|ACPM Headlines 5/22/12|
Policy and Practice
Research and Reports
1. USPSTF RECOMMENDS AGAINST PSA-SCREENING FOR PROSTATE CANCER
The U.S. Preventive Services Task Force has released its prostate cancer screening final recommendation statement, recommending against (D recommendation) prostate-specific antigen (PSA)-based screening for prostate cancer. The recommendation applies to men in the general U.S. population, regardless of age. It does not include the use of the PSA test for surveillance after diagnosis or treatment of prostate cancer, which is outside the scope of the USPSTF.
According to a statement from USPSTF Co-Chair Michael LeFevre, MD, MSPH, "Prostate cancer is a serious health problem that affects thousands of men and their families. But before getting a PSA test, all men deserve to know what the science tells us about PSA screening: there is a very small potential benefit and significant potential harms. We encourage clinicians to consider this evidence and not screen their patients with a PSA test unless the individual being screened understands what is known about PSA screening and makes the personal decision that even a small possibility of benefit outweighs the known risk of harms.”
To view the USPSTF statement, visit: ow.ly/b541b
2. SETTING THE RECORD STRAIGHT ON NUVAL
Last week, the National Consumers League issued a press release stating it has filed a complaint with the FDA calling for the banishment of the NuVal nutrition rating system from supermarket shelves. NuVal provides information on the overall nutritional quality of food items in the grocery store in a single, consumer-friendly number—1 to 100, with 1 being the least healthy and 100 being the most healthy. The rating system behind the NuVal brand is a comprehensive, scientifically-based analytical engine created by a panel of 15 national experts, led by ACPM Fellow David Katz, and endorsed by ACPM in 2010 as having met ACPM’s criteria for effective nutritional rating guidance.
Dr. Katz prepared a detailed response to the NCL release and its letter to the FDA, published in the Huffington Post and other media outlets, that essentially debunks the claims made in the release. In fact, NCL’s letter to the FDA highlights a series of "mind-boggling” scores produced by the NuVal system that, as Dr. Katz points out, actually make the case that NuVal is doing exactly what it is supposed to do and underscore why NuVal is so essential for unsuspecting consumers. To read Dr. Katz’ column, visit http://huff.to/KV7YiZ.
In keeping with its endorsement of the NuValsystem, ACPM encourages members to become more familiar with this public health tool in the fight against obesity, if not already, to convey support to colleagues who ask about it, and to blog, tweet, or express support of the system through LinkedIn, Facebook, or other forms of social media.
3. OBESITY CONFERENCE AND RELATED STUDIES GARNER NATIONAL HEADLINES
The timed release of several reports, studies, and documentaries, all centered around the recent CDC-sponsored "Weight of the Nation” conference, have thrust the national obesity epidemic even more to the forefront of the nation’s collective consciousness.
Among its highlights the conference featured the release of a study published online by the American Journal of Preventive Medicine that predicted the prevalence of obesity among Americans will swell from 36% of the adult population today to 42% by 2030. Led by a health economist at Duke University, the study also estimated that the cost of treating those additional obese people for diabetes, heart disease and other medical conditions would add up to nearly $550 billion over the next two decades. The study was picked up by nearly every major news source in the country, and even earned a mention on the David Letterman show.
The conference also served as a backdrop for the release of the IOM report, "Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation,” which identifies five key strategies for preventing obesity: integrate physical activity every day in every way; market what matters for a healthy life; make healthy foods and beverages available everywhere; activate employers and health care professionals; and strengthen schools as the heart of health.
Lastly, a centerpiece of the conference was an airing of portions of a four-part documentary (of the same name), produced by HBO and the Institute of Medicine, with support from the CDC, the National Institutes of Health, Kaiser Permanente and the Michael and Susan Dell Foundation. The documentary aired on HBO the following week.
4. ACPM BUILDS SUPPORT FOR SENATE "DEAR COLLEAGUE" LETTER TO PROTECT PREVENTION FUND
To help build congressional support for the Prevention and Public Health Fund, ACPM has urged Senators to sign a "Dear Colleague” letter drafted by Sen. Tom Harkin (D-IA). The letter opposes legislation that diverts dollars from the Fund to support activities that fall outside the prevention and public health arena. The Fund has come under attack as a potential offset in efforts to extend low interest rates for student loans, bolster Medicare reimbursement for providers, and extend tax cuts for the middle class.
The letter notes, "Right now, of the more than $2.2 trillion spent nationally on health care in the U.S. every year, only four percent is estimated to be spent on prevention and public health…Researchers at the New York Academy of Medicine have concluded that investments in proven community-based interventions to increase physical activity, improve nutrition, and prevent smoking – the very programs supported by the Fund – will generate a return of $5.60 for every $1 spent.”
To view a copy of the letter, visit http://bit.ly/Mb8FaR.
5. ACPM LEADERS ATTEND MEDICAL SPECIALTY MEETINGS
ACPM leaders attended the spring meeting of the Council of Medical Specialty Societies (CMSS) held May 11-12 in Chicago. ACPM executive director Michael Barry participated in the Chief Executive Officers component group meeting, while ACPM Fellow and chair of the Preventive Medicine Residency Program Directors Council Sandra Guerra, MD, MPH, FACPM, along with ACPM council representative Rachel Rubin, MD, MPH, participated in the Organization of Program Directors Association component group and general CMSS sessions. Dr. Rubin also participated in the Council business meeting. In addition, Dr. Guerra and Mr. Barry attended a pre-conference workshop on GME Financing, intended to identify an action plan and outcomes to have a positive influence on the future state of GME funding.
Keynote speakers for the CMSS meeting included Paul C. Tang, MD, MS, Vice President and Chief Innovation and Technology Officer at the Palo Alto Medical Foundation, presenting meaningful use of HIT, and Daniel B. Wolfson, MHSA, Executive Vice President and Chief Operating Officer of the American Board of Internal Medicine Foundation speaking on the "Choosing Wisely—Specialty Society Campaign.” Additional educational sessions featured presentations from Michael S. Barr, MD, MBA, FACP, Senior Vice President, Division of Medical Practice, Professionalism and Quality, American College of Physicians, and reactor panelist Steven E. Waldren, MD, MS, Director of the Center for Health IT, American Academy of Family Physicians, on how specialty societies can help their members select and adopt EHRs, and from Lynn Kuehn, MD, RHIA, CCS-P, CHAP, FAHIMA, President of Kuehn Consulting, and reactor panelists Christopher J. Chute, MD, DrPH, from the American Medical Informatics Association, and Steven J. Stack, MD, Chair Elect of the Board of Trustees at the American Medical Association, on transitioning to ICD-10.
6. LOOKING FOR A JOB OR AN EMPLOYEE? VISIT ACPM'S ONLINE CAREER CENTER
Looking for a job or an employee? Get connected through ACPM’s Online Career Center! ACPM offers members and the specialty at large a targeted resource for online recruitment. Employers may post jobs online, search for highly-qualified candidates based on specific job criteria, and create an online resume agent to email qualified candidates daily. Employers also will benefit from online reporting and job activity statistics that track the return on investment (ROI) for each posting.
For job seekers, ACPM Online Career Center is a free service providing access to top employers and jobs in preventive medicine. In addition to posting their CVs, job seekers may browse or view jobs based on specific criteria. As a job seeker, you also may search confidentially by creating a search agent, or a job agent that emails you when jobs matching your criteria are posted.
Don’t miss out on terrific employment opportunities! Visit the ACPM Online Career Center and get connected today!
Policy and Practice
7. TASK FORCE RECOMMENDS TEAM-BASED CARE TO IMPROVE BLOOD PRESSURE
The Community Preventive Services Task Force has recommended team-based care for improving blood pressure control. Team-based care is provided by a team of health professionals—a primary care provider supported by a pharmacist, nurse, dietitian, social worker, and/or community health worker—rather than a single physician. The Task Force found strong evidence to support the effectiveness of team-based care in improving the number of patients with controlled blood pressure and in reducing systolic (SBP) and diastolic (DBP) blood pressure. The greatest improvement in blood pressure was observed when the team members could change medications independently, or with the approval of the primary care provider. Complete findings of the review are expected to be published by May 2013.
To view the Task Force Finding and Rationale Statement, visit http://bit.ly/K7S6wg.
8. HOUSE GOP PASSES SEQUESTER REPLACEMENT WITH MORE HEALTH CARE CUTS
House Republicans moved ahead with their plan to replace the January 1, 2013 budget cuts "sequester" with a heavier round of health care cuts that would spare the defense industry from the impending budget cuts. The sequester was agreed to as part of last year’s Budget Control Act and requires an across-the-board cut to federal defense and non-defense programs necessary to secure at least $1.2 trillion in savings.
These cuts passed the House as part of the chamber’s budget reconciliation bill that would defund parts of the Affordable Care Act, impose more stringent eligibility reviews for Medicaid enrollees, and cap damages on medical malpractice awards. Senate Democrats and the White House have voiced their opposition to the House bill.
9. HOUSE SUBCOMMITTEE APPROVES LANGUAGE SUPPORTIVE OF VA AND CDC COLLABORATION ON NVDRS
The House Military Construction and Veterans Affairs (VA) Appropriations Subcommittee adopted its FY 2013 appropriations bill with language provided by ACPM. The chair of the National Violence Prevention Network called on the VA and Centers for Disease Control and Prevention (CDC) to collaborate "to improve the nation’s capacity to prevent veteran suicides. By linking VA claims data and systems with other public health surveillance data, less lag time, more complete tracking and a richer set of data will help inform targeted prevention strategies.” ACPM requested the inclusion of this language to build awareness of the National Violent Death Reporting System (NVDRS) and advance data sharing discussions between the CDC National Center for Injury Prevention and Control and the VA. The CDC National Center for Injury Prevention and Control administers the NVDRS program.
10. FDA PANEL BACKS PREVENTIVE USE OF HIV DRUG
An advisory panel to the Food and Drug Administration (FDA) has recommended that a drug currently used to treat HIV infection also be approved for prevention. The recommendation marks the first time government advisers have advocated administering antiviral medicine to healthy individuals who might be exposed to the virus through sexual activity.
After evaluating studies and hearing scientific presentations, the panel recommended that Truvada, a once-a-day treatment pill, be prescribed for people at higher risk of infection, such as individuals involved in a sexual relationship with someone who is HIV positive and homosexual men with multiple partners. The drug would also be recommended for other high-risk groups.
Voting was not unanimous. Some members of the 22-member panel voted no or abstained because of their belief that data is insufficient to prove the drug safe and effective in women and African-Americans. Preventive use costs approximately $14,000 annually. However, FDA approval may increase the likelihood of coverage under health insurance plans.
11. FDA ADVISORS RECOMMEND NEW WEIGHT LOSS DRUG
A panel of advisors to the Food and Drug Administration (FDA) has recommended that the agency approve Lorcaserin, a new weight loss drug, developed by Arena Pharmaceuticals. The recommendation comes despite concerns over cardiac risks. The panel concluded that the benefits of Lorcaserin "outweigh the risks when used long term” in overweight and obese patients. The FDA has set a target date of June 27 for deciding whether to approve sales of the drug. Earlier this year, an FDA advisory panel recommended approval of weight loss drug Qnexa, developed by Vivus Pharmaceuticals. If ultimately approved, these drugs would be the first new prescription weight loss drugs available in the U.S. in 13 years.
Research and Reports
12. POLICY BRIEF EXPLORES WORKPLACE WELLNESS PROGRAMS
A new policy brief from Health Affairs and the Robert Wood Johnson Foundation explores the policy implications of health reform on employer wellness programs. Beginning in 2014, the Affordable Care Act (ACA) will expand employers’ ability to reward employees that participate in wellness programs and who meet health status goals, while also requiring employees who don’t meet these goals to pay more for their employer-sponsored health coverage. However, provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPPA) prohibit employer health benefit plans from discriminating against individuals based on any factor connected with their health status.
The brief details changes in the health reform law beginning in 2014 that will affect these workplace wellness programs, and highlights the issues at play. For example, the brief explores the pros and cons of programs that encourage employees to participate and require that they achieve and maintain measurable health status goals. Various viewpoints are covered, including those who say individuals should bear responsibility for their health behaviors and lifestyle choices, as well as others who are wary of ‘penalizing’ employees based on their ability to meet health status goals, which could potentially shift health care costs from the healthy to the sick, while also calling into question various privacy issues.
Authors say that the relationship between insurance coverage benefits and employer wellness programs will need to be addressed through regulations that carefully clarify how such programs will work. The policy brief can be accessed here: http://bit.ly/J9siCm.
13. REPORT HIGHLIGHTS POTENTIAL COST SAVINGS THROUGH PREVENTIVE CARE
The Urban Institute has released a new report on the California Public Employees' Retirement System (CalPERS), concluding that $362 million (22.4%) of the $1.6 billion spent by CalPERS in 2008 was attributable to chronic diseases, including diabetes, hypertension and the more advanced diseases associated with these conditions. The report suggests these chronic conditions could be prevented through lifestyle changes (diet, exercise, etc.).
Based on the literature, well-designed and targeted prevention interventions can achieve reductions of five to fifteen percent in the prevalence of the common conditions included in this analysis. A five percent reduction of these preventable conditions could potentially save CalPERS $18 million annually, while even a one percent reduction could net potential savings of $3.6 million annually.
To view a copy of the report, visit http://bit.ly/KrfylO.
14. AMERICAN LUNG ASSOCIATION FINDS AIR QUALITY AT HIGHEST LEVELS SINCE REPORTING BEGAN
The American Lung Association (ALA) has released its State of the Air 2012 report, finding that air quality in America’s most polluted cities is the cleanest since reporting began 13 years ago. The report notes how the standards set by the Clean Air Act to clean-up major air pollution sources are "working to drastically cut ozone (smog) and particle pollution (soot) from the air we breathe”. Despite this progress, 40 percent of people in the U.S. live in areas where air pollution continues to pose health risks.
To view the report, visit www.stateoftheair.org.
15. MEDICARE PENALTY DRIVES HOSPITALS TO INCREASE INFECTION PREVENTION
According to a study published in the May issue of the American Journal of Infection Control, policy changes at the Centers for Medicare and Medicaid Services (CMS) have led to significant changes in hospital practice and increased focus on infection prevention. In 2008, CMS decided to cease additional reimbursements to hospitals for specific healthcare-associated infections (HAIs).
Lead infection preventionists (IPs) at more than 300 acute care hospital facilities directly impacted by the policy change were surveyed for the study. Survey results indicate that 81 percent of IPs report increased focus on various healthcare-associated infections, most noteably, catheter-associated urinary tract infections and central line-associated bloodstream infections. Fifty-seven percent report a closer working relationship and greater collaboration between infection prevention and quality improvement departments.
While overall study findings were positive, some IPs reported an increase in unnecessary diagnostic testing, and shifting resources from non-targeted infections to address those targeted in the policy change. This study is one of the first to focus on effects of CMS payment policy changes related to hospital infection prevention.
To view the study results, visit http://bit.ly/KFZEse.
16. CALL FOR NOMINEES – AHRQ ADVISORY COUNCIL
AHRQ is seeking nominations for seven new public members for its National Advisory Council for Healthcare Research and Quality, which advises the Secretary of HHS and the Director of AHRQ on matters related to activities of the Agency to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. The 21-member Council meets in the Washington, DC, metropolitan area, generally in Rockville, MD, approximately three times a year. Members generally serve three-year terms, and new members will start their service in 2012. AHRQ seeks individuals who are distinguished in the conduct of research, demonstration projects and evaluations with respect to health care; in the fields of health care quality research or health care improvement; in the practice of medicine or other health professions; in the private health care sector (including health plans, providers, purchasers) or administrators of health care delivery systems; in the fields of health care economics, information systems, law, ethics, business, or public policy; and in representing the interests of patients and consumers of health care. Nominations are due July 3. For more information, please access the May 3 Federal Register notice.
17. MEMBERS IN THE NEWS – RONIT KATZ; RYUNG SUH