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Saturday, January 1, 2011

Top Health News 2010

2010 was an eventful year for health-related news. Here are some of the biggest stories from my point of view:

            • The Accountable Care Act was signed into law March 23, 2010.  The most significant piece of health legislation since Medicare, the law is projected to expand health insurance coverage to 32 million who are currently uninsured. It aims to achieve this through the creation of state-based health benefit exchanges for individuals and small businesses that promote competition amongst health insurance plans, and through an expansion of Medicaid.  The act will penalize those who do not purchase coverage, it aims to end denials based on pre-existing conditions, and will allow children to be covered under their parents policies until age 26. The legality of the individual mandate to purchase insurance has been called into question. 
            • Why the Mayo Clinic is refusing to see Medicare patients.  As Dr. Toni Brayer points out in her blog: Medicare, the government insurance company for everyone over age 65 (and for the disabled) pays fees to primary care physicians that guarantee bankruptcy.  Additionally, 70% of hospitals in the United States lose money on Medicare patients. That’s right, for every patient over age 65, it costs the hospital more to deliver care than the government reimburses.”  This problem can only be expected to worsen as Medicare tightens its belt.  The “SGR,” a formula that determines Medicare’s reimbursement rates to physicians, will decrease physician reimbursement by as much as 40 percent in years to come.  A permanent fix to the SGR has been delayed multiple times.  However, the reality is that a permanent fix is needed lest more health care providers will drop Medicare.  
            • Final meaningful use criteria published in July 2010. Beginning in 2011 Medicare and Medicaid will provide significant financial incentives for qualified health providers to adopt and use electronic health records. The final criteria for “meaningful use” qualification were released this year and are discussed in the New England Journal of Medicine by David Blumenthal.  
            • Dabigatran gets FDA approval for treatment of non-valvular atrial fibrillation as an alternative to warfarin. For years warfarin has been the sole option for management of conditions that cause  increased morbidity and mortality related to their clotting risk. A new generation of anticoagulants has emerged and appears to offer multiple advantages over warfarin. 
            • Transcatheter aortic valve replacement is superior to medical therapy for inoperable aortic stenosis. The year’s most important cardiology news,  percutaneous, transcatheter replacement of aortic valves is a new option for high risk patients who are unable to tolerate open-heart surgery. 
            • Early detection of Alzheimer’s Disease. The advent of a new biomarker test that is able to predict, with 100 percent accuracy, asymptomatic individuals who will develop Alzheimer’s Disease. This test has the potential to accurately identify millions of individuals who are at future risk and could be important to the future development of targeted therapeutics. However, widespread use of the test will bring up ethical and cost related dilemmas. 
            • The AMA publishes guidelines for the ethical use of social media by physicians.  Millions use Facebook, Twitter and blogs  to network and transmit information. This year the AMA set forth a policy to help guide the professionalism of physician-users of social media and safeguard the doctor-patient relationship. 
            • The Institute of Medicine questions the practice of high dose vitamin D supplementation.   Vitamin D mania hit the clinics several years back with the finding that a majority of Americans are deficient, and that those with higher levels do better with respect to a number of important health outcomes. However, recently the Institute of Medicine curbed the current enthusiasm for prescribing high dose vitamin D supplementation, citing a paucity of high quality data supporting the safety of this practice. 
            • Lung CT for early detection of lung cancer in high risk patients reduces lung cancer mortality.  Lung cancer continues to be the most common cause of cancer related death in Americans.  A new screening test demonstrates effectiveness in the early detection of lung cancer in those at high risk.  
            • The mammography debate continues.  In November of 2009 the U.S. Preventive Services Task Force revised its mammography recommendations, no longer recommending annual mammography for women ages 40 to 50.  This recommendation made on the eve of health reform, which contradicted the guidelines of other prominent medical societies, sent many into a furor over the appropriate role of “panels,” seen as government-sponsored, in guiding medical decision-making.

              The politics of prevention and screening are likely to continue to make big news in 2011. This year for the first time Medicare will begin to cover an annual wellness exam.  Just last week we learned that a discussion of end-of-life, advance directives would be reimbursed as an element of the annual physical for seniors.  This announcement has rekindled the “death panel” debate.

              The appropriate role and political agendas of expert panels that set policy and guide medical decision-making and reimbursement are likely to continue to stir controversy, particularly as Medicare administrators begin the attempt to rein in cost, while all the while attempting to avoid the accusation of rationing health care.