By Robert Preidt
MedicineNet.com
Originally published on May 4, 2013
About 90 percent of pediatric specialists who diagnose and manage attention-deficit/hyperactivity disorder (ADHD) in preschool children do not follow treatment guidelines published recently by the American Academy of Pediatrics, according to a new study.
Some prescribe medications too soon, while others do not give the young patients drugs even as a second-line treatment, according to study author Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Cohen Children's Medical Center in New Hyde Park, N.Y., and colleagues.
The American Academy of Pediatrics (AAP) guidelines recommend that behavior therapy be the first treatment approach for preschoolers with ADHD, and that treatment with medication should be used only when behavior-management counseling is unsuccessful. (Emphasis added)
The entire story is here.
Click here to review the guidelines.
A similar story can be found in Time.
Thursday, May 9, 2013
Wednesday, May 8, 2013
Delaware becomes 11th state with gay marriage
By Doug Denison
The Wilmington Delaware New Journal
May 7, 2013
Delaware became the 11th state to legalize same-sex marriage after a lengthy debate Tuesday in the state Senate and the surprise votes of two lawmakers.
A half hour after the 12-9 Senate vote, Gov. Jack Markell signed the legislation into law on the main stairs in the lobby of Legislative Hall.
Democratic Sen. Bethany Hall-Long and Republican Sen. Catherine Cloutier provided the swing votes in favor of the legislation. Cloutier was the lone Republican yes vote in the Senate and one of two in the General Assembly as a whole.
According to the bill, Delawareans will be able to enter into same-sex marriages effective July 1. The law provides a mechanism for converting existing same-sex civil unions established in Delaware to marriages.
The entire story is here.
The Wilmington Delaware New Journal
May 7, 2013
Delaware became the 11th state to legalize same-sex marriage after a lengthy debate Tuesday in the state Senate and the surprise votes of two lawmakers.
A half hour after the 12-9 Senate vote, Gov. Jack Markell signed the legislation into law on the main stairs in the lobby of Legislative Hall.
Democratic Sen. Bethany Hall-Long and Republican Sen. Catherine Cloutier provided the swing votes in favor of the legislation. Cloutier was the lone Republican yes vote in the Senate and one of two in the General Assembly as a whole.
According to the bill, Delawareans will be able to enter into same-sex marriages effective July 1. The law provides a mechanism for converting existing same-sex civil unions established in Delaware to marriages.
The entire story is here.
Rhode Island Legalizes Gay Marriage - 10th State to Legalize
The Huffington Post
Originally published May 2, 2013
Rhode Island became the tenth U.S. state to legalize same-sex marriage Thursday with a 56-15 vote.
Just before he signed the legislation into law, Gov. Lincoln Chafee took to the steps of the Rhode Island State House, where he told a jubilant crowd, "Today we are making history ... we are living up to the ideals of our founder."
The entire article is here.
Originally published May 2, 2013
Rhode Island became the tenth U.S. state to legalize same-sex marriage Thursday with a 56-15 vote.
Just before he signed the legislation into law, Gov. Lincoln Chafee took to the steps of the Rhode Island State House, where he told a jubilant crowd, "Today we are making history ... we are living up to the ideals of our founder."
The entire article is here.
Amid Much Tumult, France Approves ‘Marriage for All’
By Scott Sayare
The New York Times
Originally published April 12, 2013
With a definitive vote by the lower house of Parliament, France on Tuesday became the world's 14th nation, and the third in just two weeks, to approve marriage rights for same-sex couples.
The legislation is expected to be approved by the Constitutional Council and signed into law by President Francois Hollande in time to allow the country's first same-sex weddings this summer.
Passage of the "marriage for all" law, sponsored by Mr. Hollande, a Socialist, came after months of sometimes angry debate and a series of major protests, rallies that drew Roman Catholics from France's rural regions and received the backing of Christian, Jewish and Muslim religious leaders, as well as the conservative political opposition. Homophobic violence had risen in recent weeks, with a handful of attacks on gay couples reported across the country.
The entire story is here.
The New York Times
Originally published April 12, 2013
With a definitive vote by the lower house of Parliament, France on Tuesday became the world's 14th nation, and the third in just two weeks, to approve marriage rights for same-sex couples.
The legislation is expected to be approved by the Constitutional Council and signed into law by President Francois Hollande in time to allow the country's first same-sex weddings this summer.
Passage of the "marriage for all" law, sponsored by Mr. Hollande, a Socialist, came after months of sometimes angry debate and a series of major protests, rallies that drew Roman Catholics from France's rural regions and received the backing of Christian, Jewish and Muslim religious leaders, as well as the conservative political opposition. Homophobic violence had risen in recent weeks, with a handful of attacks on gay couples reported across the country.
The entire story is here.
NFL to fight anti-gay bias, says N.Y. attorney general
By Atossa Araxia Abrahamian
Reuters
Originally posted April 24, 2013
he National Football League will step up its efforts to fight discrimination based on sexual orientation, New York Attorney General Eric Schneiderman said on Wednesday.
The action comes after at least three college football players said they had been asked about their sexual orientation during NFL recruitment interviews earlier this year.
As a result of discussions with Schneiderman's office, the NFL will display posters in locker rooms that communicate the league's anti-discrimination rules, and all 32 teams in the league will undergo training, including the people involved in hiring and recruitment, Schneiderman said.
The entire story is here.
Reuters
Originally posted April 24, 2013
he National Football League will step up its efforts to fight discrimination based on sexual orientation, New York Attorney General Eric Schneiderman said on Wednesday.
The action comes after at least three college football players said they had been asked about their sexual orientation during NFL recruitment interviews earlier this year.
As a result of discussions with Schneiderman's office, the NFL will display posters in locker rooms that communicate the league's anti-discrimination rules, and all 32 teams in the league will undergo training, including the people involved in hiring and recruitment, Schneiderman said.
The entire story is here.
Tuesday, May 7, 2013
An Imperative for Change: Access to Psychological Services for Canada
Canadian Psychological Association
Press Release
May 2013
To mark the one year anniversary of Canada’s first mental health strategy next week, the Canadian Psychological Association (CPA) is releasing an independent report by a group of health economists. The report ‘An Imperative for Change’ states that the delivery of mental health services can be characterized as a silent crisis and provides a business case, and proposes models, for improved access to psychological services.
“One of the great challenges when it comes to caring for the mental health of Canadians is the significant barriers to accessing mental health services. Despite the fact that one in five Canadians will experience a mental health problem in a given year, only one-third will receive the help they need. We have psychological treatments that work, and experts trained to deliver them. Yet the services of psychologists are not funded by provincial health insurance plans, which make them inaccessible to many with modest incomes or no insurance. Publically funded services, when available, are often in short supply and wait lists are long. The cost of mental illness in Canada is estimated at 51 billion dollars annually so we need to act now and be innovative in our approach,” said Dr. Jennifer Frain, President of the CPA.
“Last year we were very pleased that Canada’s national mental health strategy called for increased access to evidence-based psychotherapies by service providers qualified to deliver them. In response, we commissioned a report to look at how this can be achieved. The report proposes and costs out four models that could be implemented and adapted here,” said Dr. Karen Cohen, Chief Executive Officer of the CPA.
“Canada has fallen behind other countries such as the United Kingdom, Australia, the Netherlands, and Finland who have launched mental health initiatives which include covering the services of psychologists through public health systems. These initiatives are proving both cost and clinically effective. Analysis of research in the United Kingdom found that substantial returns on investments could be achieved in the early detection and treatment of common mental health conditions such as depression. These models respond to the recommendations of the mental health strategy. By implementing them, we can move from conversation to action,” added Dr. Cohen.
Models for Canada
Adapt the United Kingdom’s publicly funded model for Improved Access to Psychological Therapies (IAPT) in the provinces and territories. Under this program psychologists and low intensity therapists deliver care for people with the most common mental health problems:
Read “An Imperative for Change: Access to Psychological Services for Canada” here
Press Release
May 2013
To mark the one year anniversary of Canada’s first mental health strategy next week, the Canadian Psychological Association (CPA) is releasing an independent report by a group of health economists. The report ‘An Imperative for Change’ states that the delivery of mental health services can be characterized as a silent crisis and provides a business case, and proposes models, for improved access to psychological services.
“One of the great challenges when it comes to caring for the mental health of Canadians is the significant barriers to accessing mental health services. Despite the fact that one in five Canadians will experience a mental health problem in a given year, only one-third will receive the help they need. We have psychological treatments that work, and experts trained to deliver them. Yet the services of psychologists are not funded by provincial health insurance plans, which make them inaccessible to many with modest incomes or no insurance. Publically funded services, when available, are often in short supply and wait lists are long. The cost of mental illness in Canada is estimated at 51 billion dollars annually so we need to act now and be innovative in our approach,” said Dr. Jennifer Frain, President of the CPA.
“Last year we were very pleased that Canada’s national mental health strategy called for increased access to evidence-based psychotherapies by service providers qualified to deliver them. In response, we commissioned a report to look at how this can be achieved. The report proposes and costs out four models that could be implemented and adapted here,” said Dr. Karen Cohen, Chief Executive Officer of the CPA.
“Canada has fallen behind other countries such as the United Kingdom, Australia, the Netherlands, and Finland who have launched mental health initiatives which include covering the services of psychologists through public health systems. These initiatives are proving both cost and clinically effective. Analysis of research in the United Kingdom found that substantial returns on investments could be achieved in the early detection and treatment of common mental health conditions such as depression. These models respond to the recommendations of the mental health strategy. By implementing them, we can move from conversation to action,” added Dr. Cohen.
Models for Canada
Adapt the United Kingdom’s publicly funded model for Improved Access to Psychological Therapies (IAPT) in the provinces and territories. Under this program psychologists and low intensity therapists deliver care for people with the most common mental health problems:
- depression and anxiety.
- Integrate psychologists on primary care teams so that mental health problems are addressed at the right time, in the right place, by the right provider.
- Include psychologists on specialist care teams in secondary and tertiary care facilities for health and mental health conditions.
- Expand private insurance coverage and promote employer support for psychological services
- Canadian employers could expect to recover $6 to $7 billion annually with attention to prevention, early identification and treatment of mental health problems among their workforces.
Read “An Imperative for Change: Access to Psychological Services for Canada” here
CPT and ICD: What Are They? Where Do They Come From?
By Samuel Knapp, EdD, ABPP, Director of Professional Affairs
The Pennsylvania Psychologist
May 2013
The Current Procedural Terminology (or CPT) codes are developed by the American Medical Association (AMA) to ensure a common parlance and unitary language for describing services and procedures by physicians and other health care professionals. The CPT coding manual is copyrighted and published by AMA. CPT I Codes are the five-digit codes used to describe medical procedures; CPT II Codes are supplemental codes used to facilitate data collection about the quality of services provided; and CPT III Codes are for experimental procedures where data is still being gathered. HIPAA requires the standardized use of ICD and CPT codes across insurers. Although CPT codes were widely used before the HIPAA requirement, this HIPAA requirement ended the use of local codes.
A panel of the AMA (the Editorial Panel) creates the CPT codes, although it accepts advice from advisory panels. The Editorial Panel consists of 17 members including 11 physicians nominated by specialty groups within AMA; one physician each from the Blue Cross/Blue Shield Association, America’s Health Insurance Plans (a trade association), the Centers for Medicare and Medicaid Services (CMS), and the American Hospital Association; and two other members from the advisory committees to the Editorial Panel. One of the advisory committees is the Health Care Professional Advisory Committee, which consists of 12 organizations whose members are eligible to use CPT codes (audiologists, chiropractors, registered dieticians, nurses, occupational therapists, optometrists, physical therapists, physician assistants, podiatrists, psychologists, social workers, and speech therapists).
The deliberation process is secret. There is no public comment period for the adoption of these codes and no consumer input. All participants are obligated to follow strict standards of confidentiality, and the punishment for breaking confidentiality is to be removed from the process. The AMA is under no obligation to accept the recommendations of groups impacted by the changes in the CPT codes.
Although the Editorial Panel recommends the particular CPT codes, another committee within AMA, the Relative Value Scale Update Committee (RUC; rhymes with truck) recommends Medicare fees to CMS. The recommendations of RUC are based, to a large extent, on surveys conducted by impacted organizations on the relative work effort involved with the procedure. CMS typically accepts 90% to 100% of the recommendations of the RUC. Often commercial insurers set fees by paying a percentage of what Medicare pays.
Medicare payments are based on the resource-based relative value scale (RBRVS), which consists for three factors: work product, practice expense, and professional liability. Work product involves the time, technical skill, and mental effort required to perform a certain procedure. For physicians as a whole, work product consists of 48%, practice expense consists of 47%, and professional liability insurance consists of 4% of the RBRVS. For psychologists the work product is almost 70% of the RBRVS and professional liability is around 1%. Because the portion of the practice expense component for psychologists is so much lower than for physicians, minor changes in the reimbursement formula can impact psychologists quite differently from physicians.
The American Psychological Association (APA) has a representative on the Heath Care Professional Advisory Committee and had input into revising the CPT codes and the RUC process. Representatives from APA are bound by the very strict standards of confidentiality concerning their participation in the process. I have spoken briefly with APA representatives who can describe their involvement only in general terms. Participation in the process should not be interpreted to mean agreement with the recommendations concerning CPT codes or acceptance of payment.
Diseases are classified according to the ICD (International Classification of Diseases), which was developed by the World Health Organization (an affiliate of the United Nations) to gather information world-wide about the prevalence and incidence of diseases. The United States uses the ICD-cm-9, which means it is the 9th edition of the ICD. The cm refers to “clinical modification,” which is a modification of the ICD for the United States. The rest of the world uses the ICD-10, and the United States will adopt it by October 1, 2014.
Currently, the diagnostic numbers in the DSM-IV correspond to the ICD-9 codes (with a few exceptions). So psychologists can use the DSM-IV coding system and still conform to the ICD-9 system almost all of the time. However, at this time, the coding system in the DSM-V does not correspond to the numbers that would be used in the ICD-10. Although psychologists may wish to learn about the DSM-V as a way to keep abreast of new developments in the area of diagnostics, they will continue to bill only with the ICD-9 (DSM-IV-TR) numerical codes even after the DSM-V is released. Psychologists and other health care professionals will begin coding with the ICD-10 in October 2014.
The Pennsylvania Psychologist
May 2013
The Current Procedural Terminology (or CPT) codes are developed by the American Medical Association (AMA) to ensure a common parlance and unitary language for describing services and procedures by physicians and other health care professionals. The CPT coding manual is copyrighted and published by AMA. CPT I Codes are the five-digit codes used to describe medical procedures; CPT II Codes are supplemental codes used to facilitate data collection about the quality of services provided; and CPT III Codes are for experimental procedures where data is still being gathered. HIPAA requires the standardized use of ICD and CPT codes across insurers. Although CPT codes were widely used before the HIPAA requirement, this HIPAA requirement ended the use of local codes.
A panel of the AMA (the Editorial Panel) creates the CPT codes, although it accepts advice from advisory panels. The Editorial Panel consists of 17 members including 11 physicians nominated by specialty groups within AMA; one physician each from the Blue Cross/Blue Shield Association, America’s Health Insurance Plans (a trade association), the Centers for Medicare and Medicaid Services (CMS), and the American Hospital Association; and two other members from the advisory committees to the Editorial Panel. One of the advisory committees is the Health Care Professional Advisory Committee, which consists of 12 organizations whose members are eligible to use CPT codes (audiologists, chiropractors, registered dieticians, nurses, occupational therapists, optometrists, physical therapists, physician assistants, podiatrists, psychologists, social workers, and speech therapists).
The deliberation process is secret. There is no public comment period for the adoption of these codes and no consumer input. All participants are obligated to follow strict standards of confidentiality, and the punishment for breaking confidentiality is to be removed from the process. The AMA is under no obligation to accept the recommendations of groups impacted by the changes in the CPT codes.
Although the Editorial Panel recommends the particular CPT codes, another committee within AMA, the Relative Value Scale Update Committee (RUC; rhymes with truck) recommends Medicare fees to CMS. The recommendations of RUC are based, to a large extent, on surveys conducted by impacted organizations on the relative work effort involved with the procedure. CMS typically accepts 90% to 100% of the recommendations of the RUC. Often commercial insurers set fees by paying a percentage of what Medicare pays.
Medicare payments are based on the resource-based relative value scale (RBRVS), which consists for three factors: work product, practice expense, and professional liability. Work product involves the time, technical skill, and mental effort required to perform a certain procedure. For physicians as a whole, work product consists of 48%, practice expense consists of 47%, and professional liability insurance consists of 4% of the RBRVS. For psychologists the work product is almost 70% of the RBRVS and professional liability is around 1%. Because the portion of the practice expense component for psychologists is so much lower than for physicians, minor changes in the reimbursement formula can impact psychologists quite differently from physicians.
The American Psychological Association (APA) has a representative on the Heath Care Professional Advisory Committee and had input into revising the CPT codes and the RUC process. Representatives from APA are bound by the very strict standards of confidentiality concerning their participation in the process. I have spoken briefly with APA representatives who can describe their involvement only in general terms. Participation in the process should not be interpreted to mean agreement with the recommendations concerning CPT codes or acceptance of payment.
Diseases are classified according to the ICD (International Classification of Diseases), which was developed by the World Health Organization (an affiliate of the United Nations) to gather information world-wide about the prevalence and incidence of diseases. The United States uses the ICD-cm-9, which means it is the 9th edition of the ICD. The cm refers to “clinical modification,” which is a modification of the ICD for the United States. The rest of the world uses the ICD-10, and the United States will adopt it by October 1, 2014.
Currently, the diagnostic numbers in the DSM-IV correspond to the ICD-9 codes (with a few exceptions). So psychologists can use the DSM-IV coding system and still conform to the ICD-9 system almost all of the time. However, at this time, the coding system in the DSM-V does not correspond to the numbers that would be used in the ICD-10. Although psychologists may wish to learn about the DSM-V as a way to keep abreast of new developments in the area of diagnostics, they will continue to bill only with the ICD-9 (DSM-IV-TR) numerical codes even after the DSM-V is released. Psychologists and other health care professionals will begin coding with the ICD-10 in October 2014.
Monday, May 6, 2013
Should I Report My Ex-Wife for Sleeping With Her Patient?
By Chuck Klosterman
The New York Times - The Ethicist
Originally published April 26, 2013
My ex-wife is a physician. We divorced when I found out she was having an affair with one of her H.I.V.-positive patients. I feel compelled to tell the state medical licensing board and the professional societies to which she belongs about her affair. My reasons for doing so are that I feel an intense urge to retaliate her breach of trust and that she potentially exposed me to H.I.V. (fortunately, I tested negative). I also know that, as a physician myself, I should report her to protect other patients, so that she may get increased supervision at her workplace and treatment if needed. Should I report her even though my main motivation is revenge?
The entire article is here.
The New York Times - The Ethicist
Originally published April 26, 2013
My ex-wife is a physician. We divorced when I found out she was having an affair with one of her H.I.V.-positive patients. I feel compelled to tell the state medical licensing board and the professional societies to which she belongs about her affair. My reasons for doing so are that I feel an intense urge to retaliate her breach of trust and that she potentially exposed me to H.I.V. (fortunately, I tested negative). I also know that, as a physician myself, I should report her to protect other patients, so that she may get increased supervision at her workplace and treatment if needed. Should I report her even though my main motivation is revenge?
The entire article is here.
US sues Novartis in NY again, cites doc kickbacks
By The Associated Press at The Wall Street Journal
Originally published on April 26, 2013
The U.S. government sued Novartis Pharmaceuticals Corp. again on Friday, saying it paid kickbacks for a decade to doctors to steer patients toward its drugs, sometimes disguising fishing trips off the Florida coast and trips to Hooters restaurants as speaking engagements for the doctors.
The lawsuit in U.S. District Court in Manhattan came two days after the government brought a similar lawsuit against Novartis, which is based in East Hanover, N.J.
The first lawsuit said the company paid kickbacks to pharmacies to switch kidney transplant patients from competitors' drugs to its own.
In the second lawsuit, the government accused the company of using from 2001 through 2011 multimillion-dollar "incentive programs" that targeted doctors willing to accept illegal kickbacks to urge patients to use the company's drugs.
"And for its investment, Novartis reaped dramatically increased profits on these drugs, and Medicare, Medicaid and other federal health care programs were left holding the bag," U.S. Attorney Preet Bharara said in a statement.
Novartis President Andre Wyss said the company disagreed with the way the government characterized its conduct and stands behind its compliance program.
The entire story is here.
Originally published on April 26, 2013
The U.S. government sued Novartis Pharmaceuticals Corp. again on Friday, saying it paid kickbacks for a decade to doctors to steer patients toward its drugs, sometimes disguising fishing trips off the Florida coast and trips to Hooters restaurants as speaking engagements for the doctors.
The lawsuit in U.S. District Court in Manhattan came two days after the government brought a similar lawsuit against Novartis, which is based in East Hanover, N.J.
The first lawsuit said the company paid kickbacks to pharmacies to switch kidney transplant patients from competitors' drugs to its own.
In the second lawsuit, the government accused the company of using from 2001 through 2011 multimillion-dollar "incentive programs" that targeted doctors willing to accept illegal kickbacks to urge patients to use the company's drugs.
"And for its investment, Novartis reaped dramatically increased profits on these drugs, and Medicare, Medicaid and other federal health care programs were left holding the bag," U.S. Attorney Preet Bharara said in a statement.
Novartis President Andre Wyss said the company disagreed with the way the government characterized its conduct and stands behind its compliance program.
The entire story is here.
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