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DSM-5 Debate: Committee Adds/Deletes Some Controversies
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The committee responsible for revising the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (the DSM) has dropped the inclusion of two controversial new diagnoses that it had previously proposed, and re-opened its website for public comment on other potential revisions.
One of the new diagnoses that the editors chose to exclude is "attenuated psychosis syndrome," a condition designated to describe youth who are at high risk of developing schizophrenia - before they develop the full-fledged disorder. Problem is that only 8% of those categorized as "high risk" because they having close relatives with the disorder or have suggestive symptoms actually went on to develop schizophrenia, according to a recent study. Many critics of the new diagnosis feared that it would legitimize the potentially dangerous practice of administering powerful antipsychotic drugs to youths.
The committee also dropped a new diagnosis called "mixed anxiety depressive disorder," an unnecessary designation that could have further encouraged prescription of medications. (It also made for an unfortunate acronym.)
But other major controversies remain unaddressed. Although some language was changed, the committee still seems determined to include bereavement in the definition of depression, which could allow someone who is going through normal grief after a loss to be diagnosed with major depression. Another change that remains is the elimination of the diagnosis of Asperger's syndrome, which will be subsumed under autism spectrum disorders in the DSM-5. Autism advocates oppose the change because they are concerned that families affected by Asperger's will lose critical educational and other services. (TIME)
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Tougher Requirements for Expert Witnesses Benefit Doctors in Malpractice Suits
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One of the most successful ways to control and diminish medical malpractice suits involves limitation of experts who can testify. This phenomenon, which occurs by legislative action, has remained largely unreported, but it is a method that is gaining in popularity in some state legislatures. There is a risk that state supreme courts may overturn these efforts, but continued efforts in this direction hopefully will prevail and lead to fewer medical malpractice suits.
This requirement has been an unrecognized benefit to doctors because it has resulted in a significant decrease in the number of suits filed. Plaintiffs' attorneys have found it difficult to identify an appropriate expert who meets the standards and is willing to testify.
There are generally 2 standards that must be met by would-be expert witnesses: training and location. An expert is usually required to practice within the same specialty and in the area of testimony at the time the alleged malpractice event occurred. Another requirement is provision of a pretrial report or affidavit attesting that substandard care occurred on a more-likely-than-not basis, which must be provided at the time the case is filed with the court. This has proven to be increasingly difficult; it is expensive, the trial court is more likely to reject them, and experts face retribution from state boards and hospitals where they practice. Texas and Florida have been successful in their efforts to be more stringent of experts. Read more at Medscape. |
E-Rx Penalty Deadline Approaching
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The American Medical Association (AMA) today reminds physicians that June 30, 2012 is the deadline to report on at least 10 electronic scripts to avoid the 2013 Medicare e-prescribing program penalty. Physicians who are not able to meet the requirements of the program should apply for a hardship exemption applicable to their particular case before the June 30, 2012 deadline.
"While we do not think physicians are being given enough time to comply with the Medicare e-prescribing program, we want to make them aware of the upcoming e-prescribing deadline so they can take steps now to prevent being hit with the 2013 penalty," said AMA Immediate Past-President Cecil B. Wilson, M.D.
In November 2011 CMS released the final regulation on the 2013 Medicare e-prescribing penalty program. The penalty for not successfully participating in the program, or not filing for an exemption on time, is a 1.5 percent payment reduction for all Medicare claims based on the 2013 fee schedule amounts during the year. To apply for an exemption, visit https://www.qualitynet.org/portal/server.pt/community/communications_support_system/234.
To learn more about the e-prescribing penalty and the reporting requirements, visit http://www.ama-assn.org/resources/doc/hit/avoid-erx-penalty-tip.pdf.
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