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Issue Date: July 2006

Leaders Identify Top Health Care Innovations
Recently, 100 health care leaders were asked to identify the most important innovations that are transforming health care in the United States. The leaders included representatives from hospitals, physician groups, health care suppliers, and policy makers. Interestingly, there was a lot of agreement among the 100 leaders interviewed by telephone in May and June.
In particular, they agreed that pay-for-performance programs supported by patient outcomes data is one of the strongest trends operating in health care today. Given that data are impersonal and non-judgmental, using numbers to segregate the best physicians from other providers would seem to be a sensible way to address concerns about quality. But physicians are worried that the data being used to evaluate them may come from a sample size that is too small, or that the collection methods do not reflect the actual art and science involved in delivering health care to patients. Nevertheless, health care buyers are using data to pay more to those who show they deliver top-quality care.

Is Virtual Colonoscopy Screening Ready for More Widespread Use?
Virtual reality is a hot topic these days. It is perhaps small wonder, then, that virtual colonoscopy has garnered intense interest both in the medical community and the general public. In this era of virtual reality, what could be better than a noninvasive technique that detects the second deadliest cancer at early, curative stages? But is this procedure, more properly known as computed tomography colonography (CTC), ready for widespread use as a screening tool for colorectal cancer (CRC)? Do the advantages of the procedure outweigh the disadvantages? Advocates of this procedure, including C. Daniel Johnson, MD, professor of radiology at Mayo Clinic College of Medicine in Rochester, Minn., emphasize its multiple advantages. “It is noninvasive, quick, does not require sedation, is highly acceptable to patients, has a much lower cost than colonoscopy, and, under good hands, can detect polyps just as well as colonoscopy,” he says.

Take Steps to Protect Financial Assets
Physicians and other high-income individuals should recognize that the financial planning steps outlined for most Americans may not apply to them. As professionals who earn more than the average worker, physicians must take unusual steps to protect their financial assets. There are many ways that a physician can lose his or her personal and practice assets. One way is in a lawsuit against the physician, his or her partners, or employees. In addition to the malpractice risks of a medical practice (which may be covered in part by liability insurance), physicians have other business risks that would not be covered by a malpractice policy. These risks may result from being an employer, a leaseholder, or a landlord.

Adolescent GERD Medicines: Safety of Active and Inactive Ingredients
One of the mantras of the pediatrician is, “Children are not small adults.” This statement is particularly important when pediatricians are prescribing pharmaceutical agents, including medications for pediatric gastroesophageal reflux disease (GERD). Although the two major classes of GERD medications, proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs), are commonly used in both adults and children, there are important differences between the two populations. Children who are treated with PPIs, for example, usually require a higher dose for each pound of body weight than adults due to differences in drug metabolism. Even within the pediatric population, the age of the child makes a difference. In one study, famotidine, an H2RA, was found to result in reversible agitation in more than 10% of children less than 1 year of age, but this effect has not been seen in older children or adults.