News in Brief: Week of Sept. 26-30

September 28, 2011 04:40 pm News Staff

This roundup includes the following news briefs:

HHS Releases Final Rule on Medicaid Recovery Audit Program

HHS recently released the final rule governing the operation of the Medicaid recovery audit program. The final rule, "Medicaid Program: Recovery Audit Contractors," was published in the Sept. 16 Federal Register(

The rule implements section 6411 of the Patient Protection and Affordable Care Act and, among other things, directs states to create an appeals process whereby physicians or other health care professionals who serve Medicaid patients can dispute decisions made by Medicaid recovery audit contractors. The rule is effective Jan. 1, 2012.

According to a government fact sheet(, the Medicaid recovery audit program will find and fix improper Medicaid payments; however, audit investigations are limited to three years from the date the claim was paid. HHS estimates that the combined Medicare and Medicaid recovery audit programs will recover some $2.1 billion during the next five years.

Saw Palmetto Ineffective Against BPH-associated Urinary Symptoms

Despite the promise of previous research, a recent study( (abstract) found the dietary supplement saw palmetto extract to be no more effective in treating lower urinary tract symptoms in men with benign prostatic hyperplasia than a placebo. The study, which was supported by the NIH, along with its National Institute of Diabetes and Digestive and Kidney Diseases, National Center for Complementary and Alternative Medicine, and Office of Dietary Supplements, was published in the Sept. 28 issue of JAMA: The Journal of the American Medical Association.

The double-blind, multicenter, randomized trial involved 369 men ages 45 years or older. Men in the treatment group initially received one daily dose (320 mg/d) of saw palmetto extract. The dose was doubled at 24 weeks and tripled at 48 weeks. Both groups were followed for a total of 72 weeks.

The study's primary outcome measure was the difference between American Urological Association Symptom Index, or AUASI, scores at baseline and at 72 weeks. The AUASI is a self-administered seven-item index assessing frequency of lower urinary tract symptoms (range: 0-35 points).

Secondary outcomes included measures of urinary bother; nocturia; peak uroflow; postvoid residual volume; prostate-specific antigen level; participants' global assessments of improvement and satisfaction; and indices of sexual function, continence, sleep quality, and prostatitis symptoms.

Overall, AUASI scores among both study groups dropped slightly, with men in the treatment group experiencing a decline of 2.2 points, while men taking the placebo experienced a decrease of 2.99 points. No dose-dependent effect was seen in the treatment group. In addition, saw palmetto extract was no better than placebo for any secondary outcome measure.

Survey Results: Medical Practices Cut Expenditures 2.2 Percent in 2010

A cost survey conducted by the Colorado-based Medical Group Management Association, or MGMA, has found that medical practices cut general operating expenditures by 2.2 percent in 2010. In addition, the survey found that general operating costs in medical practices have gone up by nearly 53 percent since 2001 to more than $252,000.

According to a Sept. 20 press release( from MGMA, "Cost Survey for Multispecialty Practices: 2011 Report Based on 2010 Data(" includes data from more than 44,000 providers and 1,994 medical groups.

MGMA President and CEO William Jessee, M.D., said in the release that physicians have worked hard to reduce operating expenses and renegotiate rates with vendors, suppliers and insurance companies. "There is only so much more practices can do to cut expenditures without inhibiting their ability to run a successful, innovative practice," said Jessee.

MGMA also conducted a cost survey for single-specialty practices(; reports on both surveys are available for purchase from MGMA.

AHRQ Seeks Medical Office Submissions for Patient Safety Culture Database

The Agency for Healthcare Research and Quality, or AHRQ, is encouraging medical offices that have completed AHRQ's Medical Office Survey on Patient Safety Culture to submit their results( to the agency's Medical Office Survey on Patient Safety Culture Comparative Database. The database serves as a central repository for survey data from medical offices that have administered the AHRQ patient safety culture survey instrument.

AHRQ sponsored development of the survey in response to providers' requests for a survey tool that would help them gauge the patient safety culture in their offices. The survey was designed specifically for medical offices with at least three providers (physicians; physician assistants; nurse practitioners; and other providers licensed to diagnose medical problems, treat patients, and prescribe medications).

Use of the survey in solo or two-provider offices is not recommended because it would not be possible to maintain the confidential nature of individual responses, but it can be used as a tool to initiate open dialog about patient safety and quality issues among providers and staff.

By submitting their data, medical offices are able to compare results for the items and patient safety culture dimensions included on the AHRQ survey with those from other medical offices nationwide. Data may be submitted through Oct. 15.

Campaign Encourages Better Physician, Patient Communication

A new initiative launched on Sept. 20 by the Agency for Healthcare Research and Quality, or AHRQ, in partnership with the Ad Council aims to encourage better communication between physicians and other health care professionals and their patients.

According to an AHRQ press release(, effective two-way communication can lead to better health outcomes. For example, research shows that enhanced communication correlates with higher rates of patient compliance with treatment plans.

As part of the initiative, the AHRQ website features a series of videos( that demonstrate effective physician-patient communication. The website also has other resources, including an interactive "question builder" tool, a brochure called "Be More Involved in Your Health Care: Tips for Patients," and notepads( for use in medical offices that are designed to help patients prioritize the top three questions they want to discuss during their medical appointment.