House Republican aims to repeal Medicare doctor pay cuts

U.S. House Speaker John Boehner (R-OH) (R) listens to Rep. Eric Cantor (R-VA) (L) during a news conference at the U.S. Capitol in Washington, December 22, 2011.

Credit: Reuters/Jonathan Ernst

WASHINGTON | Wed Feb 13, 2013 2:59pm EST

WASHINGTON (Reuters) - Republicans in the House of Representatives will seek a permanent solution to scheduled steep cuts in physician payments from the federal Medicare health insurance plan for retirees and disabled people, a House committee chairman said on Wednesday.

Rep. Fred Upton, chairman of the House Energy and Commerce Committee, told doctors he hopes to send so-called "Doc Fix" legislation to the House floor this summer that would repeal payment reductions enacted in 1997 as part of a law to balance the federal budget.

The 16-year-old "sustainable growth rate" (SGR) provision calls for reductions in doctor pay as a way to control spending by Medicare. Congress has prevented the SGR from taking effect through temporary measures, but that has run up the fiscal and political costs of finding a permanent solution.

U.S. Doctors have voiced frustration about uncertainty caused by the persistent threat of steep reductions in Medicare reimbursement for their services. Some have even threatened to stop serving Medicare patients.

Upton said he believes the nonpartisan Congressional Budget Office has opened "a window of opportunity" for change. The budget office recently lowered its cost estimate for a long-term SGR fix to $138 billion, from $245 billion last August, due to lower Medicare spending on physician services.

"It's obviously a very large amount but a smaller mountain to climb," the Michigan Republican said in a speech to the American Medical Association (AMA).

"Our goal is to get it done this year, to actually have it on the House floor before the end of the summer -- July or the first week of August."

Upton said he would seek support from Democrats in the Republican-controlled House to achieve a bipartisan bill that could muster support in the Democratic-run Senate.

He offered no specifics on how his bill would pay for the cost of repealing the SGR.

In the latest episode of the cat-and-mouse game, physicians escaped a 27 percent reduction in Medicare payments scheduled for January 1, 2013, when Congress enacted a one-year $25 billion Doc Fix as part of its fiscal cliff legislation. The measure holds physician payments unchanged.

Upton and other leading Republicans on his panel have released a legislative blueprint that calls for freezing doctor payment rates for 10 years and basing future increases on their willingness to embrace methods to improve the quality and efficiency of care.

A bill introduced this month by House Democrat Allyson Schwartz and Republican Joe Heck would allow four years of payment increases while new payment and delivery models are vigorously tested.

An AMA proposal calls for a similar transition period, during which physicians would be rewarded for participating in new methods of care delivery.

(Reporting by David Morgan; Editing by David Gregorio)

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ACL surgery may not shorten WNBA career

By Kathryn Doyle

NEW YORK | Wed Feb 13, 2013 3:36pm EST

NEW YORK (Reuters Health) - A common knee surgery that can sideline athletes for months does not ultimately affect the career length of women invited to the Women's National Basketball Association (WNBA), according to a new study.

"With appropriate rehabilitation, ACL injuries do not mean an early end to an otherwise promising athletic career," said lead author Dr. Moira McCarthy, an orthopedic surgeon at the Hospital for Special Surgery in New York City.

McCarthy told Reuters Health she was surprised and impressed by just how many women enter the WNBA with a history of knee injury or surgery.

In particular, the anterior cruciate ligament (ACL), which runs through the knee joint and connects the thigh and shin bones, can be damaged during running or pivoting. Women are at higher risk for ACL injuries than men, and that gender divide widens in intense sports like basketball and soccer.

To see whether female athletes with repaired knees suffer long-term career consequences, McCarthy and her colleagues looked at a healthcare database for 500 players entering the WNBA combine, an invitation-only precursor to the draft, from 2000 to 2008.

Fifteen percent of the athletes reported having torn an ACL, compared to less than a tenth of one percent in the general population. Almost all the injured athletes had reconstructive surgery.

No position on the team appeared more likely to suffer damage to the ACL or to the meniscus, another part of the knee joint subject to tearing injuries.

"The meniscus is a shock absorber, a shock transmitter, all the pounding that goes on in a performance athlete can wear that down," Dr. Richard Parker, an Orthopedic surgeon at the Cleveland Clinic in Ohio who wasn't involved in the study, told Reuters Health.

And each ACL injury is different, Parker said. Most people take six or eight months to return to sport, but "We all hear the story about the person who gets back at four months, and the person who doesn't get back at all."

With or without a history of surgery at these locations, the average WNBA career lasts between three and four years.

McCarthy's team also found that neither career length nor the round in which an athlete was drafted were affected by having had knee repairs.

Parker points out that some women with more severe injuries probably could not return to their previous level of play and were not invited to the combine, skewing the results.

But the young athletes who are able to return to form after surgery and are still invited to the combine do just as well in the WNBA as women who never suffered the injury, according to the results published in the American Journal of Sports Medicine.

These are still serious injuries, said Dr. Amanda Weiss Kelly, director of pediatric sports medicine at UH Case Medical Center in Cleveland, but "what this shows you is that at least at the professional level, if you work hard, you can get recruited."

ACL injury is more common in women than in men in every sport, noted Kelly, who was not involved in the new study. This could be due to differences in core strength, joint flexibility, hamstring and quadriceps strength, and the size of the notch in the thigh bone where the ACL connects, she said.

"That is what we saw back then and see now," said Parker, who has been the team doctor for the Cleveland Cavaliers men's basketball team for 13 years, and also tended to the Cleveland Rockers WNBA team until it folded in 2003.

On the women's professional team, seven of the 12 players had one or both ACLs reconstructed, he recalls, compared to just one of the men on the Cavaliers now.

While ACL injury is still a serious problem, things are looking up, according to Parker. "Our rehab techniques are better, prevention exercises are better, surgery is better," he said.

Coaches of girls sports teams invest more in learning about prevention now that they know the risks are higher for women, Kelly said.

Prevention exercises teach girls to jump and land in a way that puts less stress on the ACL, and training to strengthen the hamstrings and quadriceps. The exercises have been effective at reducing the number of injuries on a team, but they aren't a guarantee, according to Parker.

"At the end of the day you can't go out and play a sport at the highest level and be afraid," Parker said. "The only way to 100 percent prevent these injuries is to outlaw basketball."

SOURCE: bit.ly/12M5Zve American Journal of Sports Medicine, online February 1, 2013.

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Horsemeat scandal set to spur tougher EU food tests

500g size boxes of Coop Qualite & Prix Lasagne Verdi Bolognese are seen after purchase from a Coop supermarket in Zurich, February 12, 2013. Coop took the Qualite & Prix Lasagne Verdi Bolognese with beef meat from its French supplier Comigel, produced in Luxembourg, as a precaution in the last days out of their assortment. The Lasagne Verdi Bolognese contains elements of horsemeat, the company said on Wednesday.

Credit: Reuters/Michael Buholzer

By Charlie Dunmore and Adrian Croft

BRUSSELS | Wed Feb 13, 2013 7:50pm EST

BRUSSELS (Reuters) - The European Commission has proposed increased DNA testing of meat products to assess the scale of a scandal involving horsemeat sold as beef that has shocked the public and raised concern over the continent's food supply chains.

"The tests will be on DNA in meat products in all member states," European Union Health Commissioner Tonio Borg told reporters after a ministerial meeting in Brussels to discuss the affair.

The initial one-month testing plan would include premises handling horsemeat to check whether potentially harmful equine medicine residues have entered the food chain, Borg said, with the first results expected by mid-April.

The scandal erupted when tests carried out in Ireland revealed that meat in products labeled as beef was in fact up to 100 percent horsemeat. Operators in at least eight EU countries have since been dragged into the affair, raising fears of a pan-European labeling fraud.

Officials have said no risk to public health from the adulterated foods has been identified at this stage but testing for horse medicine in meat is being undertaken to be sure.

The suspected fraud has caused particular outrage in Britain, where many view the idea of eating horsemeat with distaste, and exposed flaws in food controls.

"This is impacting on the integrity of the food chain, which is a really significant issue for a lot of countries. Now that we know this is a European problem, we need a European solution," Irish farm minister Simon Coveney told reporters before the meeting.

At the urging of ministers, Borg said the Commission would accelerate work on potential changes to EU labeling rules that would force companies to state the country of origin on processed meat products.

Currently the requirement only applies to fresh beef, and is expected to be extended to fresh lamb, pork and poultry from December 2014.

But EU officials have warned privately that the complexity of supply chains would make the requirement almost impossible to implement in practice.

EU and national authorities are still trying to uncover the source of the suspected horsemeat fraud.

"All those countries through which this meat product has passed of course are under suspicion," Borg told a news briefing earlier on Wednesday. "By the countries, I mean the companies in those countries which dealt with this meat product."

He added that it would be unfair at this stage to point the finger at any organization in particular.

NOT JUST HORSE?

On January 15, routine tests by Ireland's Food Safety Authority found horsemeat in frozen beef burgers produced by firms in Ireland and Britain and sold in supermarket chains including Tesco, Britain's biggest retailer.

Concerns grew last week when the British unit of frozen foods group Findus began recalling packets of beef lasagna on advice from its French supplier Comigel, after tests showed up to 100 percent of the meat in them was horse.

The affair has since implicated operators and middlemen in a range of EU countries, from abattoirs in Romania and factories in Luxembourg to traders in Cyprus and food companies in France.

German supermarket chain Real, part of the world's fourth largest retailer Metro, said tests revealed traces of horsemeat in frozen lasagna on Wednesday. Real, which operates more than 300 stores across Europe's largest economy, said it had already removed the ready-meal from its shelves on Friday.

The first evidence that the labeling scandal could go beyond horsemeat also emerged when the upmarket British grocer Waitrose said its testing found that some of its frozen British beef meatballs might contain pork.

The firm, part of the John Lewis Partnership, has withdrawn the product from sale.

Horsemeat is traditionally prized by many consumers in EU countries such as France, Italy and Belgium.

(Additional reporting by Barbara Lewis in Brussels, Maria Golovnina and Victoria Bryan in London, Alexandra Hudson in Berlin; Editing by Mark Heinrich)

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State policies on Medicaid committee disclosure vary

By Andrew M. Seaman

NEW YORK | Wed Feb 13, 2013 4:30pm EST

NEW YORK (Reuters Health) - No standard policy covers whether the state-level Medicaid committee members choosing which drugs and treatments the program pays for should disclose their ties to drug and medical device companies, according to a new report.

Health policy researchers at the University of California, San Francisco, who set out to examine conflict of interest policies for the 47 U.S. states plus the District of Columbia with Medicaid Preferred Drug List committees, found that many have no policy, and in the states that do, rules vary widely.

"The take home message is that there is no such thing as typical. There is no such thing as a uniformed process," said Lisa Bero, the study's lead author.

For Medicaid, the federal- and state-funded insurance program for poor Americans, decisions to pay for drugs are left up to a state committee that's made up of doctors, pharmacists and other healthcare professionals.

The U.S. Centers for Medicare and Medicaid Services, which oversees the federal part of the insurance program, requires that two members of those committees be free of conflicts of interest, but the agency does not define what constitutes a conflict.

That raises concerns over whether committee members with ties to companies may consciously or unconsciously support drugs and products that benefit those relationships, instead of making decisions based on scientific evidence.

Bero and a colleague, who published their findings in JAMA Internal Medicine, searched the states' Medicaid websites to find their policies.

If a state's committee membership policy was not listed on its website, the researchers called or emailed the state Medicaid office.

They were only able to get 27 of the policies. Some state Medicaid offices didn't answer the inquiry, two that did answer said the state had no policy and one state office said the policy is "not in the public domain."

With the 27 state policies they obtained, the researchers compared each against a list of 12 possible disclosure requirements - looking to see whether the policy included, for example, a requirement to disclose any conflicts of interest, or to update disclosure documents on a regular schedule or a ban on ties between members and companies.

Seven of the state policies did not even mention conflicts of interest. Of the remaining 20 policies, five met between two and four of the requirements, 13 met between five and eight requirements and two met nine of them.

Only four of the states - Idaho, Washington, Nevada and Texas - banned committee members from having relationships with companies.

"So if I am a committee member and I have a financial tie with a drug company, I wouldn't be allowed to participate in that discussion. Very few had that type of policy," Bero said.

One state's bureau chief for Medicaid Pharmacy Services quoted in the report told the researchers he didn't worry about conflicts since committee members were not paid to serve on the panel, and "I don't believe that the pharmaceutical industry would pay a committee member an honorarium to be on the committee and attend meetings. That would really be 'over the top.'"

Bero said it's hard to have a "cookie-cutter approach" to the state policies, but that she hoped the federal government would provide some advice on the matter.

"Basically, the medicine people have available to them should be available because they are the safest and most effective medicine for their condition, and not just because it's driven by people's profits motives," Bero said.

Dr. Nirav Shah, commissioner of the New York State Department of Health in Albany, told Reuters Health it's important to note that this does not mean conflicts of interest are happening, but that there is the potential for conflicts of interest.

"We need to do a better job of explaining ourselves, but the public should not be afraid and the public should not be worried," said Shah, who wrote a commentary accompanying the study.

He added that he believes it's hard to make a blanket statement about what type of system states should have, but he agrees that the federal government should issue some guidance.

"We can all do better and work toward greater transparency, and it would be very helpful if we had federal guidance of what we should adhere to because that's a level playing field for everyone," Shah said.

SOURCE: bit.ly/YrGQ23 and bit.ly/12MaHsU JAMA Internal Medicine, online February 11, 2013.

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