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CMS Proposes Payment, Policy Changes For Physicians Services To Medicare Beneficiaries In 2010
The Centers for Medicare & Medicaid Services (CMS) announced today proposed changes to policies and payment rates for services to be furnished during calendar year (CY 2010) by over 1 million physicians and nonphysician practitioners who are paid under the Medicare Physician Fee Schedule (MPFS). The MPFS sets payment rates for more than 7,000 types of services in physician offices, hospitals, and other settings.

Evidence Challenges Effectiveness Of Embryo Screening For Older Women
There is growing evidence that a procedure for identifying chromosomal abnormalities in embryos prior to in vitro fertilization is ineffective at helping older women become pregnant, the Wall Street Journal reports. The procedure -- known as pre-implantation genetic screening, or PGS -- is performed in dozen of U.S. fertility clinics and sometimes marketed to older women as a way to increase the odds of a healthy live birth. PGS involves extracting a single cell from a six-cell embryo and inspecting it for chromosomal abnormalities known as aneuploidies; unaffected embryos can then be implanted through IVF. Women older than age 35 have a higher risk of aneuploidies, in which embryos have fewer or more than the usual number of 23 pairs of chromosomes. Aneuploidies can trigger early miscarriage or certain genetics conditions, such as Down syndrome. Most medical experts agree that embryo screening is capable of significantly reducing the risk of Down syndrome and other serious chromosome-related illnesses. However, evidence from several studies increasingly suggests that the procedure does not increase older women"s chances of healthy live births. The American Society for Reproductive Medicine released an initial opinion about PGS in 2007, saying that available evidence does not support the use of embryo screening to increase live birth rates in older women. Andrew La Barbera, scientific director of the society, said, "Since that time, there have been several more trials that have reached the same conclusion." Another shortcoming is that most clinics can only test for fewer than half of the 23 chromosomes, meaning that many defects can go undetected. However, medical experts say that the use of PGS has increased in the two years since ASRM issued its recommendations. According to the Journal, PGS can add more than $2,000 to the roughly $10,000 cost of one IVF cycle. Very few health insurers cover PGS, though some pay for IVF. Some experts contend that studies showing a lack of clinical benefit from PGS do not use more efficient biopsy techniques that can prevent damage to the embryo. Santiago Munne, scientific director for Reprogenetics, said that the treatment is "effective." In a 2007 study, Munne and colleagues used PGS to reduce the rate at which patients miscarried. However, the chances of a woman getting pregnant largely were unchanged, which the authors said could be attributed to the small number of study participants (Naik, Wall Street Journal, 6/1).
News of the day
Roche To Offer Developing Countries Discounted Tamiflu
The pharmaceutical company Roche on Wednesday announced a program to help ensure developing countries have access to its antiviral Tamiflu, for "the management of a novel influenza strain defined by the WHO as having significant and current pandemic potential," Reuters reports (Egenter, 7/1). The program will make Tamiflu, which has been shown to be effective against the H1N1 (swine flu) virus, available to developing countries for "half the price normally charged," Dow Jones Newswires/Wall Street Journal reports (Mengewein, 7/1).
Diagnostics

Emphysema Severity Directly Linked To Coal Dust Exposure

Coal dust exposure is directly linked to severity of emphysema in smokers and nonsmokers alike, according to new research from the National Institute for Occupational Safety and Health (NIOSH). "In this study we have shown that coal mine dust exposure is a significant predictor of emphysema severity," said Eileen Kuempel, Ph.D., a senior scientist at NIOSH and lead author of the study. The findings, which were reported in the August 1 issue of the American Thoracic Society"s American Journal of Respiratory and Critical Care Medicine (AJRCCM), highlight a health problem related to a growing industry. In the past 25 years, coal production has nearly doubled worldwide. Dr. Kuempel and colleagues compared lung autopsy results from 722 individuals, including 616 coal miners from West Virginia and 106 non-miners from West Virginia and Vermont. Those from West Virginia were collected from consecutive autopsies from 1957 and 1973 at the Beckley Southern Appalachian Regional Hospital as part of a black lung study. Those from Vermont were taken from consecutive autopsies performed at the University of Vermont between 1972 and 1978. Age at death, race, miner/non-miner status and smoking history were established where possible, and individual exposure to coal dust was estimated using work history data and job-specific dust exposure estimates. Pathologists Francis Green, M.D., and Val Vallyathan, Ph.D., two of the coauthors on this study, examined sections of the lungs to determine the presence and extent of emphysema. A smaller subset of the study group had their lung tissue analyzed for dust content. Emphysema was graded for type and severity. The researchers found that cumulative exposure to respirable coal mine dust was a highly significant predictor of emphysema severity after accounting for cigarette smoking, age at death, and race. Miners tended to be older at death than non-miners due to a higher proportion of accidental or other sudden deaths among the non-miners. Miners also smoked less on average, though differences were nonsignificant. However, emphysema in miners was significantly more severe than in non-miners among both smokers and never-smokers. Unsurprisingly, emphysema was also more severe among smokers than never smokers in both miners and non-miners. Coal mine dust exposure and cigarette smoking had similar, additive effects on emphysema severity in this study. The lung tissue analysis corroborated these findings; the greater the concentration of coal dust in the lungs, the more severe the emphysema. While the data were collected on miners who worked in the mines before the enforcement of the federal standard limiting legal coal dust concentrations to 2mg/m3 imposed in 1972, the study does have immediate relevance to current occupational safety standards. Even at the current federal standard, a full working lifetime"s exposure would produce a cumulative exposure similar to the levels found in the autopsied miners. "Based on our findings, exposure to respirable coal mine dust for a full working lifetime at the current 2 mg/m3 standard would increase the emphysema severity index by 99 points on average. This provides additional evidence of the need to reduce dust exposures to 1 mg/m3 or less as NIOSH has recommended." said Dr. Kuempel. "Furthermore, miners in developing countries may be faced with exposure levels in excess of those reported here. Thus, the effects of dust that we report are relevant to current conditions in many countries, including the U.S." A 99-point increase on the 1000-point emphysema severity index scale is equivalent to an approximately 10 percent increase in diseased lung tissue. Previous studies have shown that a 99-point increase in emphysema severity could mean the difference between "normal" and "abnormal" lung function or the worsening of existing lung function. Coal mine dust exposure is now generally accepted as a cause of COPD, but this study will provide the basis for improved recognition of dust-induced COPD, its relationship to cigarette smoking, and may enhance efforts at prevention, diagnosis and medical management of occupational dust-related lung diseases, according to Dr. Kuempel. "Coal employs over 7 million people worldwide, 90 percent of whom are in developing countries. Coal production has almost doubled in the past 25 years," notes Benoit Nemery, M.D., Ph.D., in an editorial in the same issue of the AJRCCM. "The environmental and climatic impacts of burning coal are, quite rightly, a of concern. However, the direct consequences of extracting coal on the health of millions of coal miners must be an equal concern." "Improving disease surveillance and awareness among healthcare professionals about the occupational components of COPD including emphysema can increase the effective detection and management of these diseases," said Dr. Kuempel. American Thoracic Society (ATS)


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