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ACPM Headlines 3/27/14
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In this Issue


Top Stories

1.   ACPM priorities fare well in President’s budget

2.    ACPM meets with new AHRQ Administrator

3.    ACPM meets with CDC Injury Center Director

 

ACPM News

4.    ACPM compensation survey reopened

5.    Applications for ACPM health policy rotation now being accepted

6.    Medical Student Section seeking nominations for office

7.    ACPM members invited to join ‘Choosing Wisely’ task force

8.    ACPM joins partner organizations on letter to FDA re: antibiotic resistance

9.    ACPM weighs in on CMS lung cancer screening coverage

 

Policy and Practice

10. FDA proposes updates to nutrition facts labels

11. CMS nixes changes to Medicare drug program

12. Updates from the USPSTF

 

Research and Reports

13. Rapid growth in sales of dangerous liquid nicotine for e-cigarettes

14. Study: alcohol-related vehicle crashes greatly underreported

15. Study finds dramatic increase in opioid prescriptions by emergency rooms

 

Announcements

16. Call for papers: “Advances in Public Health Services and Systems Research”

17. National Public Health Week is April 7-13th

18. Members in the News: Hill, Kamerow, Tilson

 

 

Top Stories

 

1. ACPM PRIORITIES FARE WELL IN PRESIDENT’S BUDGET

 

In direct response to ACPM’s targeted advocacy efforts, President Obama’s FY 2015 budget request provides increased support for two of ACPM’s advocacy priorities, including increased funding for preventive medicine residency (PMR) training programs and expansion of the Centers for Disease Control and Prevention’s (CDC) National Violent Death Reporting System.

 

Funding for PMR training under the health professions training program at the Health Resources and Services Administration (HRSA) is projected to grow from $3.8 million in the President’s budget to $5.1 million in FY15.  The PMR line-item is only one of two programs within the overall health professions budget that was singled out for an increase.

 

Furthermore, President Obama is proposing to provide sufficient funding for the CDC to expand the NVDRS program to all 50 states and the District of Columbia.  This increase to $24 million would build on the FY 2014 appropriation that increased funding for NVDRS to $11 million, which is allowing the system to expand beyond the 18 states currently funded. NVDRS is a state-based surveillance program that identifies the who, what, when, where and how of violent deaths, leading to a more complete picture of the circumstances that lead to such deaths.  Preventive medicine physicians in state government roles and other public health officials use this information to inform and target state violent death prevention programs.

 

ACPM thanks all members who engaged directly in support of ACPM’s advocacy efforts as your voice is instrumental in helping us achieve our goals.  With the limited number of federal dollars available, White House support of ACPM’s advocacy agenda is a major win.

 

2. ACPM MEETS WITH NEW AHRQ ADMINISTRATOR

 

ACPM staff recently met with the new Agency for Healthcare Research and Quality (AHRQ) director, Richard Kronick, MD, to discuss opportunities for ACPM member involvement in the agency’s activities and programs. Opportunities for greater involvement with AHRQ include: additional nominations of ACPM members to the U.S. Preventive Services Task Force, distribution of the AHRQ Pocket Guide to Clinical Preventive Services to Preventive Medicine conference attendees, and further dissemination of AHRQ funding opportunities to ACPM members.

 

ACPM executive director Michael Barry, associate executive director for policy, advocacy, and external affairs Paul Bonta, and policy and practice manager Andrea Lowe represented the College.

 

For more information on AHRQ, please visit: http://www.ahrq.gov/

 

3. ACPM MEETS WITH CDC INJURY CENTER DIRECTOR

 

ACPM staff members Michael Barry, Paul Bonta, and Andrea Lowe met with the new interim director of the Centers for Disease Control and Prevention (CDC) National Center for Injury Prevention and Control (Injury Center), David Sosin, MD, MPH, on March 11th. This meeting served as an opportunity for ACPM to showcase its support for the Injury Center’s program and activities.  ACPM staff discussed its advocacy work for the National Violent Death Reporting System (NVDRS), a recently completed contract developing a child injury risk assessment tool for home visitation programs, and efforts to educate policymakers on the issue of prescription drug overdose.

 

For more information on the CDC Injury Center, please visit: http://www.cdc.gov/Injury/

 

ACPM News

 

4. ACPM COMPENSATION SURVEY REOPENED

 

ACPM's first survey of the preventive medicine community concerning salaries and compensation has been reopened to those who did not submit a response previously. This survey will greatly assist ACPM and the preventive medicine specialty by serving as a resource for medical students and physicians considering a career in preventive medicine. 

 

ACPM's Salary and Compensation Survey shall conform to confidentiality clause D-2 of the Ethics Code of the American Association of Public Opinion Researchers. Additionally, all data will be used in a format that will not display the identity of the individual respondents. That is, the survey responses will not be integrated, analyzed, or reported in any way in which the confidentiality of the survey responses is not protected.

 

We thank those of you who have completed the survey.  If you have not completed the survey, watch for an email from SurveyMonkey, and thank you in advance for participating.

 

5. APPLICATIONS FOR ACPM HEALTH POLICY ROTATION NO BEING ACCEPTED

 

Applications for ACPM’s practicum rotation in health policy and preventive medicine are now being accepted.  The program is intended to give preventive medicine residents an opportunity to participate in preventive medicine policy activities in the nation’s capital.  The activities during each rotation will be tailored to take advantage of ACPM’s national policy focus and the many policy bodies in Washington, DC, including Congress, federal health agencies, and non-governmental health organizations. 

 

To apply, please submit an application form found here along with a current CV and a letter of recommendation from your Residency Program Director to pbonta@acpm.org

 

6. MEDICAL STUDENT SECTION SEEKING NOMINATIONS FOR OFFICE

 

ACPM’s Medical Student Section (MSS) is now accepting nominations for members interested in running for the MSS Governing Council positions. These leaders will represent and serve the community of medical students, and work collaboratively with all member constituencies to enhance the value of membership, all while further developing their leadership skills.

 

For full details and to submit nominations, visit http://www.acpm.org/?mss_elections.
Curricula Vitae (CVs) and Statements of Interest for available positions must be received by Wednesday, April 16 at 5 PM EDT.

 

7. ACPM MEMBERS INVITED TO JOIN ‘CHOOSING WISELY’ TASK FORCE

 

The ACPM Prevention Practice Committee (PPC) is seeking input from members to participate in a task force to develop a set of five recommendations for Choosing Wisely—an initiative of the American Board of Internal Medicine (ABIM) Foundation designed to identify five common tests or procedures in each medical specialty whose necessity should be questioned and discussed.

 

As a result of member-directed input, ACPM’s Board of Regents tasked the PPC—ACPM’s scientific body that develops position statements and evidence-based criteria for College initiatives—to address the Choosing Wisely recommendations for Preventive Medicine.

If you are interested in joining this task force, please contact Andrea Lowe, ACPM Policy and Practice Manager, at alowe@acpm.org.   

 

8. ACPM JOINS PARTNERS ON LETTER TO FDA URGING ACTION TO STEM ANTIBIOTIC RESISTANCE

 

ACPM joined its partner organizations in medicine and public health on a letter to Food and Drug Administration (FDA) chief Margaret Hamburg expressing concern with a proposed rule to amend the Veterinary Feed Directive (VFD).  The VFD governs a veterinarian’s oversight role in the use of certain drugs in animal feed.

 

The letter expressed concern “that several of the proposed changes remove or compromise important public health protections in the existing rule, sometimes without demonstrated benefit.”  Some of the proposed changes addressed in the letter include: removal of the current requirement for a valid veterinarian-client-patient relationship to ensure proper veterinarian oversight of medications used in animals; a decrease in the amount of time that feed mills and veterinarians must maintain records; and submission of data to FDA for analysis and public reporting.

 

For more information please contact Paul Bonta at pbonta@apcm.org.

 

9. ACPM WEIGHS IN ON CMS LUNG CANCER SCREENING COVERAGE

 

ACPM commented on a Centers for Medicare and Medicaid Services (CMS) national coverage analysis by urging support for lung cancer screening for high-risk patients with low dose computed tomography (LDCT).  The United States Preventive Services Task Force (USPSTF) awarded a “B” recommendation in support of lung cancer screening for people between ages 55 and 80 years who are either current smokers with a 30-pack year history or former smokers with a 30-pack year history but who have quit within the past 15 years.

 

In its letter, ACPM stated that LDCT “is the only method ever proven to reduce lung cancer mortality in this high risk population and it also has been shown to be cost effective.”  The letter further notes that, “The Affordable Care Act mandates that any preventive service that receives an ‘A’ or ‘B’ recommendation from USPSTF be deemed an "Essential Health Benefit" covered without co-payment by all non-grandfathered private insurance plans.  We recognize that this mandate does not apply to Medicare. However, given that lung cancer risks increase with age and the median age of diagnosis is 70 years old, Medicare coverage of lung cancer screening should be deemed  ‘reasonable and appropriate’ for this high risk population.” 

 

Policy and Practice

 

10.     FDA ANNOUNCES PROPOSED UPDATES TO NUTRITION FACTS LABEL

 

The U.S. Food and Drug Administration (FDA) has proposed updating the Nutrition Facts Label to include more of an emphasis on the direct link between chronic diseases such as obesity and heart disease and consumption. Packaged food labels would reflect the most up-to-date scientific information available and would replace outdated serving sizes to align with more realistic portion sizes. The Nutrition Facts Label has not been revised since 2006, when trans fats were added.

 

The FDA has proposed a variety of changes, including:

 

  • Create calories and nutrition information for both “per serving” and “per package” and update the serving size to reflect more realistic eating patterns
  • Revise the Daily Values for select nutrients such as sodium, dietary fiber, and Vitamin D
  • Create a new format emphasizing calories and serving size to address the direct links to obesity and heart disease
  • Require information about the amount of “added sugars”
  • Require the inclusion of potassium and vitamin D

 

The agency is accepting public comment for 90 days with a deadline of May 28th.


 

11.     ACPM ADDS TO PRESSURE PLACED ON CMS TO NIX CHANGES TO MEDICARE PART D PROGRAM

 

ACPM delivered a comment letter to Centers for Medicare and Medicaid Services (CMS) administrator Marilyn Tavenner urging that the agency abandon its proposal to limit the number of “protected classes” established for certain medications from six to four.  The CMS proposal would have removed antidepressants and immunosuppressants from the protected classes beginning in 2015, essentially limiting insurance coverage to a narrow group of medications for each class.

 

The ACPM letter states that, “Appropriate use of prescription medicines is critical to disease prevention and treatment. Recognizing that appropriate use and adherence to prescribed medicines can be impacted substantially by access and affordability concerns, ACPM is concerned with changes proposed by this rule that would essentially limit the number of prescription medicines available to physicians charged with managing their patients’ health.”

 

Having faced a wave of criticism against its proposal, CMS announced soon after the close of the comment period that it would retain the original six “protected classes.”

 

ACPM thanks PhRMA for bringing this issue to its attention through the ACPM Corporate Roundtable.

 

12.     UPDATES FROM THE USPSTF

 

The U.S. Preventive Services Task Force has published a final recommendation statement on screening for cognitive impairment in older adults, concluding that the current evidence is insufficient to assess the balance of benefits and harms of screening for cognitive impairment (I statement).  The final recommendation statement can also be found in the online edition of Annals of Internal Medicine.

In an earlier release, the Task Force published a
final recommendation statement and evidence report on primary care behavioral interventions to reduce illicit drug and nonmedical pharmaceutical use in children and adolescents.  The Task Force concluded that the current evidence is insufficient (I statement) to assess the balance of benefits and harms of primary care–based behavioral interventions to prevent or reduce illicit drug or nonmedical pharmaceutical use in children and adolescents who have not already been diagnosed with a substance use disorder.

 

Research and Reports

 

13.     EASY ACCESS TO LIQUID NICOTINE CREATES SIGNIFICANT PUBLIC HEALTH RISK

 

Fueled by the use and popularity of e-cigarettes, liquid nicotine is becoming more readily available to the public and posing significant public health risk.  The National Poison Data System reports that number of reported poison cases linked to e-liquids grew 300% in 2013 and is set to double in 2014.

 

As e-cigarette technology evolves, newer versions have reusable compartments that consumers refill with “e-liquid,” which is primarily liquid nicotine, instead of just disposing of them once the liquid was gone. Toxicologists are beginning to sound the alarm on the emerging potential dangers of e-liquids because of their neurotoxicity and ability to be lethally absorbed quickly through the skin.  The public health risks are especially high for children, who can be drawn to e-liquids’ bright colors and fragrant flavorings.  Only a teaspoon of e-liquid could cause fatalities in small children.

 

The Food and Drug Administration currently does not regulate e-liquids, but plans to in the future in a similar fashion as the regulation of nicotine gums and patches. With estimated sales of one million to two million liters of e-liquid this year, the public health community is starting to mobilize to raise awareness around what many see as the one of the most potent naturally occurring toxins on the market.


 

14.     ALCOHOL-RELATED VEHICLE CRASHES GREATLY UNDER REPORTED

 

Alcohol is a far greater factor in U.S. motor vehicle deaths than has been reported, according to a new study in the Journal of Studies on Alcohol and Drugs.  In the decade from 1999 to 2009, while only a little more than 3 percent of the death certificates for traffic deaths included alcohol as a contributing cause, about 21 percent of the deaths were legally drunk, according to researchers using Fatality Analysis Reporting System (FARS) data from the U.S. National Highway Traffic Safety Administration.  Approximately 450,000 Americans were killed in traffic crashes during the period.

 

Officials from the U.S. National Institute on Alcohol Abuse and Alcoholism cited the time it takes coroners to take and process blood alcohol tests as one possible reason for the underreported figures.  They note that the vast discrepancy demonstrates the need for more reliable data.


 

15.     STUDY FINDS DRAMATIC INCREASE IN OPIOID PRESCRIPTIONS BY EMERGENCY ROOMS

 

Opioid analgesic prescriptions by U.S. emergency departments increased 49% between 2001-2010, while there have been only modest increases in pain-related complaints, according to the March 2014 issue of Academic Emergency Medicine. “Rising Opioid Prescribing in Adult U.S. Emergency Department Visits: 2001-2010,” which analyzed data from the National Hospital Ambulatory Medical Care Survey, found prescriptions of Schedule II drugs increased 90.8% and Schedule III drugs increased 23.8%.

 

Researchers also examined the use of non-opioid prescriptions, which remained constant over the ten-year time period.  

 

Announcements

 

16.     CALL FOR PAPERS: “ADVANCES IN PUBLIC HEALTH SERVICES AND SYSTEMS RESEARCH”

 

The American Journal of Public Health, in collaboration with the Robert Wood Johnson Foundation, the U.S. Centers for Disease Control and Prevention (CDC), and the University of Kentucky, invites research manuscript submissions for a supplement issue on the topic "Advances in Public Health Services and Systems Research (PHSSR)." Manuscripts are being accepted through May 15th.  


 

17.     NATIONAL PUBLIC HEALTH WEEK IS APRIL 7-13

 

During the first full week of April each year ACPM joins other partner organizations in recognizing and supporting National Public Health Week. Led by the American Public Health Association (APHA), the annual campaign brings together communities across the United States to recognize the contributions of public health and highlight issues that are important to improving our nation. This year’s theme is Public Health: Start Here. The week-long campaign serves to educate the public, policymakers and practitioners about issues related to each year's theme.  APHA creates new NPHW materials each year that can be used during and after NPHW to raise awareness about public health and prevention.  Resources available to partner and participate in the campaign include: fact sheets, media outreach materials, suggested community events, legislative information, resources and activities.

 

18.     MEMBERS IN THE NEWS

  • Congratulations to Linda L. Hill, MD, MPH, FACPM, who was selected as the individual recipient of the 2014 Live Well San Diego Public Health Champion Award. The Live Well San Diego Public Health Champion Awards Ceremony is a component of the County of San Diego's Live Well San Diego initiative, a 10-year strategic vision for improving health and wellness and combating the toll of chronic diseases, including obesity.  The Public Health Champion Award is provided to the individual who demonstrates “extraordinary achievement in protecting and promoting the health of residents in San Diego County.”

  • Doug Kamerow, MD, MPH, FACPM recently stepped down from his position at RTI International after more than 12 years and has transitioned to two part-time positions: (1) based at the Graham Center, the health policy research group affiliated with the American Academy of Family Physicians, and (2) increasing his teaching time at Georgetown University in his role as a Professor of Clinical Family Medicine.

  • Congratulations to Elizabeth (Betsey) Cuervo Tilson, MD, MPH, FACPM, who received the Health Care Heroes Award from Triangle Business Journal, which awards individuals for putting innovation and compassion to work to improve the human condition.  Dr. Tilson was chosen in the Physicians/Physician Practices category, which honors an M.D. or a physician group who show exemplary performance in the health care field.  Dr. Tilson, board certified in Preventive Medicine and Pediatrics, serves patients and the community on two levels: as a practicing pediatrician in a safety net clinic in Wake County and as a leader in population health with a regional network of Community Care of North Carolina (CCNC).


 

 

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