Headlines: November 30, 2010
by Meg Larkin
As the debate over health care reform continues in the federal government, cuts to Medicare are still a key sticking point. Around the country, doctors say that they are accepting fewer Medicare patients because of low reimbursement rates. However, Medicare spending has grown in recent years, and federally mandated cuts in spending have been routinely postponed. In 1997, Congress implemented the Sustainable Growth Rate (SGR), which was intended to tether Medicare spending growth to overall economic growth, but after the formula led to a 4.8 percent cut in the Medicare physician reimbursement rate in 2002, steeper cuts called for by the formula in recent years have been indefinitely postponed. This year, the SGR was set to trigger a 23 percent cut in doctor reimbursement payments on December 1, but the Senate passed a stop gap measure postponing the rate cut to January 1st, and the House is expected to approve of the extension this week. Questions have been raised about how long Congress can continue to simply postpone rate cuts without tackling larger problems in the Medicare reimbursement system. Doctors argue that Medicare reimbursement has not kept pace with the costs of running a medical practice, while others argue that Medicare spending and overutilization of health care services are out of control. Doctors are lobbying to increase Medicare reimbursement, and while it is not clear that this is an ideal solution, it is equally clear that Congress will need to find a more permanent fix in the near future.
In other US health news, a new study blames inefficiency in the health care system for America’s poor global health care ranking. While the US spends more than any other country on health care, it ranks 49th among nations in life expectancy. In a study of 13 developed nations, researchers at Columbia University found that the United States had the lowest increase in life expectancy and the highest increase in health care costs between 1975 and 2005. Some public health experts have criticized the study’s methodology in controlling for the influence of factors other than the US health care system in the US’s high rates of morbidity and mortality, including smoking and obesity.
In research news, a new study shows that an exercise routine that combines aerobics and weight lifting may produce the best results for patients with type two diabetes. The study published in the latest edition of JAMA found that the combination exercise routine was able to help patients dramatically reduce their blood sugar. The New York Times reported that, “After nine months, participants who did the combination training lowered their blood level of the glucose marker HbA1c to 7.3 percent from 7.7 percent, on average, a drop that corresponds to a significantly reduced risk of heart disease.”
Finally, in mental health news, the elimination of Narcissistic Personality Disorder from the latest edition of the Diagnostic and Statistic Manual of Mental Disorders (DSM) is causing a stir. Narcissistic Personality Disorder and four other personality disorders have been eliminated from the DSM-5 in favor of a “dimensional approach,” which “consists of making an overall, general diagnosis of personality disorder for a given patient, and then selecting particular traits from a long list in order to best describe that specific patient.” The shift in the DSM to the dimensional approach has highlighted a divide between clinicians and researchers in the psychiatric field. Clinicians generally prefer the categorical disorders that enable them to classify patients based on their symptoms, while researchers tend to favor the dimensional approach that focuses on traits that patients exhibit. Modifications to the DSM are hotly debated in the psychiatric profession because it is the industry standard that clinicians look to when diagnosing mental disorders.
Meg Larkin is a third year law student at Boston University. Please feel free to email her with any questions, comments, suggestions or concerns.