and high potential liability, will place extraordinary stress on physicians, particularly those in private practice. Only one physician in ten believes that health reform will enhance the quality of care they are able to provide to their patients, compared to 56 percent who believe reform will diminish the quality of care they are able to provide.  In 2012, physicians will increasingly need to balance these competing factors in ways that do not compromise the care they provide to patients.

“Proposed changes to our healthcare system have already significantly impacted physicians and patients,” said Lou Goodman, Ph.D., president of The Physicians Foundation and chief executive officer of the Texas Medical Association. “We hope the physician watch list helps to address the core issues under the new legislation and offers doctors and the healthcare community guidance on how to deliver the best care possible to patients in 2012.”

]]> http://www.physiciansnews.com/2011/12/08/five-issues-to-impact-docs-in-2012/feed/ 2 Both Patients And Physicians Can Suffer When Test Results Aren’t Reported http://www.physiciansnews.com/2011/11/29/both-patients-and-physicians-can-suffer-when-test-results-aren%e2%80%99t-reported/ http://www.physiciansnews.com/2011/11/29/both-patients-and-physicians-can-suffer-when-test-results-aren%e2%80%99t-reported/#comments Tue, 29 Nov 2011 16:01:38 +0000 Physicians News http://www.physiciansnews.com/?p=4438 Medical tests can reveal critical information about a person's health, but only if the results are communicated to clinicians and patients. Sometimes, the ball gets dropped somewhere between the lab or the radiology department and the clinician who ordered the test and the patient. In Peggy Kidwell's case, a mix-up over doctors' names led to a year-long delay in a breast cancer diagnosis.

After her annual gynecological exam and mammogram several years ago at a medical center near her Virginia Beach home, she got a letter from her doctor saying the results of her Pap test were normal. She assumed that she would hear from her doctor if anything untoward showed up on her mammogram exam and thought no more about it.

A year later, when Kidwell went back for her annual exam at age 59, her doctor, finding no mammogram results in her chart, asked why she hadn't gotten a screening exam the previous year. When Kidwell said she had, the doctor investigated. Five hours later, the doctor called Kidwell to tell her she had found the results and it looked as though she had breast cancer.The test results had been sent to an orthopedic surgeon at the medical center who had the same last name as Kidwell's gynecologist. The folder had been sitting on his desk for a year, according to her gynecologist. By that time her cancer had spread to her chest wall. Kidwell had a lumpectomy, chemotherapy and radiation. The following year, the cancer came back and Kidwell had a mastectomy. She filed a lawsuit and eventually settled the case. (A confidentiality agreement prohibits her from discussing specifics.) No one, she says, ever said that an earlier diagnosis might have made a difference in the course of her disease, but she believes it may have. Kidwell, who now lives in Silver Spring, blames the medical system for the mix-up, but also herself. "To this day, I don't let myself off the hook for not picking up the phone," she says. Financial Consequences There are also financial consequences for providers when tests aren't promptly reported: A recent study in the Journal of the American College of Radiology found that annual medical malpractice payouts for communication breakdowns, including failing to share test results, more than quadrupled nationally between 1991 and 2010, to million. For patients, the missteps and mistakes can be life-altering. Patient follow-up could make a difference in many instances. The study examined medical malpractice claims from 425 hospitals and 52,000 providers. Of the 306 cases in which test results were specifically cited as a factor in a malpractice case, the most common problem — it occurred almost half the time — was that the patient didn't receive the test results, cited in 143 cases. The second-most-common problem was that the clinician didn't receive the results, cited in 110 cases. Other problems included delays and slow turnaround in reporting findings and test results that were filed before the clinician reviewed them. The study examined a different database as well, the National Practitioner Data Bank, to arrive at a dollar value for malpractice claims payouts related to communications problems, examining categories that would include getting test result information to practitioners and patients alike, for the period from 1991 to 2010. That analysis showed that payouts increased from million to million during that time, a more than four-fold increase. Patient advocates and policy experts say the push for better coordination of patient care, including the adoption of electronic medical records, should help improve the delivery of test results to patients from doctors and to doctors from those who perform the tests. "Health reform and payment reform are moving us toward integrating care to a degree that we don't do right now," says Diane Pinakiewicz, president of the National Patient Safety Foundation, a Boston-based consumer group. "The one constant is the patient. The best chance is for the patient to be part of the process." A Multilayered Approach Patient involvement is important, but the burden of following up on test results shouldn't fall on their shoulders, experts agree. But doctors need a helping hand. In a given week, a primary-care doctor might need to review 360 chemistry test results, 460 hematology results, 12 pathology reports and 40 radiology reports, according to researchers at Partners HealthCare system in Boston. More than half of physicians surveyed some years ago said they weren't satisfied with the way they handled test results, which typically took more than an hour each day. Now many practices affiliated with Partners use a multilayered system that helps them manage test results. The Web-based system lets them log in and see all the tests they've ordered and the results that have come in, with those that are problematic listed first. If a test result requires urgent attention, the system generates an e-mail alerting doctors; if they ignore this warning and subsequent messages, the system alerts the practice manager, who contacts the physician directly. The system also generates letters that notify patients of their test results and has a tickler function that can alert doctors when patients haven't had follow-up tests as ordered. Even so, "nothing is foolproof," says Eric Poon, director of clinical informatics at Brigham and Women's Hospital, part of the Partners system. "No news is not good news," he says. "If a patient gets a test done and doesn't get a result, he should follow up." ### This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente. ]]> http://www.physiciansnews.com/2011/11/29/both-patients-and-physicians-can-suffer-when-test-results-aren%e2%80%99t-reported/feed/ 1 Win ,000: Essay Contest Challenges Docs To Offer Solutions To Healthcare Costs http://www.physiciansnews.com/2011/10/27/win-1000-essay-contest-challenges-docs-to-offer-solutions-to-healthcare-costs/ http://www.physiciansnews.com/2011/10/27/win-1000-essay-contest-challenges-docs-to-offer-solutions-to-healthcare-costs/#comments Thu, 27 Oct 2011 13:00:54 +0000 Physicians News http://www.physiciansnews.com/?p=4350 Costs of Care, a physician-run nonprofit based in Boston, has launched its second annual national healthcare essay contest, with the goal of expanding the public discourse on the role of doctors, nurses, and other care providers in controlling healthcare costs. Executive Director Neel Shah, who is also a third-year obstetrics and gynecology resident at the Harvard Medical School, founded Costs of Care after he began thinking, as a med student, that physicians had a good deal of power over healthcare costs but rarely thought about them. "There's a lot of talk about insurers and patients, but at the end of the day doctors decide what's on the bill," he told the LA Times. Last year, Costs of Care launched an innovative essay contest that emphasized the importance of price transparency in everyday medicine by gathering more than 100 personal stories from patients, nurses, and doctors across the nation. A vascular surgeon in Arizona, for example, wrote about a time a hospital assigned an out-of-network anesthesiologist to a surgery, sending a patient's bill skyrocketing, according to the LA Times. "There was no mechanism to make sure all of the providers a patient uses were in network," Shah said.  "That's a simple check." This year, Costs of Care is looking for more stories, and will award 00 prizes for stories about the importance of price transparency as well as solution-oriented stories that illustrate ways to reduce harmful healthcare spending and save patients’ money. As the economy struggles to recover, the spiraling costs of healthcare in the United States have become a contentious political focal point without an obvious solution. Traditionally, health care providers have been reluctant to discuss their own role in healthcare spending. However, Dr. Shah, “Ultimately, no amount of regulating, reorganizing, or otherwise reforming the healthcare system will successfully contain costs unless healthcare providers are invested in fixing the problem.” To help mobilize healthcare providers to examine their own role in spending, Costs of Care is launching an essay contest that will collect and widely disseminate stories from the front lines of medicine. Costs of Care will award 00 in prizes to top submissions. Two 00 prizes will be reserved for patients, and two 00 prizes will be reserved for care providers. Preference will be given to stories that best demonstrate the importance of cost-awareness in medicine. Examples may include a time a patient tried to find out what a test or treatment would cost but was unable to do so, a time that caring for a patient generated an unexpectedly a high medical bill, or a time a patient and care provider figured out a way to save money while still delivering high-value care. To help select the winning entries, Costs of Care has partnered with five health luminaries who will serve as judges:
  • Peter Orzsag, former Director of the White House Office of Management and Budget
  • Dr. C. Everett Koop, former United States Surgeon General
  • Hon. Jennifer Granholm, former Governor of Michigan
  • Dr. Susan Love, women’s health and cancer research advocate
  • Dr. Alan Garber, health economist and Harvard University Provost
All submissions will be due on November 15th, 2011. Finalists will be announced on December 15th, 2011 and the ,000 prize winners will be announced on January 15th, 2012. All qualifying submissions will be published biweekly at http://www.costsofcare.org during the 2012 calendar year.  ]]> http://www.physiciansnews.com/2011/10/27/win-1000-essay-contest-challenges-docs-to-offer-solutions-to-healthcare-costs/feed/ 0 ER Docs Focus On Medical Liability Reforms http://www.physiciansnews.com/2012/02/07/the-treatment-of-solid-tumors-some-recent-approaches/ http://www.physiciansnews.com/2012/02/07/the-treatment-of-solid-tumors-some-recent-approaches/#comments Tue, 07 Feb 2012 16:14:45 +0000 Physicians News http://www.physiciansnews.com/?p=4595 By Punit Dhillon At some point in their lives, one in five people will suffer from skin cancer, and the fraction is steadily rising.  In spite of innovation in sunscreen technology and public attention to the need to be shielded from the sun, data reported recently by Dermatology Times show a rise in the average American lifetime risk of one skin cancer variety—invasive melanoma—from 1/600 in 1960 to 1/50 in 2008.  Despite previous diagnosis and innovations in approaches to treatment, the age-adjusted number of annual deaths per 100,000 population is rising.  Additionally, the expense to the healthcare system and society continues to increase.  As U.S. and European populations age, the incidence of skin cancer and other solid tumor cancers will grow.  According to the latest United States Cancer Statistics, published by the Centers for Disease Control and Prevention in 2007, the top 10 cancer types (based on incidence rate) are in the solid tumor category; today the priority is probably even higher.  Thus, there are clear medical needs going unmet and the creation of novel, cost-efficient and patient-friendly treatments remain a top priority for both the healthcare community and patients. Various challenges of traditional treatments The treatment of solid tumor cancers, which range from melanoma and Merkel cell carcinoma to cutaneous T-cell lymphoma, continues to be a substantial challenge for physicians.  For example, in spite of innovations in drug discovery and development, it is still challenging to simply deliver efficient drugs into cancer cells in a safe and effective manner.  Meanwhile, today’s therapeutic approaches—involving surgery, radiation therapy and chemotherapy—each have characteristic and major drawbacks. Surgery, the current first-line treatment for localized and operable tumors or lesions, requires resecting the tumor mass and a surrounding boundary of healthy tissue to make sure that no cancer cells remain at the tumor site.  Surgery can potentially cause physical disfigurement and/or debilitating effects on organ function, and the patient quality of life has been demonstrated to be negatively impacted.  Also, surgery can require an expensive and long hospital stay. Radiation therapy is occasionally used in conjunction with surgery to shrink a tumor prior to surgical removal, or afterward to destroy any cancer cells that might remain.  Yet surgery plus radiation can damage important normal tissues like nerves, blood vessels, or vital organs such as the heart that are within the designated zone of treatment.  Radiation is also a costly therapeutic approach, and demands substantial expertise, precautionary measures and infrastructure to administer.  Radiation entails major complications, such as nausea, diarrhea, dry mouth, taste alterations, loss of appetite, and the potential for the formation of new cancerous lesions. Those who get radiation to the heart often suffer from various types of heart failure in subsequent years. Typically, chemotherapy is a secondary or palliative treatment to help mitigate systemic or metastatic tumor growth, whereas surgery and radiation may be considered local treatments.  In response to cancer’s spread, physicians will administer chemotherapeutic agents that circulate throughout the body, systemically and in high concentrations, to counter the challenge that some chemotherapeutic agents have in reaching and penetrating the cell membrane to trigger cell death.  Yet the system-wide use of chemotherapeutics frequently has major side effects by killing healthy as well as cancerous cells.  This systemic and non-targeted administration of anticancer agents can trigger alopecia; nausea; vomiting; myelosuppression; and drug resistance.  Chemotherapy is curative for only a few tumor types. Additionally, all of these conventional treatments are only minimally effective on aggressive types of cutaneous cancers, especially in later stages of the disease. Some potential approaches We now offer an abbreviated look at some current approaches to override these challenges in treating solid tumors. One possible strategy for solid tumor treatment involves a new class of small-molecule drug candidates called vascular disrupting agents.  Via interaction with vascular endothelial cytoskeletal proteins, these agents may selectively target and collapse tumor vasculature, thereby depriving the tumor of oxygen and causing death of the tumor cells. Another approach involves the use of new therapeutic monoclonal antibody candidates that target CD27, a member of the tumor necrosis factor (TNF) receptor superfamily.  Anti-CD27 monoclonal antibodies have been demonstrated to effectively promote anticancer immunity in mouse models when combined with T cell receptor stimulation.  In addition, CD27 is overexpressed in various lymphomas and leukemias and can be targeted for direct activity by anti-CD27 monoclonal antibodies with effector function against those cancers.  There are many other antibody drugs on the market, some also with linked toxins or radiation. A third tactic involves the creation of an orally available nucleoside analogue for various cancers including solid tumors.  This agent could act through a novel DNA single-strand breaking mechanism, leading to the production of DNA double strand breaks (DSBs) and/or DNA repair checkpoint activation; unrepaired DSBs go on to cause apoptosis or programmed cell death. Alternatively, solid tumors could be treated using a technique called tumor ablation, which involves destroying the tumor inside the body via various approaches.  Radioactive pellets, shorter than an inch and approximately the width of a pin, can be inserted into the tumor; the pellet subsequently emits lethal radioactive atoms that irradiate the tumor from the inside out.  As the tumor breaks down, it starts to release antigens that trigger an immune response against the cancer cells.  Sometimes, the body also develops an immune memory against the future return of tumor cells.  Another proposed ablation technique, called “pulsed electric current ablation,” involves the insertion of electrodes into tumors, which subsequently emit very high-energy electrical currents; these currents create a physical reaction that destroys the tumor cells. A separate approach involves applying local heating to the tumor using radio frequency techniques.  In this instance, a thermal energy delivery device can be focused and targeted according to the shape, size and position of a specific tumor.  Adjusting the frequency, phase, and amplitude of the radio waves, combined with different applicators and adjustment of the patient’s position, could conceivably permit a doctor to optimize the delivery of damaging energy into the tumor. Cancer scientists are also interested in attacking solid tumors by delivering drugs specifically into diseased tissues. Such a targeted approach can result in more efficient therapy while using smaller drug doses with fewer negative side effects.  For example, in animal studies, immune-deficient mice carrying human forms of various cancers have been simultaneously injected with a range of anticancer agents and a peptide known as iRGD.  iRGD can find and attach itself to receptors on solid tumor cancer cells and later activate their internal transport systems so that the peptide is essentially passed through cell after cell, moving progressively deeper into the tumor structure.  Anticancer drugs lingering near the peptide molecules may also get pulled into and through the tumor mass by this transport mechanism, enabling them to attack cancer cells previously beyond their reach. By their nature and cellular architecture, solid tumors are equipped to limit the efficacy of most anticancer drugs.  Tumors have poor vascular systems, which reduces exposure to drugs that have been administered into the circulation.  The lesions are densely fibrous, which serves as a physical barrier against transport.  Also, the tumors have high internal pressures, causing further physical challenges to any molecule attempting to enter the lesion.  The iRGD peptide is designed to act like a key, switching on the internal transport mechanism of the cells so that they absorb anything that is proximal to certain cell surface receptors.  Researchers believe the iRGD peptide could penetrate many tumor types and might be useful in treating most solid tumor cancers.  An encouraging aspect of this approach is that both the peptide and anticancer drugs are effective together without being chemically attached. Yet another promising strategy for treating solid tumor cancers involves targeting the tumor itself without affecting any of the surrounding healthy tissue.  This ensures that the drug or therapeutic agent is absorbed at once by the cancer cells and not normal tissues.  One such targeted therapy could harness a physiologic process known as “electroporation.”  Derived from the words “electric” and “pore,” this involves applying a brief electric field to the cancerous cell.  The electrical pulse triggers the temporary creation of pores in the cell’s outer membrane—pores that close again within seconds once the electric field is discontinued.  These transient pores can improve uptake of various drugs more than a thousand-fold. Several electroporation systems have been manufactured that consist of a generator that creates the pulsed electric field, and various handheld applicators with electrode needles at their proximal ends.  The applicator delivers a controlled electric pulse to the cancer cells, thus causing any cancer cells within the affected region to undergo electroporation.  The cell takes up therapeutic agents within the region of electroporation. This technology platform is being developed for use in two varieties of anticancer therapies:  electrochemotherapy and electroimmunotherapy.  In the former, an anticancer drug is injected into a targeted tumor; the lesion is then electroporated and the drug carries out its planned mechanism of action in killing the cell.  As a result of the targeted, local therapy, the amount of drug needed to kill the cells is substantially less than that required in traditional, non-targeted chemotherapy.  The lower quantity of systemic drug (cytotoxic agent) reduces harmful side effects linked to traditional chemotherapy. Electroimmunotherapy, the second application of electroporation, involves the use of a gene encoding a specific cytokine, a substance known to boost the human immune system against cancer cells.  An immune response can have both a local and a distant effect against cancerous cells.  These therapeutic approaches have been shown to be safe and effective across various types of tumors.  Both patient outcomes and pharmacoeconomic benefits are substantial.  This technology is in clinical testing in North America and is available for commercial sale in some European countries. Therapies such as those discussed here may provide a compelling set of novel approaches to the treatment of solid tumor cancers. ### Punit Dhillon is President and CEO of OncoSec Medical Inc., a biotechnology company developing its advanced-stage Oncology Medical System (OMS) ElectroOncology therapies to treat skin cancer and other solid tumor cancers. He can be reached at pdhillon@oncosec.com.]]> http://www.physiciansnews.com/2012/02/07/the-treatment-of-solid-tumors-some-recent-approaches/feed/ 0 Physicians News » News Briefs http://www.physiciansnews.com Tue, 07 Feb 2012 16:44:06 +0000 en hourly 1 http://wordpress.org/?v=3.2.1 Experts Divided Over Recommendation To Screen Children For Cholesterol http://www.physiciansnews.com/2012/02/07/experts-divided-over-recommendation-to-screen-children-for-cholesterol/ http://www.physiciansnews.com/2012/02/07/experts-divided-over-recommendation-to-screen-children-for-cholesterol/#comments Tue, 07 Feb 2012 16:15:56 +0000 Physicians News http://www.physiciansnews.com/?p=4592 One in 500 kids has an inherited disorder that causes high levels of LDL ("bad") cholesterol that may require medication to control. However, since the problem doesn't create observable symptoms, as many as half of these kids don't know they have the condition. To help identify these children, late last year an expert panel convened by the National Heart, Lung, and Blood Institute recommended that all children be screened for high cholesterol, once between the ages of 9 and 11 and again between ages 17 and 21. Reaction to the guidelines, which were included as part of a larger NHLBI report on improving cardiovascular health in children and adolescents, has been mixed. Some clinicians and researchers say universal screening is an important tool not only to help identify children who are genetically predisposed to high cholesterol, a condition called familial hypercholesterolemia, but also to pinpoint others who could benefit from treatment, including those with high LDL related to being overweight or obese. Working with these kids to eat more healthfully and to exercise more may reduce the cumulative negative effect of high cholesterol on their cardiovascular systems and lead to fewer heart attacks and strokes later in life, the experts say. Others, including clinicians who authored a pair of articles in the Journal of the American Medical Association last month, express concerns that screening may do more harm than good. To identify the relatively small number of kids who really need medical treatment, doctors cast a wide and expensive net that identifies many children as at risk who will never develop  premature cardiovascular disease, says Matthew Gillman, director of the obesity prevention program at Harvard Medical School, who co-authored one of the articles. Some of those children will probably be needlessly put on cholesterol-lowering medications, he says. The U.S. Preventive Services Task Force, an independent group of primary-care providers that evaluates the evidence for clinical care, concluded in 2007 that there isn't enough evidence to recommend for or against routine lipid screening in children and adolescents. Research has shown that 10 to 13 percent of children have elevated cholesterol levels. Treatment for the vast majority should focus on lifestyle interventions, says Stephen Daniels, chairman of the Department of Pediatrics at the University of Colorado School of Medicine, who led the NHLBI panel. A much smaller number of those children, the ones with a genetic predisposition to high cholesterol, may need to take a statin, he says. Until the new guidelines were released, the American Academy of Pediatrics recommended cholesterol screening in children primarily based on family history. If a child had a father who had heart disease or a heart attack before age 55, for example, screening would be indicated. Children who had risk factors such as obesity or diabetes were also candidates for screening. The AAP has since endorsed the new NHLBI guidelines. "Family history doesn't really catch everybody" with familial hypercholesterolemia, says Sarah de Ferranti, a member of the AAP committee on nutrition and the director of preventive cardiology at Children's Hospital Boston. In addition, she says, "Anecdotally, I can tell you that when someone comes to my office and they know they have high cholesterol values, they're much more focused." That's the case with the McFeeley family. Bill and Carolyn McFeeley, of Mullica Hill, N.J., had always considered themselves very healthy - until Bill had a heart attack two years ago at age 47. The pediatrician for their three children checked the kids' cholesterol and found that while levels for the two girls - Chelsea, now 17, and Chandler, 13 - were normal, Chase, 10, had slightly higher values: His total cholesterol was roughly 210. (In general, anything over 200 is considered high.)
The McFeeley family, from left to right: Chandler, Carolyn, Chase, Bill, and Chelsea.
Now Chase has replaced his beloved egg salad sandwiches with turkey and fat-free cheese ones. "If we can get ahead of it and keep Chase healthy, it means a lot to us," says Bill. Julie Brothers, medical director of the lipid heart clinic at Children's Hospital of Philadelphia, sees Chase once a year now and says she hopes they can manage his cholesterol without medication. "None of us wants to slap medication on anyone," she says. Maybe not. "But if you're going to test every child, it's a sure bet you're going to be medicating more kids," says H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, who has written extensively on the problems created by aggressive screening. Research on the safety and effectiveness of statins in children is scant; studies that have looked at statin use haven't enrolled more than a few hundred kids, and none has followed them for more than two years, say experts. "We don't know what taking a 10- to 11-year-old kid and putting them on statins long term will do," says Frederick Rivara, division chief of general pediatrics at Seattle Children's Hospital and co-author of one of the JAMA articles. Gillman says that while early intervention to prevent heart disease is critical, screening all children may not be the best way to do it. As an example, he cites a study that he co-authored last year examining the cost-effectiveness of blood pressure screening in adolescents. "The bottom line of that study is that population approaches like taking the salt out of food are more effective and less costly than any screening program," he says. ### This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente. ]]> http://www.physiciansnews.com/2012/02/07/experts-divided-over-recommendation-to-screen-children-for-cholesterol/feed/ 0 The Treatment of Solid Tumors: Some Recent Approaches http://www.physiciansnews.com/2012/02/07/the-treatment-of-solid-tumors-some-recent-approaches/ http://www.physiciansnews.com/2012/02/07/the-treatment-of-solid-tumors-some-recent-approaches/#comments Tue, 07 Feb 2012 16:14:45 +0000 Physicians News http://www.physiciansnews.com/?p=4595 By Punit Dhillon At some point in their lives, one in five people will suffer from skin cancer, and the fraction is steadily rising.  In spite of innovation in sunscreen technology and public attention to the need to be shielded from the sun, data reported recently by Dermatology Times show a rise in the average American lifetime risk of one skin cancer variety—invasive melanoma—from 1/600 in 1960 to 1/50 in 2008.  Despite previous diagnosis and innovations in approaches to treatment, the age-adjusted number of annual deaths per 100,000 population is rising.  Additionally, the expense to the healthcare system and society continues to increase.  As U.S. and European populations age, the incidence of skin cancer and other solid tumor cancers will grow.  According to the latest United States Cancer Statistics, published by the Centers for Disease Control and Prevention in 2007, the top 10 cancer types (based on incidence rate) are in the solid tumor category; today the priority is probably even higher.  Thus, there are clear medical needs going unmet and the creation of novel, cost-efficient and patient-friendly treatments remain a top priority for both the healthcare community and patients. Various challenges of traditional treatments The treatment of solid tumor cancers, which range from melanoma and Merkel cell carcinoma to cutaneous T-cell lymphoma, continues to be a substantial challenge for physicians.  For example, in spite of innovations in drug discovery and development, it is still challenging to simply deliver efficient drugs into cancer cells in a safe and effective manner.  Meanwhile, today’s therapeutic approaches—involving surgery, radiation therapy and chemotherapy—each have characteristic and major drawbacks. Surgery, the current first-line treatment for localized and operable tumors or lesions, requires resecting the tumor mass and a surrounding boundary of healthy tissue to make sure that no cancer cells remain at the tumor site.  Surgery can potentially cause physical disfigurement and/or debilitating effects on organ function, and the patient quality of life has been demonstrated to be negatively impacted.  Also, surgery can require an expensive and long hospital stay. Radiation therapy is occasionally used in conjunction with surgery to shrink a tumor prior to surgical removal, or afterward to destroy any cancer cells that might remain.  Yet surgery plus radiation can damage important normal tissues like nerves, blood vessels, or vital organs such as the heart that are within the designated zone of treatment.  Radiation is also a costly therapeutic approach, and demands substantial expertise, precautionary measures and infrastructure to administer.  Radiation entails major complications, such as nausea, diarrhea, dry mouth, taste alterations, loss of appetite, and the potential for the formation of new cancerous lesions. Those who get radiation to the heart often suffer from various types of heart failure in subsequent years. Typically, chemotherapy is a secondary or palliative treatment to help mitigate systemic or metastatic tumor growth, whereas surgery and radiation may be considered local treatments.  In response to cancer’s spread, physicians will administer chemotherapeutic agents that circulate throughout the body, systemically and in high concentrations, to counter the challenge that some chemotherapeutic agents have in reaching and penetrating the cell membrane to trigger cell death.  Yet the system-wide use of chemotherapeutics frequently has major side effects by killing healthy as well as cancerous cells.  This systemic and non-targeted administration of anticancer agents can trigger alopecia; nausea; vomiting; myelosuppression; and drug resistance.  Chemotherapy is curative for only a few tumor types. Additionally, all of these conventional treatments are only minimally effective on aggressive types of cutaneous cancers, especially in later stages of the disease. Some potential approaches We now offer an abbreviated look at some current approaches to override these challenges in treating solid tumors. One possible strategy for solid tumor treatment involves a new class of small-molecule drug candidates called vascular disrupting agents.  Via interaction with vascular endothelial cytoskeletal proteins, these agents may selectively target and collapse tumor vasculature, thereby depriving the tumor of oxygen and causing death of the tumor cells. Another approach involves the use of new therapeutic monoclonal antibody candidates that target CD27, a member of the tumor necrosis factor (TNF) receptor superfamily.  Anti-CD27 monoclonal antibodies have been demonstrated to effectively promote anticancer immunity in mouse models when combined with T cell receptor stimulation.  In addition, CD27 is overexpressed in various lymphomas and leukemias and can be targeted for direct activity by anti-CD27 monoclonal antibodies with effector function against those cancers.  There are many other antibody drugs on the market, some also with linked toxins or radiation. A third tactic involves the creation of an orally available nucleoside analogue for various cancers including solid tumors.  This agent could act through a novel DNA single-strand breaking mechanism, leading to the production of DNA double strand breaks (DSBs) and/or DNA repair checkpoint activation; unrepaired DSBs go on to cause apoptosis or programmed cell death. Alternatively, solid tumors could be treated using a technique called tumor ablation, which involves destroying the tumor inside the body via various approaches.  Radioactive pellets, shorter than an inch and approximately the width of a pin, can be inserted into the tumor; the pellet subsequently emits lethal radioactive atoms that irradiate the tumor from the inside out.  As the tumor breaks down, it starts to release antigens that trigger an immune response against the cancer cells.  Sometimes, the body also develops an immune memory against the future return of tumor cells.  Another proposed ablation technique, called “pulsed electric current ablation,” involves the insertion of electrodes into tumors, which subsequently emit very high-energy electrical currents; these currents create a physical reaction that destroys the tumor cells. A separate approach involves applying local heating to the tumor using radio frequency techniques.  In this instance, a thermal energy delivery device can be focused and targeted according to the shape, size and position of a specific tumor.  Adjusting the frequency, phase, and amplitude of the radio waves, combined with different applicators and adjustment of the patient’s position, could conceivably permit a doctor to optimize the delivery of damaging energy into the tumor. Cancer scientists are also interested in attacking solid tumors by delivering drugs specifically into diseased tissues. Such a targeted approach can result in more efficient therapy while using smaller drug doses with fewer negative side effects.  For example, in animal studies, immune-deficient mice carrying human forms of various cancers have been simultaneously injected with a range of anticancer agents and a peptide known as iRGD.  iRGD can find and attach itself to receptors on solid tumor cancer cells and later activate their internal transport systems so that the peptide is essentially passed through cell after cell, moving progressively deeper into the tumor structure.  Anticancer drugs lingering near the peptide molecules may also get pulled into and through the tumor mass by this transport mechanism, enabling them to attack cancer cells previously beyond their reach. By their nature and cellular architecture, solid tumors are equipped to limit the efficacy of most anticancer drugs.  Tumors have poor vascular systems, which reduces exposure to drugs that have been administered into the circulation.  The lesions are densely fibrous, which serves as a physical barrier against transport.  Also, the tumors have high internal pressures, causing further physical challenges to any molecule attempting to enter the lesion.  The iRGD peptide is designed to act like a key, switching on the internal transport mechanism of the cells so that they absorb anything that is proximal to certain cell surface receptors.  Researchers believe the iRGD peptide could penetrate many tumor types and might be useful in treating most solid tumor cancers.  An encouraging aspect of this approach is that both the peptide and anticancer drugs are effective together without being chemically attached. Yet another promising strategy for treating solid tumor cancers involves targeting the tumor itself without affecting any of the surrounding healthy tissue.  This ensures that the drug or therapeutic agent is absorbed at once by the cancer cells and not normal tissues.  One such targeted therapy could harness a physiologic process known as “electroporation.”  Derived from the words “electric” and “pore,” this involves applying a brief electric field to the cancerous cell.  The electrical pulse triggers the temporary creation of pores in the cell’s outer membrane—pores that close again within seconds once the electric field is discontinued.  These transient pores can improve uptake of various drugs more than a thousand-fold. Several electroporation systems have been manufactured that consist of a generator that creates the pulsed electric field, and various handheld applicators with electrode needles at their proximal ends.  The applicator delivers a controlled electric pulse to the cancer cells, thus causing any cancer cells within the affected region to undergo electroporation.  The cell takes up therapeutic agents within the region of electroporation. This technology platform is being developed for use in two varieties of anticancer therapies:  electrochemotherapy and electroimmunotherapy.  In the former, an anticancer drug is injected into a targeted tumor; the lesion is then electroporated and the drug carries out its planned mechanism of action in killing the cell.  As a result of the targeted, local therapy, the amount of drug needed to kill the cells is substantially less than that required in traditional, non-targeted chemotherapy.  The lower quantity of systemic drug (cytotoxic agent) reduces harmful side effects linked to traditional chemotherapy. Electroimmunotherapy, the second application of electroporation, involves the use of a gene encoding a specific cytokine, a substance known to boost the human immune system against cancer cells.  An immune response can have both a local and a distant effect against cancerous cells.  These therapeutic approaches have been shown to be safe and effective across various types of tumors.  Both patient outcomes and pharmacoeconomic benefits are substantial.  This technology is in clinical testing in North America and is available for commercial sale in some European countries. Therapies such as those discussed here may provide a compelling set of novel approaches to the treatment of solid tumor cancers. ### Punit Dhillon is President and CEO of OncoSec Medical Inc., a biotechnology company developing its advanced-stage Oncology Medical System (OMS) ElectroOncology therapies to treat skin cancer and other solid tumor cancers. He can be reached at pdhillon@oncosec.com.]]> http://www.physiciansnews.com/2012/02/07/the-treatment-of-solid-tumors-some-recent-approaches/feed/ 0 Dream Of A Medical ‘Price List’ Dies In Florida Legislature http://www.physiciansnews.com/2012/01/31/dream-of-a-medical-%e2%80%98price-list%e2%80%99-dies-in-florida-legislature/ http://www.physiciansnews.com/2012/01/31/dream-of-a-medical-%e2%80%98price-list%e2%80%99-dies-in-florida-legislature/#comments Tue, 31 Jan 2012 16:30:32 +0000 Physicians News http://www.physiciansnews.com/?p=4579 approved legislation that would expand the state’s requirement that certain providers post the out-of-pocket prices of common health care services, a state Senate committee shot down a similar measure after an aggressive lobbying push by health care provider groups. Organizations representing the state’s doctors weren’t wild about the idea that certain facilities would have to display bulletin-board sized postings of their prices. Jeff Scott, general counsel for the Florida Medical Association, said that providers are all for transparency, but they don’t need the government telling them exactly how they should do it. “Next thing you know they’re going to say it has to be neon or include pictures,” he said. But providers’ most strenuous objections were to provisions in the legislation that would require providers to disclose prices to out-of-network patients and limit so-called balance billing, which happens in health care settings when providers bill patients the difference between what they charge for a service and what insurers pay it. Meanwhile, the state already requires urgent care centers to post in their reception area the prices of their 50 most frequently used services, and the posting must be at least 15 square feet.  Physicians are not required to do so, but they must follow the same rules if they post prices voluntarily. Under the proposed legislation, ambulatory care centers and diagnostic-imaging centers would have had to follow the same rules as urgent care centers, and the original bills also would have expanded the requirement to physicians. The House committee-approved bill softened this language to maintain the voluntary status quo for doctors. Both bills would have required physicians to provide patients with a written statement of prices at each visit. Richard Polangin, health care policy coordinator for the Florida Public Interest Research Group, said the legislation would have been a boon for consumers, many of whom are unaware that prices can vary among doctors and facilities. The bills would “enable persons who must pay for doctor visits, diagnostic images such as CT scans and MRIs, and for care at ambulatory surgery centers, to know the cost in advance,” he said. “The uninsured and persons with insurance deductibles would be able to make more informed health care decisions.” Insurers and business groups also supported the legislation. And, though the measure’s future is uncertain, at least one person involved in the lobbying effort said work would continue. ### This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.]]> http://www.physiciansnews.com/2012/01/31/dream-of-a-medical-%e2%80%98price-list%e2%80%99-dies-in-florida-legislature/feed/ 0 Twins Born in Different Years: What About Insurance? http://www.physiciansnews.com/2012/01/04/twins-born-in-different-years-what-about-insurance/ http://www.physiciansnews.com/2012/01/04/twins-born-in-different-years-what-about-insurance/#comments Wed, 04 Jan 2012 21:02:55 +0000 Physicians News http://www.physiciansnews.com/?p=4525 By Sarah Barr By the time newborn Freya Humenny joined her twin brother Beckett this past weekend, the calendar already had turned from 2011 to 2012. That means the twins always will have their own birthdays—but will they share an insurance statement? The twin’s mother, Stephanie Peterson, gave birth to Beckett at 6:40 p.m. on Dec. 31, 2011,  at the Hennepin County Medical Center in Minneapolis, but Freya did not follow until 12:26 a.m on Jan. 1. And so after we ooh-ed and ahh-ed over the adorable pair, we had to ask: What could a case like this mean for a family’s insurance? Paul Fronstin, director of the health research and education program at the Employee Benefit Research Institute, said that every case would vary based on the terms of a family’s policy. But, as an example, if a family had a high-deductible private insurance plan, a number of factors would be in play, according to Fronstin. For one, there is the question of the family’s deductible.  Lots of prenatal services are covered as preventive care, but some are not.  If the family had not yet met their 2011 deductible, then the first of the births would be applied to that year’s deductible, while the second could apply to the next year. There’s also the question of whether the second birth would even be considered an expense for the new year or whether it would be tied to the mother’s original admission. And as for the twins themselves, the second child’s expenses likely would be billed as new year expenses, but services for the first child, such as nights spent in a nursery, could span the two years—raising another set of questions about how to bill. Fronstin said that while a hypothetical case brings up a number of questions, an insurer’s response won’t necessarily be complicated. “It could be as simple as it was so close to midnight that it doesn’t really matter,” he said. Recommence the oohs and ahhs. ### This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.]]> http://www.physiciansnews.com/2012/01/04/twins-born-in-different-years-what-about-insurance/feed/ 0 Fox Chase Cancer Center Merges with Temple University http://www.physiciansnews.com/2011/12/17/fox-chase-cancer-center-merges-with-temple-university/ http://www.physiciansnews.com/2011/12/17/fox-chase-cancer-center-merges-with-temple-university/#comments Sat, 17 Dec 2011 16:05:33 +0000 Physicians News http://www.physiciansnews.com/?p=4493 Temple University Health System and Fox Chase Cancer Center this week signed an Affiliation Agreement that moves both institutions closer to bringing Fox Chase Cancer Center into the Temple family – marking a major milestone for two celebrated Philadelphia institutions that will enhance cancer research and patient care in the region, both immediately and for years to come. "Temple is proud and privileged to welcome Fox Chase Cancer Center into its family of academic researchers and clinicians," said Ann Weaver Hart, PhD, President of Temple University. "This bold, visionary relationship immediately establishes Temple's position as a leader in cancer care and translational research at the local, regional and national levels," said Larry R. Kaiser, MD, FACS, Senior Executive Vice President for Health Sciences of Temple University, Dean of Temple University School of Medicine, and President and CEO of Temple University Health System. "It sets the stage for many exciting opportunities to grow and enhance the cancer-related patient-care, research and educational programs of Temple’s healthcare enterprise. "The pursuit of excellence is the driving force for today's action – which offers a preview of what tomorrow represents. Indeed, this affiliation marks a fresh direction in cancer research and treatment in Philadelphia," continued Dr. Kaiser. "Sustained by the converging action of two highly respected medical institutions, it will draw on both established knowledge and original insights to pave the way for what all cancer patients and their families want and deserve – hope." "Fox Chase is proud to be the professional home to some of the most talented and compassionate scientists, doctors, and nurses working on the cancer problem anywhere in the world," said Michael V. Seiden, MD, PhD, President and CEO of Fox Chase Cancer Center. "But we're always working to strengthen the Center's ability to more vigorously pursue our mission to prevail over cancer, and we believe that this affiliation with Temple University Health System will do just that, enabling us to begin recruiting new researchers and clinicians almost immediately and to expand our clinical services significantly in coming years to serve the region's cancer-care needs well into the future."   Fox Chase Cancer Center is one of only two National Cancer Institute (NCI)-designated comprehensive cancer centers in Philadelphia, and one of only 40 in the U.S. Its addition to Temple creates collaborative synergies between and among physician-scientists at Temple University School of Medicine, Fox Chase Cancer Center, and Temple Cancer Center that will accelerate the pace of further discovery and development of the most effective approaches to cancer prevention, diagnosis, and treatment. By becoming an affiliate of Temple University Health System, Fox Chase will be able to significantly expand its outpatient and surgical-care services – within its existing facilities and through the use of leased space in Jeanes Hospital, an affiliate of Temple University Health System since 1996. Given the geographic proximity of Fox Chase to Jeanes Hospital (home to TUH's highly-regarded Bone Marrow Transplant Program), a natural byproduct of the agreement is the creation of a contiguous, 47.5-acre site to serve as Temple's "cancer hub" for the development of future innovations in cancer-care and research. The affiliation also gives Jeanes Hospital the opportunity to meet the associated health care needs of cancer patients by providing a broad array of services on its premises in areas such as outpatient diagnostic testing, interventional radiology, breast care, general surgery, thoracic surgery, endocrine surgery, urology and diagnostic GI. Temple University Health System will invest in cancer research at Fox Chase – providing new resources to recruit additional physician-scientists who will further advance the collaborative efforts of Temple and Fox Chase researchers in creating new knowledge and pathways for the prevention, treatment, and, ultimately, cures for cancer and cancer-related conditions. "The affiliation of Fox Chase Cancer Center with Temple University Health System signifies an important step in the transformation of Temple’s healthcare enterprise," said Jane Scaccetti, Chair of Temple University Health System's Board and a Temple University Trustee. "The combined strength of both highly regarded institutions will fuel innovations in cancer research and patient care," added Patrick J. O'Connor, Esq., Chair of the Board of Trustees of Temple University. "We at Fox Chase Cancer Center have long understood the potential value of joining forces with Temple University Health System, particularly with Jeanes Hospital as our immediate neighbor," said David G. Marshall, Chair of the Board of Directors of Fox Chase Cancer Center. "Thanks to the committed leadership of Dr. Michael Seiden and Dr. Larry Kaiser, we're proud to announce today an affiliation agreement that will meet Fox Chase's growth needs for the foreseeable future while bringing a National Cancer Institute-designated comprehensive cancer center into Temple's vibrant academic medical community." Finally, the affiliation will bring efficiencies and savings, as economies-of-scale are recognized and leveraged across TUHS, Fox Chase Cancer Center, and Jeanes Hospital. The ability to demonstrate collaborative efficiencies is particularly important in a time when the ability to demonstrate both excellence and value matters more than ever before… to patients, payors, and grant-funding agencies. Temple's newly-consolidated cancer hub will serve as a vital source of discovery, development, and delivery of the most effective approaches to cancer prevention, diagnosis, and treatment that will give patients the best of both worlds: access to the comprehensive treatments and innovative clinical-trials available at both Temple Cancer Center and Fox Chase Cancer Center. Fold in the full array of academic and clinical expertise of Temple University School of Medicine faculty, and the most advanced diagnostic and therapeutic technologies available at Temple University Hospital, and it becomes clear that this affiliation will benefit all cancer patients and their families throughout the Delaware Valley… and beyond.
]]> http://www.physiciansnews.com/2011/12/17/fox-chase-cancer-center-merges-with-temple-university/feed/ 0 Physicians Pessimistic on Benefits of Health Care Reform http://www.physiciansnews.com/2011/12/13/physicians-pessimistic-on-benefits-of-health-care-reform/ http://www.physiciansnews.com/2011/12/13/physicians-pessimistic-on-benefits-of-health-care-reform/#comments Tue, 13 Dec 2011 15:47:24 +0000 Physicians News http://www.physiciansnews.com/?p=4488 A new Deloitte study reveals physicians are skeptical about core promises associated with the Patient Protection and Affordable Care Act.  Only 27 percent of physicians surveyed believe the PPACA is likely to reduce costs by increasing efficiency, and only 33 percent feel it is likely to decrease disparities.  Moreover, half say access to health care will decrease because of hospital closures that result from the law. The report, “Physician Perspectives about Health Care Reform and the Future of the Medical Profession,” also shows that the majority of doctors (73 percent) are not excited about the future of medicine and believe (69 percent) the “best and brightest” who might consider a career in medicine will think otherwise. “The data confirms that physicians are resistant to reform and are frustrated with the direction of the profession,” says Paul Keckley, Ph.D., executive director of the Deloitte Center for Health Solutions and lead author of the report.  “Understanding the view of the physician is fundamental to any attempt to change the health care model – this is the person prescribing the medicine, ordering the test and performing the surgery." The negativity is driven in part by concern over the pressure primary doctors will face from millions of newly-insured consumers seeking care and the reverberations this sudden impact could create on the larger system. Another stumbling block for physicians is the view that reform will mean a loss of autonomy and more costs and administrative burdens in adopting processes and technologies.  For decades this sense of autonomy has been sacrosanct to the profession, and it’s difficult to uproot that overnight, continues Keckley. “Effective reform has to consider the physician’s view as a starting point,” says Keckley.  “We not only have to design the right model, but we have to create the right incentives and processes for implementing that model.  The concept of change management is just as important for doctors in the health care system as it is for employees in a corporation.” Additional key findings from the study include:
  • Nearly three-quarters of respondents think that emergency rooms could get overwhelmed if primary care physician appointments are full as a result of the Patient Protection and Affordable Care Act.
  • More than 80 percent believe it is likely that wait times for primary care appointments will increase because of a lack of providers.  More than half indicate that other medical professionals (physician assistants, nurse practitioners) will deliver primary care both independently and as an adjunct to physician services.
  • Surgical specialists (57 percent) are much more likely to support the law’s repeal compared to primary-care providers (38 percent) and non-surgical specialists (34 percent).  They are also more likely to say the legislation is a step in the wrong direction and believe their net income will decrease as a result of reform.
  • There is a disparity among generations, as 59 percent of physicians 50 to 59 years old feel PPACA is a step in the wrong direction while only 36 percent of those ages 25 to 39 share this sentiment. Younger physicians (ages 25 to 39) are also more likely than older doctors (ages 40 to 59) to think the transition to evidence-based medicine will improve care.
For more information about Physician Perspectives about Health Care Reform and the Future of the Medical Profession, visit www.deloitte.com/us/physiciansurvey.]]> http://www.physiciansnews.com/2011/12/13/physicians-pessimistic-on-benefits-of-health-care-reform/feed/ 0 Five Issues To Impact Docs in 2012 http://www.physiciansnews.com/2011/12/08/five-issues-to-impact-docs-in-2012/ http://www.physiciansnews.com/2011/12/08/five-issues-to-impact-docs-in-2012/#comments Thu, 08 Dec 2011 15:40:50 +0000 Physicians News http://www.physiciansnews.com/?p=4473 As the New Year approaches and the future of health reform hangs in the balance, The Physicians Foundation – a nonprofit organization that seeks to advance the work of practicing physicians and improve the quality of healthcare for all Americans – has identified five key areas that will impact the practice of medicine in the year ahead. The Physicians Watch List for 2012 is based on research the Foundation released earlier this year, including the 2010 Health Reform Research Study and 2011 Roadmap for Physicians to Healthcare Reform Paper.

  1. Changing nature of medical practices. Many physicians are choosing hospital and group settings versus private practice due to the perceived security employed settings offer. Only one quarter of physicians surveyed said they plan to continue practicing as they are; half said they would adopt a style of practice different from the traditional full-time independent private practice model. In 2012, physicians will need to carefully assess their individual circumstances and determine the practice configuration that best meets their needs and those of their patients.
  2.  Decreased return on increased burden. The added regulations and administrative responsibilities based on the Patient Protection and Affordable Care Act (PPACA) have caused physicians to focus less on the patient and more on administrating their practices. Sixty-three percent of physicians surveyed said that non-clinical paperwork has caused them to spend less time with their patients and 94 percent said time they devote to non-clinical paperwork in the last three years has increased. In 2012, physicians will need to vigilantly monitor their administrative burdens and take steps to minimize any further impact on their relationship with patients.
  3. Acute shortages of primary care physicians. A growing shortage of physicians threatens the medical profession’s ability to serve patients across key specialties and geographies. Physicians will need to redefine their roles and rethink delivery models in order to meet rising demand. The majority of physicians (60 percent) said health reform will compel them to close or significantly limit their practices to certain categories of patients. Of these, 93 percent said they will close or significantly limit their practices to Medicaid patients and 87 percent said they would close or significantly restrict their practices to Medicare patients. In 2012, physicians will need to evaluate how they can optimize their time to accommodate the current and future needs of their patients.
  4. Critical need for physician leadership tools / skills. In the healthcare environment of tomorrow, many physicians will assume greater business and people management responsibilities within practice groups and hospital settings.  In 2012, physicians will need to acquire new types of non-medical leadership skills to be effective in these expanded roles, while still maintaining their trusted relationships with patients.
  5. Impact on patients. The need to provide higher quality in an environment characterized by increased reporting, problematic reimbursement and high potential liability, will place extraordinary stress on physicians, particularly those in private practice. Only one physician in ten believes that health reform will enhance the quality of care they are able to provide to their patients, compared to 56 percent who believe reform will diminish the quality of care they are able to provide.  In 2012, physicians will increasingly need to balance these competing factors in ways that do not compromise the care they provide to patients.

“Proposed changes to our healthcare system have already significantly impacted physicians and patients,” said Lou Goodman, Ph.D., president of The Physicians Foundation and chief executive officer of the Texas Medical Association. “We hope the physician watch list helps to address the core issues under the new legislation and offers doctors and the healthcare community guidance on how to deliver the best care possible to patients in 2012.”

]]> http://www.physiciansnews.com/2011/12/08/five-issues-to-impact-docs-in-2012/feed/ 2 Both Patients And Physicians Can Suffer When Test Results Aren’t Reported http://www.physiciansnews.com/2011/11/29/both-patients-and-physicians-can-suffer-when-test-results-aren%e2%80%99t-reported/ http://www.physiciansnews.com/2011/11/29/both-patients-and-physicians-can-suffer-when-test-results-aren%e2%80%99t-reported/#comments Tue, 29 Nov 2011 16:01:38 +0000 Physicians News http://www.physiciansnews.com/?p=4438 Medical tests can reveal critical information about a person's health, but only if the results are communicated to clinicians and patients. Sometimes, the ball gets dropped somewhere between the lab or the radiology department and the clinician who ordered the test and the patient. In Peggy Kidwell's case, a mix-up over doctors' names led to a year-long delay in a breast cancer diagnosis.

After her annual gynecological exam and mammogram several years ago at a medical center near her Virginia Beach home, she got a letter from her doctor saying the results of her Pap test were normal. She assumed that she would hear from her doctor if anything untoward showed up on her mammogram exam and thought no more about it.

A year later, when Kidwell went back for her annual exam at age 59, her doctor, finding no mammogram results in her chart, asked why she hadn't gotten a screening exam the previous year. When Kidwell said she had, the doctor investigated. Five hours later, the doctor called Kidwell to tell her she had found the results and it looked as though she had breast cancer.The test results had been sent to an orthopedic surgeon at the medical center who had the same last name as Kidwell's gynecologist. The folder had been sitting on his desk for a year, according to her gynecologist. By that time her cancer had spread to her chest wall. Kidwell had a lumpectomy, chemotherapy and radiation. The following year, the cancer came back and Kidwell had a mastectomy. She filed a lawsuit and eventually settled the case. (A confidentiality agreement prohibits her from discussing specifics.) No one, she says, ever said that an earlier diagnosis might have made a difference in the course of her disease, but she believes it may have. Kidwell, who now lives in Silver Spring, blames the medical system for the mix-up, but also herself. "To this day, I don't let myself off the hook for not picking up the phone," she says. Financial Consequences There are also financial consequences for providers when tests aren't promptly reported: A recent study in the Journal of the American College of Radiology found that annual medical malpractice payouts for communication breakdowns, including failing to share test results, more than quadrupled nationally between 1991 and 2010, to million. For patients, the missteps and mistakes can be life-altering. Patient follow-up could make a difference in many instances. The study examined medical malpractice claims from 425 hospitals and 52,000 providers. Of the 306 cases in which test results were specifically cited as a factor in a malpractice case, the most common problem — it occurred almost half the time — was that the patient didn't receive the test results, cited in 143 cases. The second-most-common problem was that the clinician didn't receive the results, cited in 110 cases. Other problems included delays and slow turnaround in reporting findings and test results that were filed before the clinician reviewed them. The study examined a different database as well, the National Practitioner Data Bank, to arrive at a dollar value for malpractice claims payouts related to communications problems, examining categories that would include getting test result information to practitioners and patients alike, for the period from 1991 to 2010. That analysis showed that payouts increased from million to million during that time, a more than four-fold increase. Patient advocates and policy experts say the push for better coordination of patient care, including the adoption of electronic medical records, should help improve the delivery of test results to patients from doctors and to doctors from those who perform the tests. "Health reform and payment reform are moving us toward integrating care to a degree that we don't do right now," says Diane Pinakiewicz, president of the National Patient Safety Foundation, a Boston-based consumer group. "The one constant is the patient. The best chance is for the patient to be part of the process." A Multilayered Approach Patient involvement is important, but the burden of following up on test results shouldn't fall on their shoulders, experts agree. But doctors need a helping hand. In a given week, a primary-care doctor might need to review 360 chemistry test results, 460 hematology results, 12 pathology reports and 40 radiology reports, according to researchers at Partners HealthCare system in Boston. More than half of physicians surveyed some years ago said they weren't satisfied with the way they handled test results, which typically took more than an hour each day. Now many practices affiliated with Partners use a multilayered system that helps them manage test results. The Web-based system lets them log in and see all the tests they've ordered and the results that have come in, with those that are problematic listed first. If a test result requires urgent attention, the system generates an e-mail alerting doctors; if they ignore this warning and subsequent messages, the system alerts the practice manager, who contacts the physician directly. The system also generates letters that notify patients of their test results and has a tickler function that can alert doctors when patients haven't had follow-up tests as ordered. Even so, "nothing is foolproof," says Eric Poon, director of clinical informatics at Brigham and Women's Hospital, part of the Partners system. "No news is not good news," he says. "If a patient gets a test done and doesn't get a result, he should follow up." ### This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente. ]]> http://www.physiciansnews.com/2011/11/29/both-patients-and-physicians-can-suffer-when-test-results-aren%e2%80%99t-reported/feed/ 1 Win ,000: Essay Contest Challenges Docs To Offer Solutions To Healthcare Costs http://www.physiciansnews.com/2011/10/27/win-1000-essay-contest-challenges-docs-to-offer-solutions-to-healthcare-costs/ http://www.physiciansnews.com/2011/10/27/win-1000-essay-contest-challenges-docs-to-offer-solutions-to-healthcare-costs/#comments Thu, 27 Oct 2011 13:00:54 +0000 Physicians News http://www.physiciansnews.com/?p=4350 Costs of Care, a physician-run nonprofit based in Boston, has launched its second annual national healthcare essay contest, with the goal of expanding the public discourse on the role of doctors, nurses, and other care providers in controlling healthcare costs. Executive Director Neel Shah, who is also a third-year obstetrics and gynecology resident at the Harvard Medical School, founded Costs of Care after he began thinking, as a med student, that physicians had a good deal of power over healthcare costs but rarely thought about them. "There's a lot of talk about insurers and patients, but at the end of the day doctors decide what's on the bill," he told the LA Times. Last year, Costs of Care launched an innovative essay contest that emphasized the importance of price transparency in everyday medicine by gathering more than 100 personal stories from patients, nurses, and doctors across the nation. A vascular surgeon in Arizona, for example, wrote about a time a hospital assigned an out-of-network anesthesiologist to a surgery, sending a patient's bill skyrocketing, according to the LA Times. "There was no mechanism to make sure all of the providers a patient uses were in network," Shah said.  "That's a simple check." This year, Costs of Care is looking for more stories, and will award 00 prizes for stories about the importance of price transparency as well as solution-oriented stories that illustrate ways to reduce harmful healthcare spending and save patients’ money. As the economy struggles to recover, the spiraling costs of healthcare in the United States have become a contentious political focal point without an obvious solution. Traditionally, health care providers have been reluctant to discuss their own role in healthcare spending. However, Dr. Shah, “Ultimately, no amount of regulating, reorganizing, or otherwise reforming the healthcare system will successfully contain costs unless healthcare providers are invested in fixing the problem.” To help mobilize healthcare providers to examine their own role in spending, Costs of Care is launching an essay contest that will collect and widely disseminate stories from the front lines of medicine. Costs of Care will award 00 in prizes to top submissions. Two 00 prizes will be reserved for patients, and two 00 prizes will be reserved for care providers. Preference will be given to stories that best demonstrate the importance of cost-awareness in medicine. Examples may include a time a patient tried to find out what a test or treatment would cost but was unable to do so, a time that caring for a patient generated an unexpectedly a high medical bill, or a time a patient and care provider figured out a way to save money while still delivering high-value care. To help select the winning entries, Costs of Care has partnered with five health luminaries who will serve as judges:
  • Peter Orzsag, former Director of the White House Office of Management and Budget
  • Dr. C. Everett Koop, former United States Surgeon General
  • Hon. Jennifer Granholm, former Governor of Michigan
  • Dr. Susan Love, women’s health and cancer research advocate
  • Dr. Alan Garber, health economist and Harvard University Provost
All submissions will be due on November 15th, 2011. Finalists will be announced on December 15th, 2011 and the ,000 prize winners will be announced on January 15th, 2012. All qualifying submissions will be published biweekly at http://www.costsofcare.org during the 2012 calendar year.  ]]> http://www.physiciansnews.com/2011/10/27/win-1000-essay-contest-challenges-docs-to-offer-solutions-to-healthcare-costs/feed/ 0 ER Docs Focus On Medical Liability Reforms http://www.physiciansnews.com/2012/01/31/dream-of-a-medical-%e2%80%98price-list%e2%80%99-dies-in-florida-legislature/ http://www.physiciansnews.com/2012/01/31/dream-of-a-medical-%e2%80%98price-list%e2%80%99-dies-in-florida-legislature/#comments Tue, 31 Jan 2012 16:30:32 +0000 Physicians News http://www.physiciansnews.com/?p=4579 approved legislation that would expand the state’s requirement that certain providers post the out-of-pocket prices of common health care services, a state Senate committee shot down a similar measure after an aggressive lobbying push by health care provider groups. Organizations representing the state’s doctors weren’t wild about the idea that certain facilities would have to display bulletin-board sized postings of their prices. Jeff Scott, general counsel for the Florida Medical Association, said that providers are all for transparency, but they don’t need the government telling them exactly how they should do it. “Next thing you know they’re going to say it has to be neon or include pictures,” he said. But providers’ most strenuous objections were to provisions in the legislation that would require providers to disclose prices to out-of-network patients and limit so-called balance billing, which happens in health care settings when providers bill patients the difference between what they charge for a service and what insurers pay it. Meanwhile, the state already requires urgent care centers to post in their reception area the prices of their 50 most frequently used services, and the posting must be at least 15 square feet.  Physicians are not required to do so, but they must follow the same rules if they post prices voluntarily. Under the proposed legislation, ambulatory care centers and diagnostic-imaging centers would have had to follow the same rules as urgent care centers, and the original bills also would have expanded the requirement to physicians. The House committee-approved bill softened this language to maintain the voluntary status quo for doctors. Both bills would have required physicians to provide patients with a written statement of prices at each visit. Richard Polangin, health care policy coordinator for the Florida Public Interest Research Group, said the legislation would have been a boon for consumers, many of whom are unaware that prices can vary among doctors and facilities. The bills would “enable persons who must pay for doctor visits, diagnostic images such as CT scans and MRIs, and for care at ambulatory surgery centers, to know the cost in advance,” he said. “The uninsured and persons with insurance deductibles would be able to make more informed health care decisions.” Insurers and business groups also supported the legislation. And, though the measure’s future is uncertain, at least one person involved in the lobbying effort said work would continue. ### This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.]]> http://www.physiciansnews.com/2012/01/31/dream-of-a-medical-%e2%80%98price-list%e2%80%99-dies-in-florida-legislature/feed/ 0 Physicians News » News Briefs http://www.physiciansnews.com Tue, 07 Feb 2012 16:44:06 +0000 en hourly 1 http://wordpress.org/?v=3.2.1 Experts Divided Over Recommendation To Screen Children For Cholesterol http://www.physiciansnews.com/2012/02/07/experts-divided-over-recommendation-to-screen-children-for-cholesterol/ http://www.physiciansnews.com/2012/02/07/experts-divided-over-recommendation-to-screen-children-for-cholesterol/#comments Tue, 07 Feb 2012 16:15:56 +0000 Physicians News http://www.physiciansnews.com/?p=4592 One in 500 kids has an inherited disorder that causes high levels of LDL ("bad") cholesterol that may require medication to control. However, since the problem doesn't create observable symptoms, as many as half of these kids don't know they have the condition. To help identify these children, late last year an expert panel convened by the National Heart, Lung, and Blood Institute recommended that all children be screened for high cholesterol, once between the ages of 9 and 11 and again between ages 17 and 21. Reaction to the guidelines, which were included as part of a larger NHLBI report on improving cardiovascular health in children and adolescents, has been mixed. Some clinicians and researchers say universal screening is an important tool not only to help identify children who are genetically predisposed to high cholesterol, a condition called familial hypercholesterolemia, but also to pinpoint others who could benefit from treatment, including those with high LDL related to being overweight or obese. Working with these kids to eat more healthfully and to exercise more may reduce the cumulative negative effect of high cholesterol on their cardiovascular systems and lead to fewer heart attacks and strokes later in life, the experts say. Others, including clinicians who authored a pair of articles in the Journal of the American Medical Association last month, express concerns that screening may do more harm than good. To identify the relatively small number of kids who really need medical treatment, doctors cast a wide and expensive net that identifies many children as at risk who will never develop  premature cardiovascular disease, says Matthew Gillman, director of the obesity prevention program at Harvard Medical School, who co-authored one of the articles. Some of those children will probably be needlessly put on cholesterol-lowering medications, he says. The U.S. Preventive Services Task Force, an independent group of primary-care providers that evaluates the evidence for clinical care, concluded in 2007 that there isn't enough evidence to recommend for or against routine lipid screening in children and adolescents. Research has shown that 10 to 13 percent of children have elevated cholesterol levels. Treatment for the vast majority should focus on lifestyle interventions, says Stephen Daniels, chairman of the Department of Pediatrics at the University of Colorado School of Medicine, who led the NHLBI panel. A much smaller number of those children, the ones with a genetic predisposition to high cholesterol, may need to take a statin, he says. Until the new guidelines were released, the American Academy of Pediatrics recommended cholesterol screening in children primarily based on family history. If a child had a father who had heart disease or a heart attack before age 55, for example, screening would be indicated. Children who had risk factors such as obesity or diabetes were also candidates for screening. The AAP has since endorsed the new NHLBI guidelines. "Family history doesn't really catch everybody" with familial hypercholesterolemia, says Sarah de Ferranti, a member of the AAP committee on nutrition and the director of preventive cardiology at Children's Hospital Boston. In addition, she says, "Anecdotally, I can tell you that when someone comes to my office and they know they have high cholesterol values, they're much more focused." That's the case with the McFeeley family. Bill and Carolyn McFeeley, of Mullica Hill, N.J., had always considered themselves very healthy - until Bill had a heart attack two years ago at age 47. The pediatrician for their three children checked the kids' cholesterol and found that while levels for the two girls - Chelsea, now 17, and Chandler, 13 - were normal, Chase, 10, had slightly higher values: His total cholesterol was roughly 210. (In general, anything over 200 is considered high.)
The McFeeley family, from left to right: Chandler, Carolyn, Chase, Bill, and Chelsea.
Now Chase has replaced his beloved egg salad sandwiches with turkey and fat-free cheese ones. "If we can get ahead of it and keep Chase healthy, it means a lot to us," says Bill. Julie Brothers, medical director of the lipid heart clinic at Children's Hospital of Philadelphia, sees Chase once a year now and says she hopes they can manage his cholesterol without medication. "None of us wants to slap medication on anyone," she says. Maybe not. "But if you're going to test every child, it's a sure bet you're going to be medicating more kids," says H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, who has written extensively on the problems created by aggressive screening. Research on the safety and effectiveness of statins in children is scant; studies that have looked at statin use haven't enrolled more than a few hundred kids, and none has followed them for more than two years, say experts. "We don't know what taking a 10- to 11-year-old kid and putting them on statins long term will do," says Frederick Rivara, division chief of general pediatrics at Seattle Children's Hospital and co-author of one of the JAMA articles. Gillman says that while early intervention to prevent heart disease is critical, screening all children may not be the best way to do it. As an example, he cites a study that he co-authored last year examining the cost-effectiveness of blood pressure screening in adolescents. "The bottom line of that study is that population approaches like taking the salt out of food are more effective and less costly than any screening program," he says. ### This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente. ]]> http://www.physiciansnews.com/2012/02/07/experts-divided-over-recommendation-to-screen-children-for-cholesterol/feed/ 0 The Treatment of Solid Tumors: Some Recent Approaches http://www.physiciansnews.com/2012/02/07/the-treatment-of-solid-tumors-some-recent-approaches/ http://www.physiciansnews.com/2012/02/07/the-treatment-of-solid-tumors-some-recent-approaches/#comments Tue, 07 Feb 2012 16:14:45 +0000 Physicians News http://www.physiciansnews.com/?p=4595 By Punit Dhillon At some point in their lives, one in five people will suffer from skin cancer, and the fraction is steadily rising.  In spite of innovation in sunscreen technology and public attention to the need to be shielded from the sun, data reported recently by Dermatology Times show a rise in the average American lifetime risk of one skin cancer variety—invasive melanoma—from 1/600 in 1960 to 1/50 in 2008.  Despite previous diagnosis and innovations in approaches to treatment, the age-adjusted number of annual deaths per 100,000 population is rising.  Additionally, the expense to the healthcare system and society continues to increase.  As U.S. and European populations age, the incidence of skin cancer and other solid tumor cancers will grow.  According to the latest United States Cancer Statistics, published by the Centers for Disease Control and Prevention in 2007, the top 10 cancer types (based on incidence rate) are in the solid tumor category; today the priority is probably even higher.  Thus, there are clear medical needs going unmet and the creation of novel, cost-efficient and patient-friendly treatments remain a top priority for both the healthcare community and patients. Various challenges of traditional treatments The treatment of solid tumor cancers, which range from melanoma and Merkel cell carcinoma to cutaneous T-cell lymphoma, continues to be a substantial challenge for physicians.  For example, in spite of innovations in drug discovery and development, it is still challenging to simply deliver efficient drugs into cancer cells in a safe and effective manner.  Meanwhile, today’s therapeutic approaches—involving surgery, radiation therapy and chemotherapy—each have characteristic and major drawbacks. Surgery, the current first-line treatment for localized and operable tumors or lesions, requires resecting the tumor mass and a surrounding boundary of healthy tissue to make sure that no cancer cells remain at the tumor site.  Surgery can potentially cause physical disfigurement and/or debilitating effects on organ function, and the patient quality of life has been demonstrated to be negatively impacted.  Also, surgery can require an expensive and long hospital stay. Radiation therapy is occasionally used in conjunction with surgery to shrink a tumor prior to surgical removal, or afterward to destroy any cancer cells that might remain.  Yet surgery plus radiation can damage important normal tissues like nerves, blood vessels, or vital organs such as the heart that are within the designated zone of treatment.  Radiation is also a costly therapeutic approach, and demands substantial expertise, precautionary measures and infrastructure to administer.  Radiation entails major complications, such as nausea, diarrhea, dry mouth, taste alterations, loss of appetite, and the potential for the formation of new cancerous lesions. Those who get radiation to the heart often suffer from various types of heart failure in subsequent years. Typically, chemotherapy is a secondary or palliative treatment to help mitigate systemic or metastatic tumor growth, whereas surgery and radiation may be considered local treatments.  In response to cancer’s spread, physicians will administer chemotherapeutic agents that circulate throughout the body, systemically and in high concentrations, to counter the challenge that some chemotherapeutic agents have in reaching and penetrating the cell membrane to trigger cell death.  Yet the system-wide use of chemotherapeutics frequently has major side effects by killing healthy as well as cancerous cells.  This systemic and non-targeted administration of anticancer agents can trigger alopecia; nausea; vomiting; myelosuppression; and drug resistance.  Chemotherapy is curative for only a few tumor types. Additionally, all of these conventional treatments are only minimally effective on aggressive types of cutaneous cancers, especially in later stages of the disease. Some potential approaches We now offer an abbreviated look at some current approaches to override these challenges in treating solid tumors. One possible strategy for solid tumor treatment involves a new class of small-molecule drug candidates called vascular disrupting agents.  Via interaction with vascular endothelial cytoskeletal proteins, these agents may selectively target and collapse tumor vasculature, thereby depriving the tumor of oxygen and causing death of the tumor cells. Another approach involves the use of new therapeutic monoclonal antibody candidates that target CD27, a member of the tumor necrosis factor (TNF) receptor superfamily.  Anti-CD27 monoclonal antibodies have been demonstrated to effectively promote anticancer immunity in mouse models when combined with T cell receptor stimulation.  In addition, CD27 is overexpressed in various lymphomas and leukemias and can be targeted for direct activity by anti-CD27 monoclonal antibodies with effector function against those cancers.  There are many other antibody drugs on the market, some also with linked toxins or radiation. A third tactic involves the creation of an orally available nucleoside analogue for various cancers including solid tumors.  This agent could act through a novel DNA single-strand breaking mechanism, leading to the production of DNA double strand breaks (DSBs) and/or DNA repair checkpoint activation; unrepaired DSBs go on to cause apoptosis or programmed cell death. Alternatively, solid tumors could be treated using a technique called tumor ablation, which involves destroying the tumor inside the body via various approaches.  Radioactive pellets, shorter than an inch and approximately the width of a pin, can be inserted into the tumor; the pellet subsequently emits lethal radioactive atoms that irradiate the tumor from the inside out.  As the tumor breaks down, it starts to release antigens that trigger an immune response against the cancer cells.  Sometimes, the body also develops an immune memory against the future return of tumor cells.  Another proposed ablation technique, called “pulsed electric current ablation,” involves the insertion of electrodes into tumors, which subsequently emit very high-energy electrical currents; these currents create a physical reaction that destroys the tumor cells. A separate approach involves applying local heating to the tumor using radio frequency techniques.  In this instance, a thermal energy delivery device can be focused and targeted according to the shape, size and position of a specific tumor.  Adjusting the frequency, phase, and amplitude of the radio waves, combined with different applicators and adjustment of the patient’s position, could conceivably permit a doctor to optimize the delivery of damaging energy into the tumor. Cancer scientists are also interested in attacking solid tumors by delivering drugs specifically into diseased tissues. Such a targeted approach can result in more efficient therapy while using smaller drug doses with fewer negative side effects.  For example, in animal studies, immune-deficient mice carrying human forms of various cancers have been simultaneously injected with a range of anticancer agents and a peptide known as iRGD.  iRGD can find and attach itself to receptors on solid tumor cancer cells and later activate their internal transport systems so that the peptide is essentially passed through cell after cell, moving progressively deeper into the tumor structure.  Anticancer drugs lingering near the peptide molecules may also get pulled into and through the tumor mass by this transport mechanism, enabling them to attack cancer cells previously beyond their reach. By their nature and cellular architecture, solid tumors are equipped to limit the efficacy of most anticancer drugs.  Tumors have poor vascular systems, which reduces exposure to drugs that have been administered into the circulation.  The lesions are densely fibrous, which serves as a physical barrier against transport.  Also, the tumors have high internal pressures, causing further physical challenges to any molecule attempting to enter the lesion.  The iRGD peptide is designed to act like a key, switching on the internal transport mechanism of the cells so that they absorb anything that is proximal to certain cell surface receptors.  Researchers believe the iRGD peptide could penetrate many tumor types and might be useful in treating most solid tumor cancers.  An encouraging aspect of this approach is that both the peptide and anticancer drugs are effective together without being chemically attached. Yet another promising strategy for treating solid tumor cancers involves targeting the tumor itself without affecting any of the surrounding healthy tissue.  This ensures that the drug or therapeutic agent is absorbed at once by the cancer cells and not normal tissues.  One such targeted therapy could harness a physiologic process known as “electroporation.”  Derived from the words “electric” and “pore,” this involves applying a brief electric field to the cancerous cell.  The electrical pulse triggers the temporary creation of pores in the cell’s outer membrane—pores that close again within seconds once the electric field is discontinued.  These transient pores can improve uptake of various drugs more than a thousand-fold. Several electroporation systems have been manufactured that consist of a generator that creates the pulsed electric field, and various handheld applicators with electrode needles at their proximal ends.  The applicator delivers a controlled electric pulse to the cancer cells, thus causing any cancer cells within the affected region to undergo electroporation.  The cell takes up therapeutic agents within the region of electroporation. This technology platform is being developed for use in two varieties of anticancer therapies:  electrochemotherapy and electroimmunotherapy.  In the former, an anticancer drug is injected into a targeted tumor; the lesion is then electroporated and the drug carries out its planned mechanism of action in killing the cell.  As a result of the targeted, local therapy, the amount of drug needed to kill the cells is substantially less than that required in traditional, non-targeted chemotherapy.  The lower quantity of systemic drug (cytotoxic agent) reduces harmful side effects linked to traditional chemotherapy. Electroimmunotherapy, the second application of electroporation, involves the use of a gene encoding a specific cytokine, a substance known to boost the human immune system against cancer cells.  An immune response can have both a local and a distant effect against cancerous cells.  These therapeutic approaches have been shown to be safe and effective across various types of tumors.  Both patient outcomes and pharmacoeconomic benefits are substantial.  This technology is in clinical testing in North America and is available for commercial sale in some European countries. Therapies such as those discussed here may provide a compelling set of novel approaches to the treatment of solid tumor cancers. ### Punit Dhillon is President and CEO of OncoSec Medical Inc., a biotechnology company developing its advanced-stage Oncology Medical System (OMS) ElectroOncology therapies to treat skin cancer and other solid tumor cancers. He can be reached at pdhillon@oncosec.com.]]> http://www.physiciansnews.com/2012/02/07/the-treatment-of-solid-tumors-some-recent-approaches/feed/ 0 Dream Of A Medical ‘Price List’ Dies In Florida Legislature http://www.physiciansnews.com/2012/01/31/dream-of-a-medical-%e2%80%98price-list%e2%80%99-dies-in-florida-legislature/ http://www.physiciansnews.com/2012/01/31/dream-of-a-medical-%e2%80%98price-list%e2%80%99-dies-in-florida-legislature/#comments Tue, 31 Jan 2012 16:30:32 +0000 Physicians News http://www.physiciansnews.com/?p=4579 approved legislation that would expand the state’s requirement that certain providers post the out-of-pocket prices of common health care services, a state Senate committee shot down a similar measure after an aggressive lobbying push by health care provider groups. Organizations representing the state’s doctors weren’t wild about the idea that certain facilities would have to display bulletin-board sized postings of their prices. Jeff Scott, general counsel for the Florida Medical Association, said that providers are all for transparency, but they don’t need the government telling them exactly how they should do it. “Next thing you know they’re going to say it has to be neon or include pictures,” he said. But providers’ most strenuous objections were to provisions in the legislation that would require providers to disclose prices to out-of-network patients and limit so-called balance billing, which happens in health care settings when providers bill patients the difference between what they charge for a service and what insurers pay it. Meanwhile, the state already requires urgent care centers to post in their reception area the prices of their 50 most frequently used services, and the posting must be at least 15 square feet.  Physicians are not required to do so, but they must follow the same rules if they post prices voluntarily. Under the proposed legislation, ambulatory care centers and diagnostic-imaging centers would have had to follow the same rules as urgent care centers, and the original bills also would have expanded the requirement to physicians. The House committee-approved bill softened this language to maintain the voluntary status quo for doctors. Both bills would have required physicians to provide patients with a written statement of prices at each visit. Richard Polangin, health care policy coordinator for the Florida Public Interest Research Group, said the legislation would have been a boon for consumers, many of whom are unaware that prices can vary among doctors and facilities. The bills would “enable persons who must pay for doctor visits, diagnostic images such as CT scans and MRIs, and for care at ambulatory surgery centers, to know the cost in advance,” he said. “The uninsured and persons with insurance deductibles would be able to make more informed health care decisions.” Insurers and business groups also supported the legislation. And, though the measure’s future is uncertain, at least one person involved in the lobbying effort said work would continue. ### This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.]]> http://www.physiciansnews.com/2012/01/31/dream-of-a-medical-%e2%80%98price-list%e2%80%99-dies-in-florida-legislature/feed/ 0 Twins Born in Different Years: What About Insurance? http://www.physiciansnews.com/2012/01/04/twins-born-in-different-years-what-about-insurance/ http://www.physiciansnews.com/2012/01/04/twins-born-in-different-years-what-about-insurance/#comments Wed, 04 Jan 2012 21:02:55 +0000 Physicians News http://www.physiciansnews.com/?p=4525 By Sarah Barr By the time newborn Freya Humenny joined her twin brother Beckett this past weekend, the calendar already had turned from 2011 to 2012. That means the twins always will have their own birthdays—but will they share an insurance statement? The twin’s mother, Stephanie Peterson, gave birth to Beckett at 6:40 p.m. on Dec. 31, 2011,  at the Hennepin County Medical Center in Minneapolis, but Freya did not follow until 12:26 a.m on Jan. 1. And so after we ooh-ed and ahh-ed over the adorable pair, we had to ask: What could a case like this mean for a family’s insurance? Paul Fronstin, director of the health research and education program at the Employee Benefit Research Institute, said that every case would vary based on the terms of a family’s policy. But, as an example, if a family had a high-deductible private insurance plan, a number of factors would be in play, according to Fronstin. For one, there is the question of the family’s deductible.  Lots of prenatal services are covered as preventive care, but some are not.  If the family had not yet met their 2011 deductible, then the first of the births would be applied to that year’s deductible, while the second could apply to the next year. There’s also the question of whether the second birth would even be considered an expense for the new year or whether it would be tied to the mother’s original admission. And as for the twins themselves, the second child’s expenses likely would be billed as new year expenses, but services for the first child, such as nights spent in a nursery, could span the two years—raising another set of questions about how to bill. Fronstin said that while a hypothetical case brings up a number of questions, an insurer’s response won’t necessarily be complicated. “It could be as simple as it was so close to midnight that it doesn’t really matter,” he said. Recommence the oohs and ahhs. ### This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.]]> http://www.physiciansnews.com/2012/01/04/twins-born-in-different-years-what-about-insurance/feed/ 0 Fox Chase Cancer Center Merges with Temple University http://www.physiciansnews.com/2011/12/17/fox-chase-cancer-center-merges-with-temple-university/ http://www.physiciansnews.com/2011/12/17/fox-chase-cancer-center-merges-with-temple-university/#comments Sat, 17 Dec 2011 16:05:33 +0000 Physicians News http://www.physiciansnews.com/?p=4493 Temple University Health System and Fox Chase Cancer Center this week signed an Affiliation Agreement that moves both institutions closer to bringing Fox Chase Cancer Center into the Temple family – marking a major milestone for two celebrated Philadelphia institutions that will enhance cancer research and patient care in the region, both immediately and for years to come. "Temple is proud and privileged to welcome Fox Chase Cancer Center into its family of academic researchers and clinicians," said Ann Weaver Hart, PhD, President of Temple University. "This bold, visionary relationship immediately establishes Temple's position as a leader in cancer care and translational research at the local, regional and national levels," said Larry R. Kaiser, MD, FACS, Senior Executive Vice President for Health Sciences of Temple University, Dean of Temple University School of Medicine, and President and CEO of Temple University Health System. "It sets the stage for many exciting opportunities to grow and enhance the cancer-related patient-care, research and educational programs of Temple’s healthcare enterprise. "The pursuit of excellence is the driving force for today's action – which offers a preview of what tomorrow represents. Indeed, this affiliation marks a fresh direction in cancer research and treatment in Philadelphia," continued Dr. Kaiser. "Sustained by the converging action of two highly respected medical institutions, it will draw on both established knowledge and original insights to pave the way for what all cancer patients and their families want and deserve – hope." "Fox Chase is proud to be the professional home to some of the most talented and compassionate scientists, doctors, and nurses working on the cancer problem anywhere in the world," said Michael V. Seiden, MD, PhD, President and CEO of Fox Chase Cancer Center. "But we're always working to strengthen the Center's ability to more vigorously pursue our mission to prevail over cancer, and we believe that this affiliation with Temple University Health System will do just that, enabling us to begin recruiting new researchers and clinicians almost immediately and to expand our clinical services significantly in coming years to serve the region's cancer-care needs well into the future."   Fox Chase Cancer Center is one of only two National Cancer Institute (NCI)-designated comprehensive cancer centers in Philadelphia, and one of only 40 in the U.S. Its addition to Temple creates collaborative synergies between and among physician-scientists at Temple University School of Medicine, Fox Chase Cancer Center, and Temple Cancer Center that will accelerate the pace of further discovery and development of the most effective approaches to cancer prevention, diagnosis, and treatment. By becoming an affiliate of Temple University Health System, Fox Chase will be able to significantly expand its outpatient and surgical-care services – within its existing facilities and through the use of leased space in Jeanes Hospital, an affiliate of Temple University Health System since 1996. Given the geographic proximity of Fox Chase to Jeanes Hospital (home to TUH's highly-regarded Bone Marrow Transplant Program), a natural byproduct of the agreement is the creation of a contiguous, 47.5-acre site to serve as Temple's "cancer hub" for the development of future innovations in cancer-care and research. The affiliation also gives Jeanes Hospital the opportunity to meet the associated health care needs of cancer patients by providing a broad array of services on its premises in areas such as outpatient diagnostic testing, interventional radiology, breast care, general surgery, thoracic surgery, endocrine surgery, urology and diagnostic GI. Temple University Health System will invest in cancer research at Fox Chase – providing new resources to recruit additional physician-scientists who will further advance the collaborative efforts of Temple and Fox Chase researchers in creating new knowledge and pathways for the prevention, treatment, and, ultimately, cures for cancer and cancer-related conditions. "The affiliation of Fox Chase Cancer Center with Temple University Health System signifies an important step in the transformation of Temple’s healthcare enterprise," said Jane Scaccetti, Chair of Temple University Health System's Board and a Temple University Trustee. "The combined strength of both highly regarded institutions will fuel innovations in cancer research and patient care," added Patrick J. O'Connor, Esq., Chair of the Board of Trustees of Temple University. "We at Fox Chase Cancer Center have long understood the potential value of joining forces with Temple University Health System, particularly with Jeanes Hospital as our immediate neighbor," said David G. Marshall, Chair of the Board of Directors of Fox Chase Cancer Center. "Thanks to the committed leadership of Dr. Michael Seiden and Dr. Larry Kaiser, we're proud to announce today an affiliation agreement that will meet Fox Chase's growth needs for the foreseeable future while bringing a National Cancer Institute-designated comprehensive cancer center into Temple's vibrant academic medical community." Finally, the affiliation will bring efficiencies and savings, as economies-of-scale are recognized and leveraged across TUHS, Fox Chase Cancer Center, and Jeanes Hospital. The ability to demonstrate collaborative efficiencies is particularly important in a time when the ability to demonstrate both excellence and value matters more than ever before… to patients, payors, and grant-funding agencies. Temple's newly-consolidated cancer hub will serve as a vital source of discovery, development, and delivery of the most effective approaches to cancer prevention, diagnosis, and treatment that will give patients the best of both worlds: access to the comprehensive treatments and innovative clinical-trials available at both Temple Cancer Center and Fox Chase Cancer Center. Fold in the full array of academic and clinical expertise of Temple University School of Medicine faculty, and the most advanced diagnostic and therapeutic technologies available at Temple University Hospital, and it becomes clear that this affiliation will benefit all cancer patients and their families throughout the Delaware Valley… and beyond.
]]> http://www.physiciansnews.com/2011/12/17/fox-chase-cancer-center-merges-with-temple-university/feed/ 0 Physicians Pessimistic on Benefits of Health Care Reform http://www.physiciansnews.com/2011/12/13/physicians-pessimistic-on-benefits-of-health-care-reform/ http://www.physiciansnews.com/2011/12/13/physicians-pessimistic-on-benefits-of-health-care-reform/#comments Tue, 13 Dec 2011 15:47:24 +0000 Physicians News http://www.physiciansnews.com/?p=4488 A new Deloitte study reveals physicians are skeptical about core promises associated with the Patient Protection and Affordable Care Act.  Only 27 percent of physicians surveyed believe the PPACA is likely to reduce costs by increasing efficiency, and only 33 percent feel it is likely to decrease disparities.  Moreover, half say access to health care will decrease because of hospital closures that result from the law. The report, “Physician Perspectives about Health Care Reform and the Future of the Medical Profession,” also shows that the majority of doctors (73 percent) are not excited about the future of medicine and believe (69 percent) the “best and brightest” who might consider a career in medicine will think otherwise. “The data confirms that physicians are resistant to reform and are frustrated with the direction of the profession,” says Paul Keckley, Ph.D., executive director of the Deloitte Center for Health Solutions and lead author of the report.  “Understanding the view of the physician is fundamental to any attempt to change the health care model – this is the person prescribing the medicine, ordering the test and performing the surgery." The negativity is driven in part by concern over the pressure primary doctors will face from millions of newly-insured consumers seeking care and the reverberations this sudden impact could create on the larger system. Another stumbling block for physicians is the view that reform will mean a loss of autonomy and more costs and administrative burdens in adopting processes and technologies.  For decades this sense of autonomy has been sacrosanct to the profession, and it’s difficult to uproot that overnight, continues Keckley. “Effective reform has to consider the physician’s view as a starting point,” says Keckley.  “We not only have to design the right model, but we have to create the right incentives and processes for implementing that model.  The concept of change management is just as important for doctors in the health care system as it is for employees in a corporation.” Additional key findings from the study include:
  • Nearly three-quarters of respondents think that emergency rooms could get overwhelmed if primary care physician appointments are full as a result of the Patient Protection and Affordable Care Act.
  • More than 80 percent believe it is likely that wait times for primary care appointments will increase because of a lack of providers.  More than half indicate that other medical professionals (physician assistants, nurse practitioners) will deliver primary care both independently and as an adjunct to physician services.
  • Surgical specialists (57 percent) are much more likely to support the law’s repeal compared to primary-care providers (38 percent) and non-surgical specialists (34 percent).  They are also more likely to say the legislation is a step in the wrong direction and believe their net income will decrease as a result of reform.
  • There is a disparity among generations, as 59 percent of physicians 50 to 59 years old feel PPACA is a step in the wrong direction while only 36 percent of those ages 25 to 39 share this sentiment. Younger physicians (ages 25 to 39) are also more likely than older doctors (ages 40 to 59) to think the transition to evidence-based medicine will improve care.
For more information about Physician Perspectives about Health Care Reform and the Future of the Medical Profession, visit www.deloitte.com/us/physiciansurvey.]]> http://www.physiciansnews.com/2011/12/13/physicians-pessimistic-on-benefits-of-health-care-reform/feed/ 0 Five Issues To Impact Docs in 2012 http://www.physiciansnews.com/2011/12/08/five-issues-to-impact-docs-in-2012/ http://www.physiciansnews.com/2011/12/08/five-issues-to-impact-docs-in-2012/#comments Thu, 08 Dec 2011 15:40:50 +0000 Physicians News http://www.physiciansnews.com/?p=4473 As the New Year approaches and the future of health reform hangs in the balance, The Physicians Foundation – a nonprofit organization that seeks to advance the work of practicing physicians and improve the quality of healthcare for all Americans – has identified five key areas that will impact the practice of medicine in the year ahead. The Physicians Watch List for 2012 is based on research the Foundation released earlier this year, including the 2010 Health Reform Research Study and 2011 Roadmap for Physicians to Healthcare Reform Paper.

  1. Changing nature of medical practices. Many physicians are choosing hospital and group settings versus private practice due to the perceived security employed settings offer. Only one quarter of physicians surveyed said they plan to continue practicing as they are; half said they would adopt a style of practice different from the traditional full-time independent private practice model. In 2012, physicians will need to carefully assess their individual circumstances and determine the practice configuration that best meets their needs and those of their patients.
  2.  Decreased return on increased burden. The added regulations and administrative responsibilities based on the Patient Protection and Affordable Care Act (PPACA) have caused physicians to focus less on the patient and more on administrating their practices. Sixty-three percent of physicians surveyed said that non-clinical paperwork has caused them to spend less time with their patients and 94 percent said time they devote to non-clinical paperwork in the last three years has increased. In 2012, physicians will need to vigilantly monitor their administrative burdens and take steps to minimize any further impact on their relationship with patients.
  3. Acute shortages of primary care physicians. A growing shortage of physicians threatens the medical profession’s ability to serve patients across key specialties and geographies. Physicians will need to redefine their roles and rethink delivery models in order to meet rising demand. The majority of physicians (60 percent) said health reform will compel them to close or significantly limit their practices to certain categories of patients. Of these, 93 percent said they will close or significantly limit their practices to Medicaid patients and 87 percent said they would close or significantly restrict their practices to Medicare patients. In 2012, physicians will need to evaluate how they can optimize their time to accommodate the current and future needs of their patients.
  4. Critical need for physician leadership tools / skills. In the healthcare environment of tomorrow, many physicians will assume greater business and people management responsibilities within practice groups and hospital settings.  In 2012, physicians will need to acquire new types of non-medical leadership skills to be effective in these expanded roles, while still maintaining their trusted relationships with patients.
  5. Impact on patients. The need to provide higher quality in an environment characterized by increased reporting, problematic reimbursement and high potential liability, will place extraordinary stress on physicians, particularly those in private practice. Only one physician in ten believes that health reform will enhance the quality of care they are able to provide to their patients, compared to 56 percent who believe reform will diminish the quality of care they are able to provide.  In 2012, physicians will increasingly need to balance these competing factors in ways that do not compromise the care they provide to patients.

“Proposed changes to our healthcare system have already significantly impacted physicians and patients,” said Lou Goodman, Ph.D., president of The Physicians Foundation and chief executive officer of the Texas Medical Association. “We hope the physician watch list helps to address the core issues under the new legislation and offers doctors and the healthcare community guidance on how to deliver the best care possible to patients in 2012.”

]]> http://www.physiciansnews.com/2011/12/08/five-issues-to-impact-docs-in-2012/feed/ 2 Both Patients And Physicians Can Suffer When Test Results Aren’t Reported http://www.physiciansnews.com/2011/11/29/both-patients-and-physicians-can-suffer-when-test-results-aren%e2%80%99t-reported/ http://www.physiciansnews.com/2011/11/29/both-patients-and-physicians-can-suffer-when-test-results-aren%e2%80%99t-reported/#comments Tue, 29 Nov 2011 16:01:38 +0000 Physicians News http://www.physiciansnews.com/?p=4438 Medical tests can reveal critical information about a person's health, but only if the results are communicated to clinicians and patients. Sometimes, the ball gets dropped somewhere between the lab or the radiology department and the clinician who ordered the test and the patient. In Peggy Kidwell's case, a mix-up over doctors' names led to a year-long delay in a breast cancer diagnosis.

After her annual gynecological exam and mammogram several years ago at a medical center near her Virginia Beach home, she got a letter from her doctor saying the results of her Pap test were normal. She assumed that she would hear from her doctor if anything untoward showed up on her mammogram exam and thought no more about it.

A year later, when Kidwell went back for her annual exam at age 59, her doctor, finding no mammogram results in her chart, asked why she hadn't gotten a screening exam the previous year. When Kidwell said she had, the doctor investigated. Five hours later, the doctor called Kidwell to tell her she had found the results and it looked as though she had breast cancer.The test results had been sent to an orthopedic surgeon at the medical center who had the same last name as Kidwell's gynecologist. The folder had been sitting on his desk for a year, according to her gynecologist. By that time her cancer had spread to her chest wall. Kidwell had a lumpectomy, chemotherapy and radiation. The following year, the cancer came back and Kidwell had a mastectomy. She filed a lawsuit and eventually settled the case. (A confidentiality agreement prohibits her from discussing specifics.) No one, she says, ever said that an earlier diagnosis might have made a difference in the course of her disease, but she believes it may have. Kidwell, who now lives in Silver Spring, blames the medical system for the mix-up, but also herself. "To this day, I don't let myself off the hook for not picking up the phone," she says. Financial Consequences There are also financial consequences for providers when tests aren't promptly reported: A recent study in the Journal of the American College of Radiology found that annual medical malpractice payouts for communication breakdowns, including failing to share test results, more than quadrupled nationally between 1991 and 2010, to million. For patients, the missteps and mistakes can be life-altering. Patient follow-up could make a difference in many instances. The study examined medical malpractice claims from 425 hospitals and 52,000 providers. Of the 306 cases in which test results were specifically cited as a factor in a malpractice case, the most common problem — it occurred almost half the time — was that the patient didn't receive the test results, cited in 143 cases. The second-most-common problem was that the clinician didn't receive the results, cited in 110 cases. Other problems included delays and slow turnaround in reporting findings and test results that were filed before the clinician reviewed them. The study examined a different database as well, the National Practitioner Data Bank, to arrive at a dollar value for malpractice claims payouts related to communications problems, examining categories that would include getting test result information to practitioners and patients alike, for the period from 1991 to 2010. That analysis showed that payouts increased from million to million during that time, a more than four-fold increase. Patient advocates and policy experts say the push for better coordination of patient care, including the adoption of electronic medical records, should help improve the delivery of test results to patients from doctors and to doctors from those who perform the tests. "Health reform and payment reform are moving us toward integrating care to a degree that we don't do right now," says Diane Pinakiewicz, president of the National Patient Safety Foundation, a Boston-based consumer group. "The one constant is the patient. The best chance is for the patient to be part of the process." A Multilayered Approach Patient involvement is important, but the burden of following up on test results shouldn't fall on their shoulders, experts agree. But doctors need a helping hand. In a given week, a primary-care doctor might need to review 360 chemistry test results, 460 hematology results, 12 pathology reports and 40 radiology reports, according to researchers at Partners HealthCare system in Boston. More than half of physicians surveyed some years ago said they weren't satisfied with the way they handled test results, which typically took more than an hour each day. Now many practices affiliated with Partners use a multilayered system that helps them manage test results. The Web-based system lets them log in and see all the tests they've ordered and the results that have come in, with those that are problematic listed first. If a test result requires urgent attention, the system generates an e-mail alerting doctors; if they ignore this warning and subsequent messages, the system alerts the practice manager, who contacts the physician directly. The system also generates letters that notify patients of their test results and has a tickler function that can alert doctors when patients haven't had follow-up tests as ordered. Even so, "nothing is foolproof," says Eric Poon, director of clinical informatics at Brigham and Women's Hospital, part of the Partners system. "No news is not good news," he says. "If a patient gets a test done and doesn't get a result, he should follow up." ### This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente. ]]> http://www.physiciansnews.com/2011/11/29/both-patients-and-physicians-can-suffer-when-test-results-aren%e2%80%99t-reported/feed/ 1 Win ,000: Essay Contest Challenges Docs To Offer Solutions To Healthcare Costs http://www.physiciansnews.com/2011/10/27/win-1000-essay-contest-challenges-docs-to-offer-solutions-to-healthcare-costs/ http://www.physiciansnews.com/2011/10/27/win-1000-essay-contest-challenges-docs-to-offer-solutions-to-healthcare-costs/#comments Thu, 27 Oct 2011 13:00:54 +0000 Physicians News http://www.physiciansnews.com/?p=4350 Costs of Care, a physician-run nonprofit based in Boston, has launched its second annual national healthcare essay contest, with the goal of expanding the public discourse on the role of doctors, nurses, and other care providers in controlling healthcare costs. Executive Director Neel Shah, who is also a third-year obstetrics and gynecology resident at the Harvard Medical School, founded Costs of Care after he began thinking, as a med student, that physicians had a good deal of power over healthcare costs but rarely thought about them. "There's a lot of talk about insurers and patients, but at the end of the day doctors decide what's on the bill," he told the LA Times. Last year, Costs of Care launched an innovative essay contest that emphasized the importance of price transparency in everyday medicine by gathering more than 100 personal stories from patients, nurses, and doctors across the nation. A vascular surgeon in Arizona, for example, wrote about a time a hospital assigned an out-of-network anesthesiologist to a surgery, sending a patient's bill skyrocketing, according to the LA Times. "There was no mechanism to make sure all of the providers a patient uses were in network," Shah said.  "That's a simple check." This year, Costs of Care is looking for more stories, and will award 00 prizes for stories about the importance of price transparency as well as solution-oriented stories that illustrate ways to reduce harmful healthcare spending and save patients’ money. As the economy struggles to recover, the spiraling costs of healthcare in the United States have become a contentious political focal point without an obvious solution. Traditionally, health care providers have been reluctant to discuss their own role in healthcare spending. However, Dr. Shah, “Ultimately, no amount of regulating, reorganizing, or otherwise reforming the healthcare system will successfully contain costs unless healthcare providers are invested in fixing the problem.” To help mobilize healthcare providers to examine their own role in spending, Costs of Care is launching an essay contest that will collect and widely disseminate stories from the front lines of medicine. Costs of Care will award 00 in prizes to top submissions. Two 00 prizes will be reserved for patients, and two 00 prizes will be reserved for care providers. Preference will be given to stories that best demonstrate the importance of cost-awareness in medicine. Examples may include a time a patient tried to find out what a test or treatment would cost but was unable to do so, a time that caring for a patient generated an unexpectedly a high medical bill, or a time a patient and care provider figured out a way to save money while still delivering high-value care. To help select the winning entries, Costs of Care has partnered with five health luminaries who will serve as judges:
  • Peter Orzsag, former Director of the White House Office of Management and Budget
  • Dr. C. Everett Koop, former United States Surgeon General
  • Hon. Jennifer Granholm, former Governor of Michigan
  • Dr. Susan Love, women’s health and cancer research advocate
  • Dr. Alan Garber, health economist and Harvard University Provost
All submissions will be due on November 15th, 2011. Finalists will be announced on December 15th, 2011 and the ,000 prize winners will be announced on January 15th, 2012. All qualifying submissions will be published biweekly at http://www.costsofcare.org during the 2012 calendar year.  ]]> http://www.physiciansnews.com/2011/10/27/win-1000-essay-contest-challenges-docs-to-offer-solutions-to-healthcare-costs/feed/ 0 ER Docs Focus On Medical Liability Reforms http://www.physiciansnews.com/2012/01/04/twins-born-in-different-years-what-about-insurance/ http://www.physiciansnews.com/2012/01/04/twins-born-in-different-years-what-about-insurance/#comments Wed, 04 Jan 2012 21:02:55 +0000 Physicians News http://www.physiciansnews.com/?p=4525 By Sarah Barr By the time newborn Freya Humenny joined her twin brother Beckett this past weekend, the calendar already had turned from 2011 to 2012. That means the twins always will have their own birthdays—but will they share an insurance statement? The twin’s mother, Stephanie Peterson, gave birth to Beckett at 6:40 p.m. on Dec. 31, 2011,  at the Hennepin County Medical Center in Minneapolis, but Freya did not follow until 12:26 a.m on Jan. 1. And so after we ooh-ed and ahh-ed over the adorable pair, we had to ask: What could a case like this mean for a family’s insurance? Paul Fronstin, director of the health research and education program at the Employee Benefit Research Institute, said that every case would vary based on the terms of a family’s policy. But, as an example, if a family had a high-deductible private insurance plan, a number of factors would be in play, according to Fronstin. For one, there is the question of the family’s deductible.  Lots of prenatal services are covered as preventive care, but some are not.  If the family had not yet met their 2011 deductible, then the first of the births would be applied to that year’s deductible, while the second could apply to the next year. There’s also the question of whether the second birth would even be considered an expense for the new year or whether it would be tied to the mother’s original admission. And as for the twins themselves, the second child’s expenses likely would be billed as new year expenses, but services for the first child, such as nights spent in a nursery, could span the two years—raising another set of questions about how to bill. Fronstin said that while a hypothetical case brings up a number of questions, an insurer’s response won’t necessarily be complicated. “It could be as simple as it was so close to midnight that it doesn’t really matter,” he said. Recommence the oohs and ahhs. ### This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.]]> http://www.physiciansnews.com/2012/01/04/twins-born-in-different-years-what-about-insurance/feed/ 0 Physicians News » News Briefs http://www.physiciansnews.com Tue, 07 Feb 2012 16:44:06 +0000 en hourly 1 http://wordpress.org/?v=3.2.1 Experts Divided Over Recommendation To Screen Children For Cholesterol http://www.physiciansnews.com/2012/02/07/experts-divided-over-recommendation-to-screen-children-for-cholesterol/ http://www.physiciansnews.com/2012/02/07/experts-divided-over-recommendation-to-screen-children-for-cholesterol/#comments Tue, 07 Feb 2012 16:15:56 +0000 Physicians News http://www.physiciansnews.com/?p=4592 One in 500 kids has an inherited disorder that causes high levels of LDL ("bad") cholesterol that may require medication to control. However, since the problem doesn't create observable symptoms, as many as half of these kids don't know they have the condition. To help identify these children, late last year an expert panel convened by the National Heart, Lung, and Blood Institute recommended that all children be screened for high cholesterol, once between the ages of 9 and 11 and again between ages 17 and 21. Reaction to the guidelines, which were included as part of a larger NHLBI report on improving cardiovascular health in children and adolescents, has been mixed. Some clinicians and researchers say universal screening is an important tool not only to help identify children who are genetically predisposed to high cholesterol, a condition called familial hypercholesterolemia, but also to pinpoint others who could benefit from treatment, including those with high LDL related to being overweight or obese. Working with these kids to eat more healthfully and to exercise more may reduce the cumulative negative effect of high cholesterol on their cardiovascular systems and lead to fewer heart attacks and strokes later in life, the experts say. Others, including clinicians who authored a pair of articles in the Journal of the American Medical Association last month, express concerns that screening may do more harm than good. To identify the relatively small number of kids who really need medical treatment, doctors cast a wide and expensive net that identifies many children as at risk who will never develop  premature cardiovascular disease, says Matthew Gillman, director of the obesity prevention program at Harvard Medical School, who co-authored one of the articles. Some of those children will probably be needlessly put on cholesterol-lowering medications, he says. The U.S. Preventive Services Task Force, an independent group of primary-care providers that evaluates the evidence for clinical care, concluded in 2007 that there isn't enough evidence to recommend for or against routine lipid screening in children and adolescents. Research has shown that 10 to 13 percent of children have elevated cholesterol levels. Treatment for the vast majority should focus on lifestyle interventions, says Stephen Daniels, chairman of the Department of Pediatrics at the University of Colorado School of Medicine, who led the NHLBI panel. A much smaller number of those children, the ones with a genetic predisposition to high cholesterol, may need to take a statin, he says. Until the new guidelines were released, the American Academy of Pediatrics recommended cholesterol screening in children primarily based on family history. If a child had a father who had heart disease or a heart attack before age 55, for example, screening would be indicated. Children who had risk factors such as obesity or diabetes were also candidates for screening. The AAP has since endorsed the new NHLBI guidelines. "Family history doesn't really catch everybody" with familial hypercholesterolemia, says Sarah de Ferranti, a member of the AAP committee on nutrition and the director of preventive cardiology at Children's Hospital Boston. In addition, she says, "Anecdotally, I can tell you that when someone comes to my office and they know they have high cholesterol values, they're much more focused." That's the case with the McFeeley family. Bill and Carolyn McFeeley, of Mullica Hill, N.J., had always considered themselves very healthy - until Bill had a heart attack two years ago at age 47. The pediatrician for their three children checked the kids' cholesterol and found that while levels for the two girls - Chelsea, now 17, and Chandler, 13 - were normal, Chase, 10, had slightly higher values: His total cholesterol was roughly 210. (In general, anything over 200 is considered high.)
The McFeeley family, from left to right: Chandler, Carolyn, Chase, Bill, and Chelsea.
Now Chase has replaced his beloved egg salad sandwiches with turkey and fat-free cheese ones. "If we can get ahead of it and keep Chase healthy, it means a lot to us," says Bill. Julie Brothers, medical director of the lipid heart clinic at Children's Hospital of Philadelphia, sees Chase once a year now and says she hopes they can manage his cholesterol without medication. "None of us wants to slap medication on anyone," she says. Maybe not. "But if you're going to test every child, it's a sure bet you're going to be medicating more kids," says H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, who has written extensively on the problems created by aggressive screening. Research on the safety and effectiveness of statins in children is scant; studies that have looked at statin use haven't enrolled more than a few hundred kids, and none has followed them for more than two years, say experts. "We don't know what taking a 10- to 11-year-old kid and putting them on statins long term will do," says Frederick Rivara, division chief of general pediatrics at Seattle Children's Hospital and co-author of one of the JAMA articles. Gillman says that while early intervention to prevent heart disease is critical, screening all children may not be the best way to do it. As an example, he cites a study that he co-authored last year examining the cost-effectiveness of blood pressure screening in adolescents. "The bottom line of that study is that population approaches like taking the salt out of food are more effective and less costly than any screening program," he says. ### This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente. ]]> http://www.physiciansnews.com/2012/02/07/experts-divided-over-recommendation-to-screen-children-for-cholesterol/feed/ 0 The Treatment of Solid Tumors: Some Recent Approaches http://www.physiciansnews.com/2012/02/07/the-treatment-of-solid-tumors-some-recent-approaches/ http://www.physiciansnews.com/2012/02/07/the-treatment-of-solid-tumors-some-recent-approaches/#comments Tue, 07 Feb 2012 16:14:45 +0000 Physicians News http://www.physiciansnews.com/?p=4595 By Punit Dhillon At some point in their lives, one in five people will suffer from skin cancer, and the fraction is steadily rising.  In spite of innovation in sunscreen technology and public attention to the need to be shielded from the sun, data reported recently by Dermatology Times show a rise in the average American lifetime risk of one skin cancer variety—invasive melanoma—from 1/600 in 1960 to 1/50 in 2008.  Despite previous diagnosis and innovations in approaches to treatment, the age-adjusted number of annual deaths per 100,000 population is rising.  Additionally, the expense to the healthcare system and society continues to increase.  As U.S. and European populations age, the incidence of skin cancer and other solid tumor cancers will grow.  According to the latest United States Cancer Statistics, published by the Centers for Disease Control and Prevention in 2007, the top 10 cancer types (based on incidence rate) are in the solid tumor category; today the priority is probably even higher.  Thus, there are clear medical needs going unmet and the creation of novel, cost-efficient and patient-friendly treatments remain a top priority for both the healthcare community and patients. Various challenges of traditional treatments The treatment of solid tumor cancers, which range from melanoma and Merkel cell carcinoma to cutaneous T-cell lymphoma, continues to be a substantial challenge for physicians.  For example, in spite of innovations in drug discovery and development, it is still challenging to simply deliver efficient drugs into cancer cells in a safe and effective manner.  Meanwhile, today’s therapeutic approaches—involving surgery, radiation therapy and chemotherapy—each have characteristic and major drawbacks. Surgery, the current first-line treatment for localized and operable tumors or lesions, requires resecting the tumor mass and a surrounding boundary of healthy tissue to make sure that no cancer cells remain at the tumor site.  Surgery can potentially cause physical disfigurement and/or debilitating effects on organ function, and the patient quality of life has been demonstrated to be negatively impacted.  Also, surgery can require an expensive and long hospital stay. Radiation therapy is occasionally used in conjunction with surgery to shrink a tumor prior to surgical removal, or afterward to destroy any cancer cells that might remain.  Yet surgery plus radiation can damage important normal tissues like nerves, blood vessels, or vital organs such as the heart that are within the designated zone of treatment.  Radiation is also a costly therapeutic approach, and demands substantial expertise, precautionary measures and infrastructure to administer.  Radiation entails major complications, such as nausea, diarrhea, dry mouth, taste alterations, loss of appetite, and the potential for the formation of new cancerous lesions. Those who get radiation to the heart often suffer from various types of heart failure in subsequent years. Typically, chemotherapy is a secondary or palliative treatment to help mitigate systemic or metastatic tumor growth, whereas surgery and radiation may be considered local treatments.  In response to cancer’s spread, physicians will administer chemotherapeutic agents that circulate throughout the body, systemically and in high concentrations, to counter the challenge that some chemotherapeutic agents have in reaching and penetrating the cell membrane to trigger cell death.  Yet the system-wide use of chemotherapeutics frequently has major side effects by killing healthy as well as cancerous cells.  This systemic and non-targeted administration of anticancer agents can trigger alopecia; nausea; vomiting; myelosuppression; and drug resistance.  Chemotherapy is curative for only a few tumor types. Additionally, all of these conventional treatments are only minimally effective on aggressive types of cutaneous cancers, especially in later stages of the disease. Some potential approaches We now offer an abbreviated look at some current approaches to override these challenges in treating solid tumors. One possible strategy for solid tumor treatment involves a new class of small-molecule drug candidates called vascular disrupting agents.  Via interaction with vascular endothelial cytoskeletal proteins, these agents may selectively target and collapse tumor vasculature, thereby depriving the tumor of oxygen and causing death of the tumor cells. Another approach involves the use of new therapeutic monoclonal antibody candidates that target CD27, a member of the tumor necrosis factor (TNF) receptor superfamily.  Anti-CD27 monoclonal antibodies have been demonstrated to effectively promote anticancer immunity in mouse models when combined with T cell receptor stimulation.  In addition, CD27 is overexpressed in various lymphomas and leukemias and can be targeted for direct activity by anti-CD27 monoclonal antibodies with effector function against those cancers.  There are many other antibody drugs on the market, some also with linked toxins or radiation. A third tactic involves the creation of an orally available nucleoside analogue for various cancers including solid tumors.  This agent could act through a novel DNA single-strand breaking mechanism, leading to the production of DNA double strand breaks (DSBs) and/or DNA repair checkpoint activation; unrepaired DSBs go on to cause apoptosis or programmed cell death. Alternatively, solid tumors could be treated using a technique called tumor ablation, which involves destroying the tumor inside the body via various approaches.  Radioactive pellets, shorter than an inch and approximately the width of a pin, can be inserted into the tumor; the pellet subsequently emits lethal radioactive atoms that irradiate the tumor from the inside out.  As the tumor breaks down, it starts to release antigens that trigger an immune response against the cancer cells.  Sometimes, the body also develops an immune memory against the future return of tumor cells.  Another proposed ablation technique, called “pulsed electric current ablation,” involves the insertion of electrodes into tumors, which subsequently emit very high-energy electrical currents; these currents create a physical reaction that destroys the tumor cells. A separate approach involves applying local heating to the tumor using radio frequency techniques.  In this instance, a thermal energy delivery device can be focused and targeted according to the shape, size and position of a specific tumor.  Adjusting the frequency, phase, and amplitude of the radio waves, combined with different applicators and adjustment of the patient’s position, could conceivably permit a doctor to optimize the delivery of damaging energy into the tumor. Cancer scientists are also interested in attacking solid tumors by delivering drugs specifically into diseased tissues. Such a targeted approach can result in more efficient therapy while using smaller drug doses with fewer negative side effects.  For example, in animal studies, immune-deficient mice carrying human forms of various cancers have been simultaneously injected with a range of anticancer agents and a peptide known as iRGD.  iRGD can find and attach itself to receptors on solid tumor cancer cells and later activate their internal transport systems so that the peptide is essentially passed through cell after cell, moving progressively deeper into the tumor structure.  Anticancer drugs lingering near the peptide molecules may also get pulled into and through the tumor mass by this transport mechanism, enabling them to attack cancer cells previously beyond their reach. By their nature and cellular architecture, solid tumors are equipped to limit the efficacy of most anticancer drugs.  Tumors have poor vascular systems, which reduces exposure to drugs that have been administered into the circulation.  The lesions are densely fibrous, which serves as a physical barrier against transport.  Also, the tumors have high internal pressures, causing further physical challenges to any molecule attempting to enter the lesion.  The iRGD peptide is designed to act like a key, switching on the internal transport mechanism of the cells so that they absorb anything that is proximal to certain cell surface receptors.  Researchers believe the iRGD peptide could penetrate many tumor types and might be useful in treating most solid tumor cancers.  An encouraging aspect of this approach is that both the peptide and anticancer drugs are effective together without being chemically attached. Yet another promising strategy for treating solid tumor cancers involves targeting the tumor itself without affecting any of the surrounding healthy tissue.  This ensures that the drug or therapeutic agent is absorbed at once by the cancer cells and not normal tissues.  One such targeted therapy could harness a physiologic process known as “electroporation.”  Derived from the words “electric” and “pore,” this involves applying a brief electric field to the cancerous cell.  The electrical pulse triggers the temporary creation of pores in the cell’s outer membrane—pores that close again within seconds once the electric field is discontinued.  These transient pores can improve uptake of various drugs more than a thousand-fold. Several electroporation systems have been manufactured that consist of a generator that creates the pulsed electric field, and various handheld applicators with electrode needles at their proximal ends.  The applicator delivers a controlled electric pulse to the cancer cells, thus causing any cancer cells within the affected region to undergo electroporation.  The cell takes up therapeutic agents within the region of electroporation. This technology platform is being developed for use in two varieties of anticancer therapies:  electrochemotherapy and electroimmunotherapy.  In the former, an anticancer drug is injected into a targeted tumor; the lesion is then electroporated and the drug carries out its planned mechanism of action in killing the cell.  As a result of the targeted, local therapy, the amount of drug needed to kill the cells is substantially less than that required in traditional, non-targeted chemotherapy.  The lower quantity of systemic drug (cytotoxic agent) reduces harmful side effects linked to traditional chemotherapy. Electroimmunotherapy, the second application of electroporation, involves the use of a gene encoding a specific cytokine, a substance known to boost the human immune system against cancer cells.  An immune response can have both a local and a distant effect against cancerous cells.  These therapeutic approaches have been shown to be safe and effective across various types of tumors.  Both patient outcomes and pharmacoeconomic benefits are substantial.  This technology is in clinical testing in North America and is available for commercial sale in some European countries. Therapies such as those discussed here may provide a compelling set of novel approaches to the treatment of solid tumor cancers. ### Punit Dhillon is President and CEO of OncoSec Medical Inc., a biotechnology company developing its advanced-stage Oncology Medical System (OMS) ElectroOncology therapies to treat skin cancer and other solid tumor cancers. He can be reached at pdhillon@oncosec.com.]]> http://www.physiciansnews.com/2012/02/07/the-treatment-of-solid-tumors-some-recent-approaches/feed/ 0 Dream Of A Medical ‘Price List’ Dies In Florida Legislature http://www.physiciansnews.com/2012/01/31/dream-of-a-medical-%e2%80%98price-list%e2%80%99-dies-in-florida-legislature/ http://www.physiciansnews.com/2012/01/31/dream-of-a-medical-%e2%80%98price-list%e2%80%99-dies-in-florida-legislature/#comments Tue, 31 Jan 2012 16:30:32 +0000 Physicians News http://www.physiciansnews.com/?p=4579 approved legislation that would expand the state’s requirement that certain providers post the out-of-pocket prices of common health care services, a state Senate committee shot down a similar measure after an aggressive lobbying push by health care provider groups. Organizations representing the state’s doctors weren’t wild about the idea that certain facilities would have to display bulletin-board sized postings of their prices. Jeff Scott, general counsel for the Florida Medical Association, said that providers are all for transparency, but they don’t need the government telling them exactly how they should do it. “Next thing you know they’re going to say it has to be neon or include pictures,” he said. But providers’ most strenuous objections were to provisions in the legislation that would require providers to disclose prices to out-of-network patients and limit so-called balance billing, which happens in health care settings when providers bill patients the difference between what they charge for a service and what insurers pay it. Meanwhile, the state already requires urgent care centers to post in their reception area the prices of their 50 most frequently used services, and the posting must be at least 15 square feet.  Physicians are not required to do so, but they must follow the same rules if they post prices voluntarily. Under the proposed legislation, ambulatory care centers and diagnostic-imaging centers would have had to follow the same rules as urgent care centers, and the original bills also would have expanded the requirement to physicians. The House committee-approved bill softened this language to maintain the voluntary status quo for doctors. Both bills would have required physicians to provide patients with a written statement of prices at each visit. Richard Polangin, health care policy coordinator for the Florida Public Interest Research Group, said the legislation would have been a boon for consumers, many of whom are unaware that prices can vary among doctors and facilities. The bills would “enable persons who must pay for doctor visits, diagnostic images such as CT scans and MRIs, and for care at ambulatory surgery centers, to know the cost in advance,” he said. “The uninsured and persons with insurance deductibles would be able to make more informed health care decisions.” Insurers and business groups also supported the legislation. And, though the measure’s future is uncertain, at least one person involved in the lobbying effort said work would continue. ### This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.]]> http://www.physiciansnews.com/2012/01/31/dream-of-a-medical-%e2%80%98price-list%e2%80%99-dies-in-florida-legislature/feed/ 0 Twins Born in Different Years: What About Insurance? http://www.physiciansnews.com/2012/01/04/twins-born-in-different-years-what-about-insurance/ http://www.physiciansnews.com/2012/01/04/twins-born-in-different-years-what-about-insurance/#comments Wed, 04 Jan 2012 21:02:55 +0000 Physicians News http://www.physiciansnews.com/?p=4525 By Sarah Barr By the time newborn Freya Humenny joined her twin brother Beckett this past weekend, the calendar already had turned from 2011 to 2012. That means the twins always will have their own birthdays—but will they share an insurance statement? The twin’s mother, Stephanie Peterson, gave birth to Beckett at 6:40 p.m. on Dec. 31, 2011,  at the Hennepin County Medical Center in Minneapolis, but Freya did not follow until 12:26 a.m on Jan. 1. And so after we ooh-ed and ahh-ed over the adorable pair, we had to ask: What could a case like this mean for a family’s insurance? Paul Fronstin, director of the health research and education program at the Employee Benefit Research Institute, said that every case would vary based on the terms of a family’s policy. But, as an example, if a family had a high-deductible private insurance plan, a number of factors would be in play, according to Fronstin. For one, there is the question of the family’s deductible.  Lots of prenatal services are covered as preventive care, but some are not.  If the family had not yet met their 2011 deductible, then the first of the births would be applied to that year’s deductible, while the second could apply to the next year. There’s also the question of whether the second birth would even be considered an expense for the new year or whether it would be tied to the mother’s original admission. And as for the twins themselves, the second child’s expenses likely would be billed as new year expenses, but services for the first child, such as nights spent in a nursery, could span the two years—raising another set of questions about how to bill. Fronstin said that while a hypothetical case brings up a number of questions, an insurer’s response won’t necessarily be complicated. “It could be as simple as it was so close to midnight that it doesn’t really matter,” he said. Recommence the oohs and ahhs. ### This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.]]> http://www.physiciansnews.com/2012/01/04/twins-born-in-different-years-what-about-insurance/feed/ 0 Fox Chase Cancer Center Merges with Temple University http://www.physiciansnews.com/2011/12/17/fox-chase-cancer-center-merges-with-temple-university/ http://www.physiciansnews.com/2011/12/17/fox-chase-cancer-center-merges-with-temple-university/#comments Sat, 17 Dec 2011 16:05:33 +0000 Physicians News http://www.physiciansnews.com/?p=4493 Temple University Health System and Fox Chase Cancer Center this week signed an Affiliation Agreement that moves both institutions closer to bringing Fox Chase Cancer Center into the Temple family – marking a major milestone for two celebrated Philadelphia institutions that will enhance cancer research and patient care in the region, both immediately and for years to come. "Temple is proud and privileged to welcome Fox Chase Cancer Center into its family of academic researchers and clinicians," said Ann Weaver Hart, PhD, President of Temple University. "This bold, visionary relationship immediately establishes Temple's position as a leader in cancer care and translational research at the local, regional and national levels," said Larry R. Kaiser, MD, FACS, Senior Executive Vice President for Health Sciences of Temple University, Dean of Temple University School of Medicine, and President and CEO of Temple University Health System. "It sets the stage for many exciting opportunities to grow and enhance the cancer-related patient-care, research and educational programs of Temple’s healthcare enterprise. "The pursuit of excellence is the driving force for today's action – which offers a preview of what tomorrow represents. Indeed, this affiliation marks a fresh direction in cancer research and treatment in Philadelphia," continued Dr. Kaiser. "Sustained by the converging action of two highly respected medical institutions, it will draw on both established knowledge and original insights to pave the way for what all cancer patients and their families want and deserve – hope." "Fox Chase is proud to be the professional home to some of the most talented and compassionate scientists, doctors, and nurses working on the cancer problem anywhere in the world," said Michael V. Seiden, MD, PhD, President and CEO of Fox Chase Cancer Center. "But we're always working to strengthen the Center's ability to more vigorously pursue our mission to prevail over cancer, and we believe that this affiliation with Temple University Health System will do just that, enabling us to begin recruiting new researchers and clinicians almost immediately and to expand our clinical services significantly in coming years to serve the region's cancer-care needs well into the future."   Fox Chase Cancer Center is one of only two National Cancer Institute (NCI)-designated comprehensive cancer centers in Philadelphia, and one of only 40 in the U.S. Its addition to Temple creates collaborative synergies between and among physician-scientists at Temple University School of Medicine, Fox Chase Cancer Center, and Temple Cancer Center that will accelerate the pace of further discovery and development of the most effective approaches to cancer prevention, diagnosis, and treatment. By becoming an affiliate of Temple University Health System, Fox Chase will be able to significantly expand its outpatient and surgical-care services – within its existing facilities and through the use of leased space in Jeanes Hospital, an affiliate of Temple University Health System since 1996. Given the geographic proximity of Fox Chase to Jeanes Hospital (home to TUH's highly-regarded Bone Marrow Transplant Program), a natural byproduct of the agreement is the creation of a contiguous, 47.5-acre site to serve as Temple's "cancer hub" for the development of future innovations in cancer-care and research. The affiliation also gives Jeanes Hospital the opportunity to meet the associated health care needs of cancer patients by providing a broad array of services on its premises in areas such as outpatient diagnostic testing, interventional radiology, breast care, general surgery, thoracic surgery, endocrine surgery, urology and diagnostic GI. Temple University Health System will invest in cancer research at Fox Chase – providing new resources to recruit additional physician-scientists who will further advance the collaborative efforts of Temple and Fox Chase researchers in creating new knowledge and pathways for the prevention, treatment, and, ultimately, cures for cancer and cancer-related conditions. "The affiliation of Fox Chase Cancer Center with Temple University Health System signifies an important step in the transformation of Temple’s healthcare enterprise," said Jane Scaccetti, Chair of Temple University Health System's Board and a Temple University Trustee. "The combined strength of both highly regarded institutions will fuel innovations in cancer research and patient care," added Patrick J. O'Connor, Esq., Chair of the Board of Trustees of Temple University. "We at Fox Chase Cancer Center have long understood the potential value of joining forces with Temple University Health System, particularly with Jeanes Hospital as our immediate neighbor," said David G. Marshall, Chair of the Board of Directors of Fox Chase Cancer Center. "Thanks to the committed leadership of Dr. Michael Seiden and Dr. Larry Kaiser, we're proud to announce today an affiliation agreement that will meet Fox Chase's growth needs for the foreseeable future while bringing a National Cancer Institute-designated comprehensive cancer center into Temple's vibrant academic medical community." Finally, the affiliation will bring efficiencies and savings, as economies-of-scale are recognized and leveraged across TUHS, Fox Chase Cancer Center, and Jeanes Hospital. The ability to demonstrate collaborative efficiencies is particularly important in a time when the ability to demonstrate both excellence and value matters more than ever before… to patients, payors, and grant-funding agencies. Temple's newly-consolidated cancer hub will serve as a vital source of discovery, development, and delivery of the most effective approaches to cancer prevention, diagnosis, and treatment that will give patients the best of both worlds: access to the comprehensive treatments and innovative clinical-trials available at both Temple Cancer Center and Fox Chase Cancer Center. Fold in the full array of academic and clinical expertise of Temple University School of Medicine faculty, and the most advanced diagnostic and therapeutic technologies available at Temple University Hospital, and it becomes clear that this affiliation will benefit all cancer patients and their families throughout the Delaware Valley… and beyond.
]]> http://www.physiciansnews.com/2011/12/17/fox-chase-cancer-center-merges-with-temple-university/feed/ 0 Physicians Pessimistic on Benefits of Health Care Reform http://www.physiciansnews.com/2011/12/13/physicians-pessimistic-on-benefits-of-health-care-reform/ http://www.physiciansnews.com/2011/12/13/physicians-pessimistic-on-benefits-of-health-care-reform/#comments Tue, 13 Dec 2011 15:47:24 +0000 Physicians News http://www.physiciansnews.com/?p=4488 A new Deloitte study reveals physicians are skeptical about core promises associated with the Patient Protection and Affordable Care Act.  Only 27 percent of physicians surveyed believe the PPACA is likely to reduce costs by increasing efficiency, and only 33 percent feel it is likely to decrease disparities.  Moreover, half say access to health care will decrease because of hospital closures that result from the law. The report, “Physician Perspectives about Health Care Reform and the Future of the Medical Profession,” also shows that the majority of doctors (73 percent) are not excited about the future of medicine and believe (69 percent) the “best and brightest” who might consider a career in medicine will think otherwise. “The data confirms that physicians are resistant to reform and are frustrated with the direction of the profession,” says Paul Keckley, Ph.D., executive director of the Deloitte Center for Health Solutions and lead author of the report.  “Understanding the view of the physician is fundamental to any attempt to change the health care model – this is the person prescribing the medicine, ordering the test and performing the surgery." The negativity is driven in part by concern over the pressure primary doctors will face from millions of newly-insured consumers seeking care and the reverberations this sudden impact could create on the larger system. Another stumbling block for physicians is the view that reform will mean a loss of autonomy and more costs and administrative burdens in adopting processes and technologies.  For decades this sense of autonomy has been sacrosanct to the profession, and it’s difficult to uproot that overnight, continues Keckley. “Effective reform has to consider the physician’s view as a starting point,” says Keckley.  “We not only have to design the right model, but we have to create the right incentives and processes for implementing that model.  The concept of change management is just as important for doctors in the health care system as it is for employees in a corporation.” Additional key findings from the study include:
  • Nearly three-quarters of respondents think that emergency rooms could get overwhelmed if primary care physician appointments are full as a result of the Patient Protection and Affordable Care Act.
  • More than 80 percent believe it is likely that wait times for primary care appointments will increase because of a lack of providers.  More than half indicate that other medical professionals (physician assistants, nurse practitioners) will deliver primary care both independently and as an adjunct to physician services.
  • Surgical specialists (57 percent) are much more likely to support the law’s repeal compared to primary-care providers (38 percent) and non-surgical specialists (34 percent).  They are also more likely to say the legislation is a step in the wrong direction and believe their net income will decrease as a result of reform.
  • There is a disparity among generations, as 59 percent of physicians 50 to 59 years old feel PPACA is a step in the wrong direction while only 36 percent of those ages 25 to 39 share this sentiment. Younger physicians (ages 25 to 39) are also more likely than older doctors (ages 40 to 59) to think the transition to evidence-based medicine will improve care.
For more information about Physician Perspectives about Health Care Reform and the Future of the Medical Profession, visit www.deloitte.com/us/physiciansurvey.]]> http://www.physiciansnews.com/2011/12/13/physicians-pessimistic-on-benefits-of-health-care-reform/feed/ 0 Five Issues To Impact Docs in 2012 http://www.physiciansnews.com/2011/12/08/five-issues-to-impact-docs-in-2012/ http://www.physiciansnews.com/2011/12/08/five-issues-to-impact-docs-in-2012/#comments Thu, 08 Dec 2011 15:40:50 +0000 Physicians News http://www.physiciansnews.com/?p=4473 As the New Year approaches and the future of health reform hangs in the balance, The Physicians Foundation – a nonprofit organization that seeks to advance the work of practicing physicians and improve the quality of healthcare for all Americans – has identified five key areas that will impact the practice of medicine in the year ahead. The Physicians Watch List for 2012 is based on research the Foundation released earlier this year, including the 2010 Health Reform Research Study and 2011 Roadmap for Physicians to Healthcare Reform Paper.

  1. Changing nature of medical practices. Many physicians are choosing hospital and group settings versus private practice due to the perceived security employed settings offer. Only one quarter of physicians surveyed said they plan to continue practicing as they are; half said they would adopt a style of practice different from the traditional full-time independent private practice model. In 2012, physicians will need to carefully assess their individual circumstances and determine the practice configuration that best meets their needs and those of their patients.
  2.  Decreased return on increased burden. The added regulations and administrative responsibilities based on the Patient Protection and Affordable Care Act (PPACA) have caused physicians to focus less on the patient and more on administrating their practices. Sixty-three percent of physicians surveyed said that non-clinical paperwork has caused them to spend less time with their patients and 94 percent said time they devote to non-clinical paperwork in the last three years has increased. In 2012, physicians will need to vigilantly monitor their administrative burdens and take steps to minimize any further impact on their relationship with patients.
  3. Acute shortages of primary care physicians. A growing shortage of physicians threatens the medical profession’s ability to serve patients across key specialties and geographies. Physicians will need to redefine their roles and rethink delivery models in order to meet rising demand. The majority of physicians (60 percent) said health reform will compel them to close or significantly limit their practices to certain categories of patients. Of these, 93 percent said they will close or significantly limit their practices to Medicaid patients and 87 percent said they would close or significantly restrict their practices to Medicare patients. In 2012, physicians will need to evaluate how they can optimize their time to accommodate the current and future needs of their patients.
  4. Critical need for physician leadership tools / skills. In the healthcare environment of tomorrow, many physicians will assume greater business and people management responsibilities within practice groups and hospital settings.  In 2012, physicians will need to acquire new types of non-medical leadership skills to be effective in these expanded roles, while still maintaining their trusted relationships with patients.
  5. Impact on patients. The need to provide higher quality in an environment characterized by increased reporting, problematic reimbursement and high potential liability, will place extraordinary stress on physicians, particularly those in private practice. Only one physician in ten believes that health reform will enhance the quality of care they are able to provide to their patients, compared to 56 percent who believe reform will diminish the quality of care they are able to provide.  In 2012, physicians will increasingly need to balance these competing factors in ways that do not compromise the care they provide to patients.

“Proposed changes to our healthcare system have already significantly impacted physicians and patients,” said Lou Goodman, Ph.D., president of The Physicians Foundation and chief executive officer of the Texas Medical Association. “We hope the physician watch list helps to address the core issues under the new legislation and offers doctors and the healthcare community guidance on how to deliver the best care possible to patients in 2012.”

]]> http://www.physiciansnews.com/2011/12/08/five-issues-to-impact-docs-in-2012/feed/ 2 Both Patients And Physicians Can Suffer When Test Results Aren’t Reported http://www.physiciansnews.com/2011/11/29/both-patients-and-physicians-can-suffer-when-test-results-aren%e2%80%99t-reported/ http://www.physiciansnews.com/2011/11/29/both-patients-and-physicians-can-suffer-when-test-results-aren%e2%80%99t-reported/#comments Tue, 29 Nov 2011 16:01:38 +0000 Physicians News http://www.physiciansnews.com/?p=4438 Medical tests can reveal critical information about a person's health, but only if the results are communicated to clinicians and patients. Sometimes, the ball gets dropped somewhere between the lab or the radiology department and the clinician who ordered the test and the patient. In Peggy Kidwell's case, a mix-up over doctors' names led to a year-long delay in a breast cancer diagnosis.

After her annual gynecological exam and mammogram several years ago at a medical center near her Virginia Beach home, she got a letter from her doctor saying the results of her Pap test were normal. She assumed that she would hear from her doctor if anything untoward showed up on her mammogram exam and thought no more about it.

A year later, when Kidwell went back for her annual exam at age 59, her doctor, finding no mammogram results in her chart, asked why she hadn't gotten a screening exam the previous year. When Kidwell said she had, the doctor investigated. Five hours later, the doctor called Kidwell to tell her she had found the results and it looked as though she had breast cancer.The test results had been sent to an orthopedic surgeon at the medical center who had the same last name as Kidwell's gynecologist. The folder had been sitting on his desk for a year, according to her gynecologist. By that time her cancer had spread to her chest wall. Kidwell had a lumpectomy, chemotherapy and radiation. The following year, the cancer came back and Kidwell had a mastectomy. She filed a lawsuit and eventually settled the case. (A confidentiality agreement prohibits her from discussing specifics.) No one, she says, ever said that an earlier diagnosis might have made a difference in the course of her disease, but she believes it may have. Kidwell, who now lives in Silver Spring, blames the medical system for the mix-up, but also herself. "To this day, I don't let myself off the hook for not picking up the phone," she says. Financial Consequences There are also financial consequences for providers when tests aren't promptly reported: A recent study in the Journal of the American College of Radiology found that annual medical malpractice payouts for communication breakdowns, including failing to share test results, more than quadrupled nationally between 1991 and 2010, to million. For patients, the missteps and mistakes can be life-altering. Patient follow-up could make a difference in many instances. The study examined medical malpractice claims from 425 hospitals and 52,000 providers. Of the 306 cases in which test results were specifically cited as a factor in a malpractice case, the most common problem — it occurred almost half the time — was that the patient didn't receive the test results, cited in 143 cases. The second-most-common problem was that the clinician didn't receive the results, cited in 110 cases. Other problems included delays and slow turnaround in reporting findings and test results that were filed before the clinician reviewed them. The study examined a different database as well, the National Practitioner Data Bank, to arrive at a dollar value for malpractice claims payouts related to communications problems, examining categories that would include getting test result information to practitioners and patients alike, for the period from 1991 to 2010. That analysis showed that payouts increased from million to million during that time, a more than four-fold increase. Patient advocates and policy experts say the push for better coordination of patient care, including the adoption of electronic medical records, should help improve the delivery of test results to patients from doctors and to doctors from those who perform the tests. "Health reform and payment reform are moving us toward integrating care to a degree that we don't do right now," says Diane Pinakiewicz, president of the National Patient Safety Foundation, a Boston-based consumer group. "The one constant is the patient. The best chance is for the patient to be part of the process." A Multilayered Approach Patient involvement is important, but the burden of following up on test results shouldn't fall on their shoulders, experts agree. But doctors need a helping hand. In a given week, a primary-care doctor might need to review 360 chemistry test results, 460 hematology results, 12 pathology reports and 40 radiology reports, according to researchers at Partners HealthCare system in Boston. More than half of physicians surveyed some years ago said they weren't satisfied with the way they handled test results, which typically took more than an hour each day. Now many practices affiliated with Partners use a multilayered system that helps them manage test results. The Web-based system lets them log in and see all the tests they've ordered and the results that have come in, with those that are problematic listed first. If a test result requires urgent attention, the system generates an e-mail alerting doctors; if they ignore this warning and subsequent messages, the system alerts the practice manager, who contacts the physician directly. The system also generates letters that notify patients of their test results and has a tickler function that can alert doctors when patients haven't had follow-up tests as ordered. Even so, "nothing is foolproof," says Eric Poon, director of clinical informatics at Brigham and Women's Hospital, part of the Partners system. "No news is not good news," he says. "If a patient gets a test done and doesn't get a result, he should follow up." ### This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente. ]]> http://www.physiciansnews.com/2011/11/29/both-patients-and-physicians-can-suffer-when-test-results-aren%e2%80%99t-reported/feed/ 1 Win ,000: Essay Contest Challenges Docs To Offer Solutions To Healthcare Costs http://www.physiciansnews.com/2011/10/27/win-1000-essay-contest-challenges-docs-to-offer-solutions-to-healthcare-costs/ http://www.physiciansnews.com/2011/10/27/win-1000-essay-contest-challenges-docs-to-offer-solutions-to-healthcare-costs/#comments Thu, 27 Oct 2011 13:00:54 +0000 Physicians News http://www.physiciansnews.com/?p=4350 Costs of Care, a physician-run nonprofit based in Boston, has launched its second annual national healthcare essay contest, with the goal of expanding the public discourse on the role of doctors, nurses, and other care providers in controlling healthcare costs. Executive Director Neel Shah, who is also a third-year obstetrics and gynecology resident at the Harvard Medical School, founded Costs of Care after he began thinking, as a med student, that physicians had a good deal of power over healthcare costs but rarely thought about them. "There's a lot of talk about insurers and patients, but at the end of the day doctors decide what's on the bill," he told the LA Times. Last year, Costs of Care launched an innovative essay contest that emphasized the importance of price transparency in everyday medicine by gathering more than 100 personal stories from patients, nurses, and doctors across the nation. A vascular surgeon in Arizona, for example, wrote about a time a hospital assigned an out-of-network anesthesiologist to a surgery, sending a patient's bill skyrocketing, according to the LA Times. "There was no mechanism to make sure all of the providers a patient uses were in network," Shah said.  "That's a simple check." This year, Costs of Care is looking for more stories, and will award 00 prizes for stories about the importance of price transparency as well as solution-oriented stories that illustrate ways to reduce harmful healthcare spending and save patients’ money. As the economy struggles to recover, the spiraling costs of healthcare in the United States have become a contentious political focal point without an obvious solution. Traditionally, health care providers have been reluctant to discuss their own role in healthcare spending. However, Dr. Shah, “Ultimately, no amount of regulating, reorganizing, or otherwise reforming the healthcare system will successfully contain costs unless healthcare providers are invested in fixing the problem.” To help mobilize healthcare providers to examine their own role in spending, Costs of Care is launching an essay contest that will collect and widely disseminate stories from the front lines of medicine. Costs of Care will award 00 in prizes to top submissions. Two 00 prizes will be reserved for patients, and two 00 prizes will be reserved for care providers. Preference will be given to stories that best demonstrate the importance of cost-awareness in medicine. Examples may include a time a patient tried to find out what a test or treatment would cost but was unable to do so, a time that caring for a patient generated an unexpectedly a high medical bill, or a time a patient and care provider figured out a way to save money while still delivering high-value care. To help select the winning entries, Costs of Care has partnered with five health luminaries who will serve as judges:
  • Peter Orzsag, former Director of the White House Office of Management and Budget
  • Dr. C. Everett Koop, former United States Surgeon General
  • Hon. Jennifer Granholm, former Governor of Michigan
  • Dr. Susan Love, women’s health and cancer research advocate
  • Dr. Alan Garber, health economist and Harvard University Provost
All submissions will be due on November 15th, 2011. Finalists will be announced on December 15th, 2011 and the ,000 prize winners will be announced on January 15th, 2012. All qualifying submissions will be published biweekly at http://www.costsofcare.org during the 2012 calendar year.  ]]> http://www.physiciansnews.com/2011/10/27/win-1000-essay-contest-challenges-docs-to-offer-solutions-to-healthcare-costs/feed/ 0 ER Docs Focus On Medical Liability Reforms http://www.physiciansnews.com/2011/12/17/fox-chase-cancer-center-merges-with-temple-university/ http://www.physiciansnews.com/2011/12/17/fox-chase-cancer-center-merges-with-temple-university/#comments Sat, 17 Dec 2011 16:05:33 +0000 Physicians News http://www.physiciansnews.com/?p=4493 Temple University Health System and Fox Chase Cancer Center this week signed an Affiliation Agreement that moves both institutions closer to bringing Fox Chase Cancer Center into the Temple family – marking a major milestone for two celebrated Philadelphia institutions that will enhance cancer research and patient care in the region, both immediately and for years to come. "Temple is proud and privileged to welcome Fox Chase Cancer Center into its family of academic researchers and clinicians," said Ann Weaver Hart, PhD, President of Temple University. "This bold, visionary relationship immediately establishes Temple's position as a leader in cancer care and translational research at the local, regional and national levels," said Larry R. Kaiser, MD, FACS, Senior Executive Vice President for Health Sciences of Temple University, Dean of Temple University School of Medicine, and President and CEO of Temple University Health System. "It sets the stage for many exciting opportunities to grow and enhance the cancer-related patient-care, research and educational programs of Temple’s healthcare enterprise. "The pursuit of excellence is the driving force for today's action – which offers a preview of what tomorrow represents. Indeed, this affiliation marks a fresh direction in cancer research and treatment in Philadelphia," continued Dr. Kaiser. "Sustained by the converging action of two highly respected medical institutions, it will draw on both established knowledge and original insights to pave the way for what all cancer patients and their families want and deserve – hope." "Fox Chase is proud to be the professional home to some of the most talented and compassionate scientists, doctors, and nurses working on the cancer problem anywhere in the world," said Michael V. Seiden, MD, PhD, President and CEO of Fox Chase Cancer Center. "But we're always working to strengthen the Center's ability to more vigorously pursue our mission to prevail over cancer, and we believe that this affiliation with Temple University Health System will do just that, enabling us to begin recruiting new researchers and clinicians almost immediately and to expand our clinical services significantly in coming years to serve the region's cancer-care needs well into the future."   Fox Chase Cancer Center is one of only two National Cancer Institute (NCI)-designated comprehensive cancer centers in Philadelphia, and one of only 40 in the U.S. Its addition to Temple creates collaborative synergies between and among physician-scientists at Temple University School of Medicine, Fox Chase Cancer Center, and Temple Cancer Center that will accelerate the pace of further discovery and development of the most effective approaches to cancer prevention, diagnosis, and treatment. By becoming an affiliate of Temple University Health System, Fox Chase will be able to significantly expand its outpatient and surgical-care services – within its existing facilities and through the use of leased space in Jeanes Hospital, an affiliate of Temple University Health System since 1996. Given the geographic proximity of Fox Chase to Jeanes Hospital (home to TUH's highly-regarded Bone Marrow Transplant Program), a natural byproduct of the agreement is the creation of a contiguous, 47.5-acre site to serve as Temple's "cancer hub" for the development of future innovations in cancer-care and research. The affiliation also gives Jeanes Hospital the opportunity to meet the associated health care needs of cancer patients by providing a broad array of services on its premises in areas such as outpatient diagnostic testing, interventional radiology, breast care, general surgery, thoracic surgery, endocrine surgery, urology and diagnostic GI. Temple University Health System will invest in cancer research at Fox Chase – providing new resources to recruit additional physician-scientists who will further advance the collaborative efforts of Temple and Fox Chase researchers in creating new knowledge and pathways for the prevention, treatment, and, ultimately, cures for cancer and cancer-related conditions. "The affiliation of Fox Chase Cancer Center with Temple University Health System signifies an important step in the transformation of Temple’s healthcare enterprise," said Jane Scaccetti, Chair of Temple University Health System's Board and a Temple University Trustee. "The combined strength of both highly regarded institutions will fuel innovations in cancer research and patient care," added Patrick J. O'Connor, Esq., Chair of the Board of Trustees of Temple University. "We at Fox Chase Cancer Center have long understood the potential value of joining forces with Temple University Health System, particularly with Jeanes Hospital as our immediate neighbor," said David G. Marshall, Chair of the Board of Directors of Fox Chase Cancer Center. "Thanks to the committed leadership of Dr. Michael Seiden and Dr. Larry Kaiser, we're proud to announce today an affiliation agreement that will meet Fox Chase's growth needs for the foreseeable future while bringing a National Cancer Institute-designated comprehensive cancer center into Temple's vibrant academic medical community." Finally, the affiliation will bring efficiencies and savings, as economies-of-scale are recognized and leveraged across TUHS, Fox Chase Cancer Center, and Jeanes Hospital. The ability to demonstrate collaborative efficiencies is particularly important in a time when the ability to demonstrate both excellence and value matters more than ever before… to patients, payors, and grant-funding agencies. Temple's newly-consolidated cancer hub will serve as a vital source of discovery, development, and delivery of the most effective approaches to cancer prevention, diagnosis, and treatment that will give patients the best of both worlds: access to the comprehensive treatments and innovative clinical-trials available at both Temple Cancer Center and Fox Chase Cancer Center. Fold in the full array of academic and clinical expertise of Temple University School of Medicine faculty, and the most advanced diagnostic and therapeutic technologies available at Temple University Hospital, and it becomes clear that this affiliation will benefit all cancer patients and their families throughout the Delaware Valley… and beyond.
]]> http://www.physiciansnews.com/2011/12/17/fox-chase-cancer-center-merges-with-temple-university/feed/ 0 Physicians News » News Briefs http://www.physiciansnews.com Tue, 07 Feb 2012 16:44:06 +0000 en hourly 1 http://wordpress.org/?v=3.2.1 Experts Divided Over Recommendation To Screen Children For Cholesterol http://www.physiciansnews.com/2012/02/07/experts-divided-over-recommendation-to-screen-children-for-cholesterol/ http://www.physiciansnews.com/2012/02/07/experts-divided-over-recommendation-to-screen-children-for-cholesterol/#comments Tue, 07 Feb 2012 16:15:56 +0000 Physicians News http://www.physiciansnews.com/?p=4592 One in 500 kids has an inherited disorder that causes high levels of LDL ("bad") cholesterol that may require medication to control. However, since the problem doesn't create observable symptoms, as many as half of these kids don't know they have the condition. To help identify these children, late last year an expert panel convened by the National Heart, Lung, and Blood Institute recommended that all children be screened for high cholesterol, once between the ages of 9 and 11 and again between ages 17 and 21. Reaction to the guidelines, which were included as part of a larger NHLBI report on improving cardiovascular health in children and adolescents, has been mixed. Some clinicians and researchers say universal screening is an important tool not only to help identify children who are genetically predisposed to high cholesterol, a condition called familial hypercholesterolemia, but also to pinpoint others who could benefit from treatment, including those with high LDL related to being overweight or obese. Working with these kids to eat more healthfully and to exercise more may reduce the cumulative negative effect of high cholesterol on their cardiovascular systems and lead to fewer heart attacks and strokes later in life, the experts say. Others, including clinicians who authored a pair of articles in the Journal of the American Medical Association last month, express concerns that screening may do more harm than good. To identify the relatively small number of kids who really need medical treatment, doctors cast a wide and expensive net that identifies many children as at risk who will never develop  premature cardiovascular disease, says Matthew Gillman, director of the obesity prevention program at Harvard Medical School, who co-authored one of the articles. Some of those children will probably be needlessly put on cholesterol-lowering medications, he says. The U.S. Preventive Services Task Force, an independent group of primary-care providers that evaluates the evidence for clinical care, concluded in 2007 that there isn't enough evidence to recommend for or against routine lipid screening in children and adolescents. Research has shown that 10 to 13 percent of children have elevated cholesterol levels. Treatment for the vast majority should focus on lifestyle interventions, says Stephen Daniels, chairman of the Department of Pediatrics at the University of Colorado School of Medicine, who led the NHLBI panel. A much smaller number of those children, the ones with a genetic predisposition to high cholesterol, may need to take a statin, he says. Until the new guidelines were released, the American Academy of Pediatrics recommended cholesterol screening in children primarily based on family history. If a child had a father who had heart disease or a heart attack before age 55, for example, screening would be indicated. Children who had risk factors such as obesity or diabetes were also candidates for screening. The AAP has since endorsed the new NHLBI guidelines. "Family history doesn't really catch everybody" with familial hypercholesterolemia, says Sarah de Ferranti, a member of the AAP committee on nutrition and the director of preventive cardiology at Children's Hospital Boston. In addition, she says, "Anecdotally, I can tell you that when someone comes to my office and they know they have high cholesterol values, they're much more focused." That's the case with the McFeeley family. Bill and Carolyn McFeeley, of Mullica Hill, N.J., had always considered themselves very healthy - until Bill had a heart attack two years ago at age 47. The pediatrician for their three children checked the kids' cholesterol and found that while levels for the two girls - Chelsea, now 17, and Chandler, 13 - were normal, Chase, 10, had slightly higher values: His total cholesterol was roughly 210. (In general, anything over 200 is considered high.)
The McFeeley family, from left to right: Chandler, Carolyn, Chase, Bill, and Chelsea.
Now Chase has replaced his beloved egg salad sandwiches with turkey and fat-free cheese ones. "If we can get ahead of it and keep Chase healthy, it means a lot to us," says Bill. Julie Brothers, medical director of the lipid heart clinic at Children's Hospital of Philadelphia, sees Chase once a year now and says she hopes they can manage his cholesterol without medication. "None of us wants to slap medication on anyone," she says. Maybe not. "But if you're going to test every child, it's a sure bet you're going to be medicating more kids," says H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, who has written extensively on the problems created by aggressive screening. Research on the safety and effectiveness of statins in children is scant; studies that have looked at statin use haven't enrolled more than a few hundred kids, and none has followed them for more than two years, say experts. "We don't know what taking a 10- to 11-year-old kid and putting them on statins long term will do," says Frederick Rivara, division chief of general pediatrics at Seattle Children's Hospital and co-author of one of the JAMA articles. Gillman says that while early intervention to prevent heart disease is critical, screening all children may not be the best way to do it. As an example, he cites a study that he co-authored last year examining the cost-effectiveness of blood pressure screening in adolescents. "The bottom line of that study is that population approaches like taking the salt out of food are more effective and less costly than any screening program," he says. ### This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente. ]]> http://www.physiciansnews.com/2012/02/07/experts-divided-over-recommendation-to-screen-children-for-cholesterol/feed/ 0 The Treatment of Solid Tumors: Some Recent Approaches http://www.physiciansnews.com/2012/02/07/the-treatment-of-solid-tumors-some-recent-approaches/ http://www.physiciansnews.com/2012/02/07/the-treatment-of-solid-tumors-some-recent-approaches/#comments Tue, 07 Feb 2012 16:14:45 +0000 Physicians News http://www.physiciansnews.com/?p=4595 By Punit Dhillon At some point in their lives, one in five people will suffer from skin cancer, and the fraction is steadily rising.  In spite of innovation in sunscreen technology and public attention to the need to be shielded from the sun, data reported recently by Dermatology Times show a rise in the average American lifetime risk of one skin cancer variety—invasive melanoma—from 1/600 in 1960 to 1/50 in 2008.  Despite previous diagnosis and innovations in approaches to treatment, the age-adjusted number of annual deaths per 100,000 population is rising.  Additionally, the expense to the healthcare system and society continues to increase.  As U.S. and European populations age, the incidence of skin cancer and other solid tumor cancers will grow.  According to the latest United States Cancer Statistics, published by the Centers for Disease Control and Prevention in 2007, the top 10 cancer types (based on incidence rate) are in the solid tumor category; today the priority is probably even higher.  Thus, there are clear medical needs going unmet and the creation of novel, cost-efficient and patient-friendly treatments remain a top priority for both the healthcare community and patients. Various challenges of traditional treatments The treatment of solid tumor cancers, which range from melanoma and Merkel cell carcinoma to cutaneous T-cell lymphoma, continues to be a substantial challenge for physicians.  For example, in spite of innovations in drug discovery and development, it is still challenging to simply deliver efficient drugs into cancer cells in a safe and effective manner.  Meanwhile, today’s therapeutic approaches—involving surgery, radiation therapy and chemotherapy—each have characteristic and major drawbacks. Surgery, the current first-line treatment for localized and operable tumors or lesions, requires resecting the tumor mass and a surrounding boundary of healthy tissue to make sure that no cancer cells remain at the tumor site.  Surgery can potentially cause physical disfigurement and/or debilitating effects on organ function, and the patient quality of life has been demonstrated to be negatively impacted.  Also, surgery can require an expensive and long hospital stay. Radiation therapy is occasionally used in conjunction with surgery to shrink a tumor prior to surgical removal, or afterward to destroy any cancer cells that might remain.  Yet surgery plus radiation can damage important normal tissues like nerves, blood vessels, or vital organs such as the heart that are within the designated zone of treatment.  Radiation is also a costly therapeutic approach, and demands substantial expertise, precautionary measures and infrastructure to administer.  Radiation entails major complications, such as nausea, diarrhea, dry mouth, taste alterations, loss of appetite, and the potential for the formation of new cancerous lesions. Those who get radiation to the heart often suffer from various types of heart failure in subsequent years. Typically, chemotherapy is a secondary or palliative treatment to help mitigate systemic or metastatic tumor growth, whereas surgery and radiation may be considered local treatments.  In response to cancer’s spread, physicians will administer chemotherapeutic agents that circulate throughout the body, systemically and in high concentrations, to counter the challenge that some chemotherapeutic agents have in reaching and penetrating the cell membrane to trigger cell death.  Yet the system-wide use of chemotherapeutics frequently has major side effects by killing healthy as well as cancerous cells.  This systemic and non-targeted administration of anticancer agents can trigger alopecia; nausea; vomiting; myelosuppression; and drug resistance.  Chemotherapy is curative for only a few tumor types. Additionally, all of these conventional treatments are only minimally effective on aggressive types of cutaneous cancers, especially in later stages of the disease. Some potential approaches We now offer an abbreviated look at some current approaches to override these challenges in treating solid tumors. One possible strategy for solid tumor treatment involves a new class of small-molecule drug candidates called vascular disrupting agents.  Via interaction with vascular endothelial cytoskeletal proteins, these agents may selectively target and collapse tumor vasculature, thereby depriving the tumor of oxygen and causing death of the tumor cells. Another approach involves the use of new therapeutic monoclonal antibody candidates that target CD27, a member of the tumor necrosis factor (TNF) receptor superfamily.  Anti-CD27 monoclonal antibodies have been demonstrated to effectively promote anticancer immunity in mouse models when combined with T cell receptor stimulation.  In addition, CD27 is overexpressed in various lymphomas and leukemias and can be targeted for direct activity by anti-CD27 monoclonal antibodies with effector function against those cancers.  There are many other antibody drugs on the market, some also with linked toxins or radiation. A third tactic involves the creation of an orally available nucleoside analogue for various cancers including solid tumors.  This agent could act through a novel DNA single-strand breaking mechanism, leading to the production of DNA double strand breaks (DSBs) and/or DNA repair checkpoint activation; unrepaired DSBs go on to cause apoptosis or programmed cell death. Alternatively, solid tumors could be treated using a technique called tumor ablation, which involves destroying the tumor inside the body via various approaches.  Radioactive pellets, shorter than an inch and approximately the width of a pin, can be inserted into the tumor; the pellet subsequently emits lethal radioactive atoms that irradiate the tumor from the inside out.  As the tumor breaks down, it starts to release antigens that trigger an immune response against the cancer cells.  Sometimes, the body also develops an immune memory against the future return of tumor cells.  Another proposed ablation technique, called “pulsed electric current ablation,” involves the insertion of electrodes into tumors, which subsequently emit very high-energy electrical currents; these currents create a physical reaction that destroys the tumor cells. A separate approach involves applying local heating to the tumor using radio frequency techniques.  In this instance, a thermal energy delivery device can be focused and targeted according to the shape, size and position of a specific tumor.  Adjusting the frequency, phase, and amplitude of the radio waves, combined with different applicators and adjustment of the patient’s position, could conceivably permit a doctor to optimize the delivery of damaging energy into the tumor. Cancer scientists are also interested in attacking solid tumors by delivering drugs specifically into diseased tissues. Such a targeted approach can result in more efficient therapy while using smaller drug doses with fewer negative side effects.  For example, in animal studies, immune-deficient mice carrying human forms of various cancers have been simultaneously injected with a range of anticancer agents and a peptide known as iRGD.  iRGD can find and attach itself to receptors on solid tumor cancer cells and later activate their internal transport systems so that the peptide is essentially passed through cell after cell, moving progressively deeper into the tumor structure.  Anticancer drugs lingering near the peptide molecules may also get pulled into and through the tumor mass by this transport mechanism, enabling them to attack cancer cells previously beyond their reach. By their nature and cellular architecture, solid tumors are equipped to limit the efficacy of most anticancer drugs.  Tumors have poor vascular systems, which reduces exposure to drugs that have been administered into the circulation.  The lesions are densely fibrous, which serves as a physical barrier against transport.  Also, the tumors have high internal pressures, causing further physical challenges to any molecule attempting to enter the lesion.  The iRGD peptide is designed to act like a key, switching on the internal transport mechanism of the cells so that they absorb anything that is proximal to certain cell surface receptors.  Researchers believe the iRGD peptide could penetrate many tumor types and might be useful in treating most solid tumor cancers.  An encouraging aspect of this approach is that both the peptide and anticancer drugs are effective together without being chemically attached. Yet another promising strategy for treating solid tumor cancers involves targeting the tumor itself without affecting any of the surrounding healthy tissue.  This ensures that the drug or therapeutic agent is absorbed at once by the cancer cells and not normal tissues.  One such targeted therapy could harness a physiologic process known as “electroporation.”  Derived from the words “electric” and “pore,” this involves applying a brief electric field to the cancerous cell.  The electrical pulse triggers the temporary creation of pores in the cell’s outer membrane—pores that close again within seconds once the electric field is discontinued.  These transient pores can improve uptake of various drugs more than a thousand-fold. Several electroporation systems have been manufactured that consist of a generator that creates the pulsed electric field, and various handheld applicators with electrode needles at their proximal ends.  The applicator delivers a controlled electric pulse to the cancer cells, thus causing any cancer cells within the affected region to undergo electroporation.  The cell takes up therapeutic agents within the region of electroporation. This technology platform is being developed for use in two varieties of anticancer therapies:  electrochemotherapy and electroimmunotherapy.  In the former, an anticancer drug is injected into a targeted tumor; the lesion is then electroporated and the drug carries out its planned mechanism of action in killing the cell.  As a result of the targeted, local therapy, the amount of drug needed to kill the cells is substantially less than that required in traditional, non-targeted chemotherapy.  The lower quantity of systemic drug (cytotoxic agent) reduces harmful side effects linked to traditional chemotherapy. Electroimmunotherapy, the second application of electroporation, involves the use of a gene encoding a specific cytokine, a substance known to boost the human immune system against cancer cells.  An immune response can have both a local and a distant effect against cancerous cells.  These therapeutic approaches have been shown to be safe and effective across various types of tumors.  Both patient outcomes and pharmacoeconomic benefits are substantial.  This technology is in clinical testing in North America and is available for commercial sale in some European countries. Therapies such as those discussed here may provide a compelling set of novel approaches to the treatment of solid tumor cancers. ### Punit Dhillon is President and CEO of OncoSec Medical Inc., a biotechnology company developing its advanced-stage Oncology Medical System (OMS) ElectroOncology therapies to treat skin cancer and other solid tumor cancers. He can be reached at pdhillon@oncosec.com.]]> http://www.physiciansnews.com/2012/02/07/the-treatment-of-solid-tumors-some-recent-approaches/feed/ 0 Dream Of A Medical ‘Price List’ Dies In Florida Legislature http://www.physiciansnews.com/2012/01/31/dream-of-a-medical-%e2%80%98price-list%e2%80%99-dies-in-florida-legislature/ http://www.physiciansnews.com/2012/01/31/dream-of-a-medical-%e2%80%98price-list%e2%80%99-dies-in-florida-legislature/#comments Tue, 31 Jan 2012 16:30:32 +0000 Physicians News http://www.physiciansnews.com/?p=4579 approved legislation that would expand the state’s requirement that certain providers post the out-of-pocket prices of common health care services, a state Senate committee shot down a similar measure after an aggressive lobbying push by health care provider groups. Organizations representing the state’s doctors weren’t wild about the idea that certain facilities would have to display bulletin-board sized postings of their prices. Jeff Scott, general counsel for the Florida Medical Association, said that providers are all for transparency, but they don’t need the government telling them exactly how they should do it. “Next thing you know they’re going to say it has to be neon or include pictures,” he said. But providers’ most strenuous objections were to provisions in the legislation that would require providers to disclose prices to out-of-network patients and limit so-called balance billing, which happens in health care settings when providers bill patients the difference between what they charge for a service and what insurers pay it. Meanwhile, the state already requires urgent care centers to post in their reception area the prices of their 50 most frequently used services, and the posting must be at least 15 square feet.  Physicians are not required to do so, but they must follow the same rules if they post prices voluntarily. Under the proposed legislation, ambulatory care centers and diagnostic-imaging centers would have had to follow the same rules as urgent care centers, and the original bills also would have expanded the requirement to physicians. The House committee-approved bill softened this language to maintain the voluntary status quo for doctors. Both bills would have required physicians to provide patients with a written statement of prices at each visit. Richard Polangin, health care policy coordinator for the Florida Public Interest Research Group, said the legislation would have been a boon for consumers, many of whom are unaware that prices can vary among doctors and facilities. The bills would “enable persons who must pay for doctor visits, diagnostic images such as CT scans and MRIs, and for care at ambulatory surgery centers, to know the cost in advance,” he said. “The uninsured and persons with insurance deductibles would be able to make more informed health care decisions.” Insurers and business groups also supported the legislation. And, though the measure’s future is uncertain, at least one person involved in the lobbying effort said work would continue. ### This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.]]> http://www.physiciansnews.com/2012/01/31/dream-of-a-medical-%e2%80%98price-list%e2%80%99-dies-in-florida-legislature/feed/ 0 Twins Born in Different Years: What About Insurance? http://www.physiciansnews.com/2012/01/04/twins-born-in-different-years-what-about-insurance/ http://www.physiciansnews.com/2012/01/04/twins-born-in-different-years-what-about-insurance/#comments Wed, 04 Jan 2012 21:02:55 +0000 Physicians News http://www.physiciansnews.com/?p=4525 By Sarah Barr By the time newborn Freya Humenny joined her twin brother Beckett this past weekend, the calendar already had turned from 2011 to 2012. That means the twins always will have their own birthdays—but will they share an insurance statement? The twin’s mother, Stephanie Peterson, gave birth to Beckett at 6:40 p.m. on Dec. 31, 2011,  at the Hennepin County Medical Center in Minneapolis, but Freya did not follow until 12:26 a.m on Jan. 1. And so after we ooh-ed and ahh-ed over the adorable pair, we had to ask: What could a case like this mean for a family’s insurance? Paul Fronstin, director of the health research and education program at the Employee Benefit Research Institute, said that every case would vary based on the terms of a family’s policy. But, as an example, if a family had a high-deductible private insurance plan, a number of factors would be in play, according to Fronstin. For one, there is the question of the family’s deductible.  Lots of prenatal services are covered as preventive care, but some are not.  If the family had not yet met their 2011 deductible, then the first of the births would be applied to that year’s deductible, while the second could apply to the next year. There’s also the question of whether the second birth would even be considered an expense for the new year or whether it would be tied to the mother’s original admission. And as for the twins themselves, the second child’s expenses likely would be billed as new year expenses, but services for the first child, such as nights spent in a nursery, could span the two years—raising another set of questions about how to bill. Fronstin said that while a hypothetical case brings up a number of questions, an insurer’s response won’t necessarily be complicated. “It could be as simple as it was so close to midnight that it doesn’t really matter,” he said. Recommence the oohs and ahhs. ### This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.]]> http://www.physiciansnews.com/2012/01/04/twins-born-in-different-years-what-about-insurance/feed/ 0 Fox Chase Cancer Center Merges with Temple University http://www.physiciansnews.com/2011/12/17/fox-chase-cancer-center-merges-with-temple-university/ http://www.physiciansnews.com/2011/12/17/fox-chase-cancer-center-merges-with-temple-university/#comments Sat, 17 Dec 2011 16:05:33 +0000 Physicians News http://www.physiciansnews.com/?p=4493 Temple University Health System and Fox Chase Cancer Center this week signed an Affiliation Agreement that moves both institutions closer to bringing Fox Chase Cancer Center into the Temple family – marking a major milestone for two celebrated Philadelphia institutions that will enhance cancer research and patient care in the region, both immediately and for years to come. "Temple is proud and privileged to welcome Fox Chase Cancer Center into its family of academic researchers and clinicians," said Ann Weaver Hart, PhD, President of Temple University. "This bold, visionary relationship immediately establishes Temple's position as a leader in cancer care and translational research at the local, regional and national levels," said Larry R. Kaiser, MD, FACS, Senior Executive Vice President for Health Sciences of Temple University, Dean of Temple University School of Medicine, and President and CEO of Temple University Health System. "It sets the stage for many exciting opportunities to grow and enhance the cancer-related patient-care, research and educational programs of Temple’s healthcare enterprise. "The pursuit of excellence is the driving force for today's action – which offers a preview of what tomorrow represents. Indeed, this affiliation marks a fresh direction in cancer research and treatment in Philadelphia," continued Dr. Kaiser. "Sustained by the converging action of two highly respected medical institutions, it will draw on both established knowledge and original insights to pave the way for what all cancer patients and their families want and deserve – hope." "Fox Chase is proud to be the professional home to some of the most talented and compassionate scientists, doctors, and nurses working on the cancer problem anywhere in the world," said Michael V. Seiden, MD, PhD, President and CEO of Fox Chase Cancer Center. "But we're always working to strengthen the Center's ability to more vigorously pursue our mission to prevail over cancer, and we believe that this affiliation with Temple University Health System will do just that, enabling us to begin recruiting new researchers and clinicians almost immediately and to expand our clinical services significantly in coming years to serve the region's cancer-care needs well into the future."   Fox Chase Cancer Center is one of only two National Cancer Institute (NCI)-designated comprehensive cancer centers in Philadelphia, and one of only 40 in the U.S. Its addition to Temple creates collaborative synergies between and among physician-scientists at Temple University School of Medicine, Fox Chase Cancer Center, and Temple Cancer Center that will accelerate the pace of further discovery and development of the most effective approaches to cancer prevention, diagnosis, and treatment. By becoming an affiliate of Temple University Health System, Fox Chase will be able to significantly expand its outpatient and surgical-care services – within its existing facilities and through the use of leased space in Jeanes Hospital, an affiliate of Temple University Health System since 1996. Given the geographic proximity of Fox Chase to Jeanes Hospital (home to TUH's highly-regarded Bone Marrow Transplant Program), a natural byproduct of the agreement is the creation of a contiguous, 47.5-acre site to serve as Temple's "cancer hub" for the development of future innovations in cancer-care and research. The affiliation also gives Jeanes Hospital the opportunity to meet the associated health care needs of cancer patients by providing a broad array of services on its premises in areas such as outpatient diagnostic testing, interventional radiology, breast care, general surgery, thoracic surgery, endocrine surgery, urology and diagnostic GI. Temple University Health System will invest in cancer research at Fox Chase – providing new resources to recruit additional physician-scientists who will further advance the collaborative efforts of Temple and Fox Chase researchers in creating new knowledge and pathways for the prevention, treatment, and, ultimately, cures for cancer and cancer-related conditions. "The affiliation of Fox Chase Cancer Center with Temple University Health System signifies an important step in the transformation of Temple’s healthcare enterprise," said Jane Scaccetti, Chair of Temple University Health System's Board and a Temple University Trustee. "The combined strength of both highly regarded institutions will fuel innovations in cancer research and patient care," added Patrick J. O'Connor, Esq., Chair of the Board of Trustees of Temple University. "We at Fox Chase Cancer Center have long understood the potential value of joining forces with Temple University Health System, particularly with Jeanes Hospital as our immediate neighbor," said David G. Marshall, Chair of the Board of Directors of Fox Chase Cancer Center. "Thanks to the committed leadership of Dr. Michael Seiden and Dr. Larry Kaiser, we're proud to announce today an affiliation agreement that will meet Fox Chase's growth needs for the foreseeable future while bringing a National Cancer Institute-designated comprehensive cancer center into Temple's vibrant academic medical community." Finally, the affiliation will bring efficiencies and savings, as economies-of-scale are recognized and leveraged across TUHS, Fox Chase Cancer Center, and Jeanes Hospital. The ability to demonstrate collaborative efficiencies is particularly important in a time when the ability to demonstrate both excellence and value matters more than ever before… to patients, payors, and grant-funding agencies. Temple's newly-consolidated cancer hub will serve as a vital source of discovery, development, and delivery of the most effective approaches to cancer prevention, diagnosis, and treatment that will give patients the best of both worlds: access to the comprehensive treatments and innovative clinical-trials available at both Temple Cancer Center and Fox Chase Cancer Center. Fold in the full array of academic and clinical expertise of Temple University School of Medicine faculty, and the most advanced diagnostic and therapeutic technologies available at Temple University Hospital, and it becomes clear that this affiliation will benefit all cancer patients and their families throughout the Delaware Valley… and beyond.
]]> http://www.physiciansnews.com/2011/12/17/fox-chase-cancer-center-merges-with-temple-university/feed/ 0 Physicians Pessimistic on Benefits of Health Care Reform http://www.physiciansnews.com/2011/12/13/physicians-pessimistic-on-benefits-of-health-care-reform/ http://www.physiciansnews.com/2011/12/13/physicians-pessimistic-on-benefits-of-health-care-reform/#comments Tue, 13 Dec 2011 15:47:24 +0000 Physicians News http://www.physiciansnews.com/?p=4488 A new Deloitte study reveals physicians are skeptical about core promises associated with the Patient Protection and Affordable Care Act.  Only 27 percent of physicians surveyed believe the PPACA is likely to reduce costs by increasing efficiency, and only 33 percent feel it is likely to decrease disparities.  Moreover, half say access to health care will decrease because of hospital closures that result from the law. The report, “Physician Perspectives about Health Care Reform and the Future of the Medical Profession,” also shows that the majority of doctors (73 percent) are not excited about the future of medicine and believe (69 percent) the “best and brightest” who might consider a career in medicine will think otherwise. “The data confirms that physicians are resistant to reform and are frustrated with the direction of the profession,” says Paul Keckley, Ph.D., executive director of the Deloitte Center for Health Solutions and lead author of the report.  “Understanding the view of the physician is fundamental to any attempt to change the health care model – this is the person prescribing the medicine, ordering the test and performing the surgery." The negativity is driven in part by concern over the pressure primary doctors will face from millions of newly-insured consumers seeking care and the reverberations this sudden impact could create on the larger system. Another stumbling block for physicians is the view that reform will mean a loss of autonomy and more costs and administrative burdens in adopting processes and technologies.  For decades this sense of autonomy has been sacrosanct to the profession, and it’s difficult to uproot that overnight, continues Keckley. “Effective reform has to consider the physician’s view as a starting point,” says Keckley.  “We not only have to design the right model, but we have to create the right incentives and processes for implementing that model.  The concept of change management is just as important for doctors in the health care system as it is for employees in a corporation.” Additional key findings from the study include:
  • Nearly three-quarters of respondents think that emergency rooms could get overwhelmed if primary care physician appointments are full as a result of the Patient Protection and Affordable Care Act.
  • More than 80 percent believe it is likely that wait times for primary care appointments will increase because of a lack of providers.  More than half indicate that other medical professionals (physician assistants, nurse practitioners) will deliver primary care both independently and as an adjunct to physician services.
  • Surgical specialists (57 percent) are much more likely to support the law’s repeal compared to primary-care providers (38 percent) and non-surgical specialists (34 percent).  They are also more likely to say the legislation is a step in the wrong direction and believe their net income will decrease as a result of reform.
  • There is a disparity among generations, as 59 percent of physicians 50 to 59 years old feel PPACA is a step in the wrong direction while only 36 percent of those ages 25 to 39 share this sentiment. Younger physicians (ages 25 to 39) are also more likely than older doctors (ages 40 to 59) to think the transition to evidence-based medicine will improve care.
For more information about Physician Perspectives about Health Care Reform and the Future of the Medical Profession, visit www.deloitte.com/us/physiciansurvey.]]> http://www.physiciansnews.com/2011/12/13/physicians-pessimistic-on-benefits-of-health-care-reform/feed/ 0 Five Issues To Impact Docs in 2012 http://www.physiciansnews.com/2011/12/08/five-issues-to-impact-docs-in-2012/ http://www.physiciansnews.com/2011/12/08/five-issues-to-impact-docs-in-2012/#comments Thu, 08 Dec 2011 15:40:50 +0000 Physicians News http://www.physiciansnews.com/?p=4473 As the New Year approaches and the future of health reform hangs in the balance, The Physicians Foundation – a nonprofit organization that seeks to advance the work of practicing physicians and improve the quality of healthcare for all Americans – has identified five key areas that will impact the practice of medicine in the year ahead. The Physicians Watch List for 2012 is based on research the Foundation released earlier this year, including the 2010 Health Reform Research Study and 2011 Roadmap for Physicians to Healthcare Reform Paper.

  1. Changing nature of medical practices. Many physicians are choosing hospital and group settings versus private practice due to the perceived security employed settings offer. Only one quarter of physicians surveyed said they plan to continue practicing as they are; half said they would adopt a style of practice different from the traditional full-time independent private practice model. In 2012, physicians will need to carefully assess their individual circumstances and determine the practice configuration that best meets their needs and those of their patients.
  2.  Decreased return on increased burden. The added regulations and administrative responsibilities based on the Patient Protection and Affordable Care Act (PPACA) have caused physicians to focus less on the patient and more on administrating their practices. Sixty-three percent of physicians surveyed said that non-clinical paperwork has caused them to spend less time with their patients and 94 percent said time they devote to non-clinical paperwork in the last three years has increased. In 2012, physicians will need to vigilantly monitor their administrative burdens and take steps to minimize any further impact on their relationship with patients.
  3. Acute shortages of primary care physicians. A growing shortage of physicians threatens the medical profession’s ability to serve patients across key specialties and geographies. Physicians will need to redefine their roles and rethink delivery models in order to meet rising demand. The majority of physicians (60 percent) said health reform will compel them to close or significantly limit their practices to certain categories of patients. Of these, 93 percent said they will close or significantly limit their practices to Medicaid patients and 87 percent said they would close or significantly restrict their practices to Medicare patients. In 2012, physicians will need to evaluate how they can optimize their time to accommodate the current and future needs of their patients.
  4. Critical need for physician leadership tools / skills. In the healthcare environment of tomorrow, many physicians will assume greater business and people management responsibilities within practice groups and hospital settings.  In 2012, physicians will need to acquire new types of non-medical leadership skills to be effective in these expanded roles, while still maintaining their trusted relationships with patients.
  5. Impact on patients. The need to provide higher quality in an environment characterized by increased reporting, problematic reimbursement and high potential liability, will place extraordinary stress on physicians, particularly those in private practice. Only one physician in ten believes that health reform will enhance the quality of care they are able to provide to their patients, compared to 56 percent who believe reform will diminish the quality of care they are able to provide.  In 2012, physicians will increasingly need to balance these competing factors in ways that do not compromise the care they provide to patients.

“Proposed changes to our healthcare system have already significantly impacted physicians and patients,” said Lou Goodman, Ph.D., president of The Physicians Foundation and chief executive officer of the Texas Medical Association. “We hope the physician watch list helps to address the core issues under the new legislation and offers doctors and the healthcare community guidance on how to deliver the best care possible to patients in 2012.”

]]> http://www.physiciansnews.com/2011/12/08/five-issues-to-impact-docs-in-2012/feed/ 2 Both Patients And Physicians Can Suffer When Test Results Aren’t Reported http://www.physiciansnews.com/2011/11/29/both-patients-and-physicians-can-suffer-when-test-results-aren%e2%80%99t-reported/ http://www.physiciansnews.com/2011/11/29/both-patients-and-physicians-can-suffer-when-test-results-aren%e2%80%99t-reported/#comments Tue, 29 Nov 2011 16:01:38 +0000 Physicians News http://www.physiciansnews.com/?p=4438 Medical tests can reveal critical information about a person's health, but only if the results are communicated to clinicians and patients. Sometimes, the ball gets dropped somewhere between the lab or the radiology department and the clinician who ordered the test and the patient. In Peggy Kidwell's case, a mix-up over doctors' names led to a year-long delay in a breast cancer diagnosis.

After her annual gynecological exam and mammogram several years ago at a medical center near her Virginia Beach home, she got a letter from her doctor saying the results of her Pap test were normal. She assumed that she would hear from her doctor if anything untoward showed up on her mammogram exam and thought no more about it.

A year later, when Kidwell went back for her annual exam at age 59, her doctor, finding no mammogram results in her chart, asked why she hadn't gotten a screening exam the previous year. When Kidwell said she had, the doctor investigated. Five hours later, the doctor called Kidwell to tell her she had found the results and it looked as though she had breast cancer.The test results had been sent to an orthopedic surgeon at the medical center who had the same last name as Kidwell's gynecologist. The folder had been sitting on his desk for a year, according to her gynecologist. By that time her cancer had spread to her chest wall. Kidwell had a lumpectomy, chemotherapy and radiation. The following year, the cancer came back and Kidwell had a mastectomy. She filed a lawsuit and eventually settled the case. (A confidentiality agreement prohibits her from discussing specifics.) No one, she says, ever said that an earlier diagnosis might have made a difference in the course of her disease, but she believes it may have. Kidwell, who now lives in Silver Spring, blames the medical system for the mix-up, but also herself. "To this day, I don't let myself off the hook for not picking up the phone," she says. Financial Consequences There are also financial consequences for providers when tests aren't promptly reported: A recent study in the Journal of the American College of Radiology found that annual medical malpractice payouts for communication breakdowns, including failing to share test results, more than quadrupled nationally between 1991 and 2010, to million. For patients, the missteps and mistakes can be life-altering. Patient follow-up could make a difference in many instances. The study examined medical malpractice claims from 425 hospitals and 52,000 providers. Of the 306 cases in which test results were specifically cited as a factor in a malpractice case, the most common problem — it occurred almost half the time — was that the patient didn't receive the test results, cited in 143 cases. The second-most-common problem was that the clinician didn't receive the results, cited in 110 cases. Other problems included delays and slow turnaround in reporting findings and test results that were filed before the clinician reviewed them. The study examined a different database as well, the National Practitioner Data Bank, to arrive at a dollar value for malpractice claims payouts related to communications problems, examining categories that would include getting test result information to practitioners and patients alike, for the period from 1991 to 2010. That analysis showed that payouts increased from million to million during that time, a more than four-fold increase. Patient advocates and policy experts say the push for better coordination of patient care, including the adoption of electronic medical records, should help improve the delivery of test results to patients from doctors and to doctors from those who perform the tests. "Health reform and payment reform are moving us toward integrating care to a degree that we don't do right now," says Diane Pinakiewicz, president of the National Patient Safety Foundation, a Boston-based consumer group. "The one constant is the patient. The best chance is for the patient to be part of the process." A Multilayered Approach Patient involvement is important, but the burden of following up on test results shouldn't fall on their shoulders, experts agree. But doctors need a helping hand. In a given week, a primary-care doctor might need to review 360 chemistry test results, 460 hematology results, 12 pathology reports and 40 radiology reports, according to researchers at Partners HealthCare system in Boston. More than half of physicians surveyed some years ago said they weren't satisfied with the way they handled test results, which typically took more than an hour each day. Now many practices affiliated with Partners use a multilayered system that helps them manage test results. The Web-based system lets them log in and see all the tests they've ordered and the results that have come in, with those that are problematic listed first. If a test result requires urgent attention, the system generates an e-mail alerting doctors; if they ignore this warning and subsequent messages, the system alerts the practice manager, who contacts the physician directly. The system also generates letters that notify patients of their test results and has a tickler function that can alert doctors when patients haven't had follow-up tests as ordered. Even so, "nothing is foolproof," says Eric Poon, director of clinical informatics at Brigham and Women's Hospital, part of the Partners system. "No news is not good news," he says. "If a patient gets a test done and doesn't get a result, he should follow up." ### This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente. ]]> http://www.physiciansnews.com/2011/11/29/both-patients-and-physicians-can-suffer-when-test-results-aren%e2%80%99t-reported/feed/ 1 Win ,000: Essay Contest Challenges Docs To Offer Solutions To Healthcare Costs http://www.physiciansnews.com/2011/10/27/win-1000-essay-contest-challenges-docs-to-offer-solutions-to-healthcare-costs/ http://www.physiciansnews.com/2011/10/27/win-1000-essay-contest-challenges-docs-to-offer-solutions-to-healthcare-costs/#comments Thu, 27 Oct 2011 13:00:54 +0000 Physicians News http://www.physiciansnews.com/?p=4350 Costs of Care, a physician-run nonprofit based in Boston, has launched its second annual national healthcare essay contest, with the goal of expanding the public discourse on the role of doctors, nurses, and other care providers in controlling healthcare costs. Executive Director Neel Shah, who is also a third-year obstetrics and gynecology resident at the Harvard Medical School, founded Costs of Care after he began thinking, as a med student, that physicians had a good deal of power over healthcare costs but rarely thought about them. "There's a lot of talk about insurers and patients, but at the end of the day doctors decide what's on the bill," he told the LA Times. Last year, Costs of Care launched an innovative essay contest that emphasized the importance of price transparency in everyday medicine by gathering more than 100 personal stories from patients, nurses, and doctors across the nation. A vascular surgeon in Arizona, for example, wrote about a time a hospital assigned an out-of-network anesthesiologist to a surgery, sending a patient's bill skyrocketing, according to the LA Times. "There was no mechanism to make sure all of the providers a patient uses were in network," Shah said.  "That's a simple check." This year, Costs of Care is looking for more stories, and will award 00 prizes for stories about the importance of price transparency as well as solution-oriented stories that illustrate ways to reduce harmful healthcare spending and save patients’ money. As the economy struggles to recover, the spiraling costs of healthcare in the United States have become a contentious political focal point without an obvious solution. Traditionally, health care providers have been reluctant to discuss their own role in healthcare spending. However, Dr. Shah, “Ultimately, no amount of regulating, reorganizing, or otherwise reforming the healthcare system will successfully contain costs unless healthcare providers are invested in fixing the problem.” To help mobilize healthcare providers to examine their own role in spending, Costs of Care is launching an essay contest that will collect and widely disseminate stories from the front lines of medicine. Costs of Care will award 00 in prizes to top submissions. Two 00 prizes will be reserved for patients, and two 00 prizes will be reserved for care providers. Preference will be given to stories that best demonstrate the importance of cost-awareness in medicine. Examples may include a time a patient tried to find out what a test or treatment would cost but was unable to do so, a time that caring for a patient generated an unexpectedly a high medical bill, or a time a patient and care provider figured out a way to save money while still delivering high-value care. To help select the winning entries, Costs of Care has partnered with five health luminaries who will serve as judges:
  • Peter Orzsag, former Director of the White House Office of Management and Budget
  • Dr. C. Everett Koop, former United States Surgeon General
  • Hon. Jennifer Granholm, former Governor of Michigan
  • Dr. Susan Love, women’s health and cancer research advocate
  • Dr. Alan Garber, health economist and Harvard University Provost
All submissions will be due on November 15th, 2011. Finalists will be announced on December 15th, 2011 and the ,000 prize winners will be announced on January 15th, 2012. All qualifying submissions will be published biweekly at http://www.costsofcare.org during the 2012 calendar year.  ]]> http://www.physiciansnews.com/2011/10/27/win-1000-essay-contest-challenges-docs-to-offer-solutions-to-healthcare-costs/feed/ 0 ER Docs Focus On Medical Liability Reforms http://www.physiciansnews.com/2011/12/13/physicians-pessimistic-on-benefits-of-health-care-reform/ http://www.physiciansnews.com/2011/12/13/physicians-pessimistic-on-benefits-of-health-care-reform/#comments Tue, 13 Dec 2011 15:47:24 +0000 Physicians News http://www.physiciansnews.com/?p=4488 A new Deloitte study reveals physicians are skeptical about core promises associated with the Patient Protection and Affordable Care Act.  Only 27 percent of physicians surveyed believe the PPACA is likely to reduce costs by increasing efficiency, and only 33 percent feel it is likely to decrease disparities.  Moreover, half say access to health care will decrease because of hospital closures that result from the law. The report, “Physician Perspectives about Health Care Reform and the Future of the Medical Profession,” also shows that the majority of doctors (73 percent) are not excited about the future of medicine and believe (69 percent) the “best and brightest” who might consider a career in medicine will think otherwise. “The data confirms that physicians are resistant to reform and are frustrated with the direction of the profession,” says Paul Keckley, Ph.D., executive director of the Deloitte Center for Health Solutions and lead author of the report.  “Understanding the view of the physician is fundamental to any attempt to change the health care model – this is the person prescribing the medicine, ordering the test and performing the surgery." The negativity is driven in part by concern over the pressure primary doctors will face from millions of newly-insured consumers seeking care and the reverberations this sudden impact could create on the larger system. Another stumbling block for physicians is the view that reform will mean a loss of autonomy and more costs and administrative burdens in adopting processes and technologies.  For decades this sense of autonomy has been sacrosanct to the profession, and it’s difficult to uproot that overnight, continues Keckley. “Effective reform has to consider the physician’s view as a starting point,” says Keckley.  “We not only have to design the right model, but we have to create the right incentives and processes for implementing that model.  The concept of change management is just as important for doctors in the health care system as it is for employees in a corporation.” Additional key findings from the study include:
  • Nearly three-quarters of respondents think that emergency rooms could get overwhelmed if primary care physician appointments are full as a result of the Patient Protection and Affordable Care Act.
  • More than 80 percent believe it is likely that wait times for primary care appointments will increase because of a lack of providers.  More than half indicate that other medical professionals (physician assistants, nurse practitioners) will deliver primary care both independently and as an adjunct to physician services.
  • Surgical specialists (57 percent) are much more likely to support the law’s repeal compared to primary-care providers (38 percent) and non-surgical specialists (34 percent).  They are also more likely to say the legislation is a step in the wrong direction and believe their net income will decrease as a result of reform.
  • There is a disparity among generations, as 59 percent of physicians 50 to 59 years old feel PPACA is a step in the wrong direction while only 36 percent of those ages 25 to 39 share this sentiment. Younger physicians (ages 25 to 39) are also more likely than older doctors (ages 40 to 59) to think the transition to evidence-based medicine will improve care.
For more information about Physician Perspectives about Health Care Reform and the Future of the Medical Profession, visit www.deloitte.com/us/physiciansurvey.]]> http://www.physiciansnews.com/2011/12/13/physicians-pessimistic-on-benefits-of-health-care-reform/feed/ 0 Physicians News » News Briefs http://www.physiciansnews.com Tue, 07 Feb 2012 16:44:06 +0000 en hourly 1 http://wordpress.org/?v=3.2.1 Experts Divided Over Recommendation To Screen Children For Cholesterol http://www.physiciansnews.com/2012/02/07/experts-divided-over-recommendation-to-screen-children-for-cholesterol/ http://www.physiciansnews.com/2012/02/07/experts-divided-over-recommendation-to-screen-children-for-cholesterol/#comments Tue, 07 Feb 2012 16:15:56 +0000 Physicians News http://www.physiciansnews.com/?p=4592 One in 500 kids has an inherited disorder that causes high levels of LDL ("bad") cholesterol that may require medication to control. However, since the problem doesn't create observable symptoms, as many as half of these kids don't know they have the condition. To help identify these children, late last year an expert panel convened by the National Heart, Lung, and Blood Institute recommended that all children be screened for high cholesterol, once between the ages of 9 and 11 and again between ages 17 and 21. Reaction to the guidelines, which were included as part of a larger NHLBI report on improving cardiovascular health in children and adolescents, has been mixed. Some clinicians and researchers say universal screening is an important tool not only to help identify children who are genetically predisposed to high cholesterol, a condition called familial hypercholesterolemia, but also to pinpoint others who could benefit from treatment, including those with high LDL related to being overweight or obese. Working with these kids to eat more healthfully and to exercise more may reduce the cumulative negative effect of high cholesterol on their cardiovascular systems and lead to fewer heart attacks and strokes later in life, the experts say. Others, including clinicians who authored a pair of articles in the Journal of the American Medical Association last month, express concerns that screening may do more harm than good. To identify the relatively small number of kids who really need medical treatment, doctors cast a wide and expensive net that identifies many children as at risk who will never develop  premature cardiovascular disease, says Matthew Gillman, director of the obesity prevention program at Harvard Medical School, who co-authored one of the articles. Some of those children will probably be needlessly put on cholesterol-lowering medications, he says. The U.S. Preventive Services Task Force, an independent group of primary-care providers that evaluates the evidence for clinical care, concluded in 2007 that there isn't enough evidence to recommend for or against routine lipid screening in children and adolescents. Research has shown that 10 to 13 percent of children have elevated cholesterol levels. Treatment for the vast majority should focus on lifestyle interventions, says Stephen Daniels, chairman of the Department of Pediatrics at the University of Colorado School of Medicine, who led the NHLBI panel. A much smaller number of those children, the ones with a genetic predisposition to high cholesterol, may need to take a statin, he says. Until the new guidelines were released, the American Academy of Pediatrics recommended cholesterol screening in children primarily based on family history. If a child had a father who had heart disease or a heart attack before age 55, for example, screening would be indicated. Children who had risk factors such as obesity or diabetes were also candidates for screening. The AAP has since endorsed the new NHLBI guidelines. "Family history doesn't really catch everybody" with familial hypercholesterolemia, says Sarah de Ferranti, a member of the AAP committee on nutrition and the director of preventive cardiology at Children's Hospital Boston. In addition, she says, "Anecdotally, I can tell you that when someone comes to my office and they know they have high cholesterol values, they're much more focused." That's the case with the McFeeley family. Bill and Carolyn McFeeley, of Mullica Hill, N.J., had always considered themselves very healthy - until Bill had a heart attack two years ago at age 47. The pediatrician for their three children checked the kids' cholesterol and found that while levels for the two girls - Chelsea, now 17, and Chandler, 13 - were normal, Chase, 10, had slightly higher values: His total cholesterol was roughly 210. (In general, anything over 200 is considered high.)
The McFeeley family, from left to right: Chandler, Carolyn, Chase, Bill, and Chelsea.
Now Chase has replaced his beloved egg salad sandwiches with turkey and fat-free cheese ones. "If we can get ahead of it and keep Chase healthy, it means a lot to us," says Bill. Julie Brothers, medical director of the lipid heart clinic at Children's Hospital of Philadelphia, sees Chase once a year now and says she hopes they can manage his cholesterol without medication. "None of us wants to slap medication on anyone," she says. Maybe not. "But if you're going to test every child, it's a sure bet you're going to be medicating more kids," says H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, who has written extensively on the problems created by aggressive screening. Research on the safety and effectiveness of statins in children is scant; studies that have looked at statin use haven't enrolled more than a few hundred kids, and none has followed them for more than two years, say experts. "We don't know what taking a 10- to 11-year-old kid and putting them on statins long term will do," says Frederick Rivara, division chief of general pediatrics at Seattle Children's Hospital and co-author of one of the JAMA articles. Gillman says that while early intervention to prevent heart disease is critical, screening all children may not be the best way to do it. As an example, he cites a study that he co-authored last year examining the cost-effectiveness of blood pressure screening in adolescents. "The bottom line of that study is that population approaches like taking the salt out of food are more effective and less costly than any screening program," he says. ### This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kai