 has begun charging for some electronic messages its doctors send to patients.

On November 17 the Cleveland Clinic began billing patients’ insurers for messages that typically take more than five minutes to answer and require a doctor’s “medical expertise,” according to 

 on the Clinic’s website. Among these are:

check-ups on care for long-term conditions, and

Message charges will be billed to patients’ insurers. For Medicare beneficiaries, that could result in an out-of-pocket charge of between$3 and $8. Most commercial insurers cover these messages at little or no cost to the patient, the Clinic says. However, patients with plans that don’t cover messages could see charges anywhere between $33 and $50.

“The provider looking at your message might be reviewing the information you sent over and changing part of your treatment plan, or recommending you get a test to learn more. They might need to look at your medical history and do an in-depth review of your records to make sure they give you the best possible advice,” according to the announcement.

The Clinic uses the MyChart electronic health record for its messaging system.

questions about an issue for which the patient was seen within the past seven days,

check-ins that are part of follow-up care after a procedure, or

The Clinic’s announcement comes at a time of financial stress for hospitals and hospitals. The median year-to-date operating margin index for hospitals was -0.1% in September, for a ninth straight month of negative actual operating margins, according to findings in the latest 

Primary care doctors seemingly endorse getting reimbursed for electronic messaging. In a recent 

, 86% said reimbursement for responding to queries through emails, texts, or phone calls was an important tool for enhancing access to care and improving outcomes.

But PatientRightsAdvocate.org, a nonprofit organization advocating price transparency, takes a different view. In 

 on cleveland.com, founder and chairman Cynthia A. Fisher calls the practice “egregious.”

“Billing them [patients] for electronic messages to their providers is just the latest attempt to wring even more blood from the stone,” she said.

This article originally appeared on Medical Economics®. 

Articles

Cleveland Clinic begins charging for doctors’ time spent responding to some electronic messages.

Five minutes of a doctor’s time could cost patients $50

You can reach her a lcarr@mjhlifesciences.com.

Alison Cowan, MD, ob-gyn hospitalist and head of medical affairs at Mirvie, discusses the latest predictions for women’s health in 2023. From maternal mortality to preterm birth, Cowan dives into what health conditions will be affecting women most in 2023 and how the specialty is trying to combat these issues.

Podcasts

In this episode of Pap Talk, Alison Cowan, MD, discusses her predictions for women's health trends in 2023.

Pap Talk S4E10: 2023 women's health outlook

Dextromethorphan was not a successful adjunctive pain management option for medication abortion, according to research results published in 

Through a randomized, double-blinded, placebo-controlled trial, investigators used data from 156 women who were eligible for medication abortion at Planned Parenthood of Western Pennsylvania to evaluate dextromethorphan (DXM) as a non-narcotic option for post-abortion pain management.

Investigators randomized 156 women to adjunctively take DXM—loading dose 60 mg and 2 subsequent 30 mg doses at 2 and 5 hours after misoprostol administration—or placebo combined with nonsteroidal anti-inflammatory medications (NSAIDS) and/or opioids for pain. Patients reported pain scores and satisfaction 2, 5, 8, and 24 hours after misoprostol administration via a secure texting application. The study’s primary outcomes were worst pain score and total analgesic use.

Patients were able to opt for a printed oxycodone prescription—10 tabs of 5 mg—to fill at their pharmacy. All patients received routine counseling to take ibuprofen—600 mg orally every 6 hours as needed and/or acetaminophen for pain control during the medication abortion process and to secondarily use the prescribed opioid as needed.

Results showed no difference in worst pain scores for patients receiving DXM versus placebo (8.0 vs 7.0 

0.06), or in total milligram usage of ibuprofen (800 mg vs 610 mg, 

 = .62), acetaminophen (10000 mg vs 1300 mg, 

 = 0.51). Patients randomized to placebo were significantly more likely to be satisfied with their pain control (91% vs 75%, p = 0.02).

Patients receiving placebo were significantly more likely to rate their pain control as good or very good, compared to the DXM group (91% vs 75%, 

= 0.02). While patient age was a differing factor between groups (25.8 vs 27.4, 

< 0.05), dissatisfaction scores did not differ by patient age after adjustments (95% vs 71%, 

Of total patients, 124 (79%) opted to receive oxycodone prescriptions. Of those, 78 (63%) filled their prescriptions, and 6 of/156 (40%) reported taking any oxycodone during their medication abortion.

Patients who opted for an opioid prescription but did not get it filled reported lower rates of satisfaction in the DXM arm compared to placebo (70% vs 95% 

Investigators found worse pain scores and significantly less satisfaction in the DXM group overall, contrary to previous research that found DXM beneficial as an adjunctive option for gynecologic surgery.

“Given that patients do experience severe pain during this process, we should seek to improve patient use of ibuprofen, which is effective, and counsel patients on safe disposal of unused opioids,” the investigators concluded.

Ferguson GP, Achilles SL, Meyn LA, et al. Dextromethorphan as a novel nonopioid adjunctive agent for pain control with medication abortion: A randomized controlled trial. 

. Published online November 2022. doi:10.1016/j.contraception.2022.10.010

Results from a randomized controlled trial study suggest dextromethorphan may even worsen patient pain experience. 

Dextromethorphan ineffective adjuvant option for medication abortion pain management

At the American College of Rheumatology (ACR) Convergence 2022, Amit Golding, MD, PhD, medical officer for the US Food and Drug Administration (FDA), provided updates on recent FDA approvals for drugs and discussed how biosimilars are approved.

Golding outlined the 4 categories of similarity between adult and pediatric conditions. Different conditions show no overlap, dissimilar conditions contain slight overlap with significant differences, similar conditions show significant overlap with slight differences, and same conditions show significant overlap with no clear significant differences.

The first approval discussed by Golding was the use of belimumab IV (BENLYSTA; GlaxoSmithKline plc) for pediatric lupus nephritis in patients aged 5 to 17 years. Approval was based on established efficacy in adults and a successful study in pediatric patients. The pediatric dosage is 10 mg/kg in 2-week intervals for the first 3 doses, followed by 4-week intervals, matching the adult dosage.

Another approval was the use of ustekinumab SC (Stelara; Janssen Pharmaceuticals) for psoriatic arthritis in pediatric patients aged 6 to 17 years. The approval followed efficacy in adults and completed studies in pediatric patients with plaque psoriasis. A dosage based on weight is given 4 weeks after the initial dose, then every following 12 weeks.

Golding also discussed a study for secukinumab (COSENTYX; Novartis) for pediatric psoriatic arthritis and enthesitis-related arthritis. The study evaluated the treatment in pediatric patients aged 2 to under 18 years. In part 2 of the study, participants were randomized to secukinumab or placebo, with a primary endpoint of time to flare.

Following the study, approval was given to the product. Adverse events were mild and matched the safety profile for secukinumab, and efficacy for reducing flare rate was proven.

In discussing biosimilars, Golding described them as treatments that are highly similar and with, “no clinically meaningful differences from the FDA approved reference product.” They use the same mechanisms for conditions of use, which have been previously approved for the reference product. Biosimilars should meet the standards of safety, purity, and potency.

To evaluate differences in products, Golding recommended analytical study. Golding also stated that a biosimilar should have similar efficacy and safety as the reference product, and that an assessment of immunogenicity should be conducted.

This article originally appeared on Contemporary Pediatrics®.

Golding, A. Pediatric rheumatology FDA update 2022 ACR Convergence November 14, 2022. Presented at: ACR Convergence 2022, Philadelphia, Pennsylvania. November 11 to November 14, 2022.

At ACR Convergence 2022, Amit Golding, MD, PhD, outlined drugs recently approved by the FDA, and discussed the requirements for biosimilars to meet approval.

Updates on FDA drug approvals

What are some of the challenges about diagnosing recurrent VVC [vulvovaginal candidiasis]? Do you think people are very aware in the community at large?

The first issue really, as far as diagnosis is concerned, is so-called self-diagnosis. This is the ability of any individual woman to be able to diagnose with great certainty that her symptoms are attributable to a yeast. Self-diagnoses are remarkably inaccurate. I know there’s always going to be some argument from the people listening in on this, participants hearing this, watching this video, but really there are numerous good objective studies that show just how unreliable self-diagnosis is. That doesn’t mean patients, women, don’t have symptoms, it simply means that the symptoms are entirely nonspecific. There’s nothing unique to the symptoms that says, “Oh, I obviously do have a yeast infection.” Repeatedly, women are referred to me because of recurrent candida vaginitis, and when I start interrogating and talking to them, and getting a history, and we do the appropriate tests, we find that there’s a lot of overdiagnosis of recurrent infections and there are some elements of underdiagnosis, especially for chronic disease. But you’ve already outlined the various symptoms involved, so the next issue, as far as diagnosis is concerned, it’s not difficult to diagnose once the patient finds herself visiting a practitioner, and this is not a telehealth visit. Telehealth is a wonderful advance in medicine and science, but in the diagnosis of vaginitis it’s about 10 steps backwards. You cannot diagnose reliably any form of vulvovaginal disease without seeing a practitioner who takes a history and does a good physical examination as well as the appropriate immediate local tests that are available within the doctor’s office.

I agree with you. The physical exam is invaluable and we’ll touch upon the concept of overdiagnosis, underdiagnosis in a little bit and how the impact of telehealth and teleprescribing, and you had mentioned that people are misdiagnosing or over the counter, we don’t have confirmation of diagnoses, so overdiagnosis. Every vaginitis is not yeast. Sometimes there’s BV [bacterial vaginosis]. Sometimes there’s a mixed infection. Sometimes it’s vulvovaginal atrophy. I think part of the issue that we are seeing is we have created this issue where there is a lot of telephone diagnosis and treatment because we didn’t have a choice with COVID-19, and then we’re overtreating. We’re seeing the emergence of resistance. We’re seeing more nonalbicans candidiasis. We’re seeing a variety of things that are changing in the landscape.

Videos

Michael L. Krychman, MD, and Jack D. Sobel, MD, review diagnostic criteria of diagnosis of RVVC and the impact of misdiagnosis.

The Challenges of Diagnosing Recurrent Vulvovaginal Candidiasis

The volume of fat mass, as analyzed by a Principal Component Analysis (PCA), was shown to negatively modulate the severity of fibromyalgia syndrome (FMS), according to a study published in Reumatología Clínica.1 Investigators urge clinicians to evaluate body composition as part of the basic clinical approach for the treatment of this patient population.

“Since at least part of the pathogenesis of FM appears to be influenced by impaired regulation of pain modulating cytokines,both centrally and peripherally, the hypothesis that body composition can modulate the symptomatic context of fibromyalgia syndrome is perfectly plausible, although the results coming from studies devoted to the topic are contradictory,” investigators stated.

In this observational, quantitative, cross-sectional study, the association between type of body composition and FMS was evaluated using 43 women with clinically diagnosed FMS, per the American College of Rheumatology (ACR) 2010 criteria.

Clinical outcome measures included the Fibromyalgia Impact Questionnaire (FIQ), Symptom Severity Scale (SSS), and the Widespread Pain Index (WPI). Anthropometric data was categorized into PCA-

. Patients were also classified into high and low categories for each clinical indicator, which were used in the binomial logistic regression (BLR) models. Inclusion criteria included female sex, aged 18 years or older, with a clinical diagnosis of fibromyalgia (FM). Patients were selected through the Rheumatology outpatient clinic at the Yucatán Peninsula’s High Specialties Regional Hospital.

The median age of patients was 52.7 (± 11.3 years) years and had an average disease duration of 53.6 ± 54 months. Most patients were currently receiving some form of medication, including nonsteroidal anti-inflammatory drugs (NSAIDs) (65%, n = 30), opioids (28%, n = 13), and benzodiazepines or antidepressants (62%, n = 27, combined). Nearly all patients were classified as overweight or obese (90.7%), and most had 1 or more comorbidity (62.7%).

A positive correlation was shown between PCA-

 and both WPI (r = 0.326, P = .043) and FIQ (r = 0.325, 

 = .044). There was a negative correlation between PCA-

 was a significant predictor of high WPI (OR = 2.477, 

 was an inversely significant predictor of high SSS (OR = 0.303, 

“Our results strongly suggest that hyper-adiposity states may negatively modulate the clinical severity in FM,” investigators concluded. “Thus, body composition appraisal must be part of the global assessment of FM patients, with mandatory nutritional counseling, and special emphasis in the diet, from which patients can see benefits ranging from reduced anxiety symptoms, mood disturbance, and even disappointment with body image.”

This article originally appeared on Rheumatology Network®.

Álvarez-Nemegyei J, Pacheco-Pantoja EL, Olán-Centeno LJ, Angulo-Ramírez A, Rodríguez-Magaña FE, Aranda-Muiña JF. Association between fibromyalgia syndrome clinical severity and body composition. A principal component analysis. 

. 2022;18(9):538-545. doi:10.1016/j.reumae.2021.09.008

The association between type of body composition and fibromyalgia was evaluated using 43 women with clinically diagnosed fibromyalgia.

Volume of fat mass negatively impacts severity of fibromyalgia

Bacterial vaginosis during pregnancy may heighten risk of preterm birth, pregnancy loss

Bacterial vaginosis during pregnancy may lead to increased risks for preterm birth, preterm delivery, and spontaneous abortion, according to new research in the Archives of Gynecology and Obstetrics.

In case you missed it: November 21 to November 25

For the first time ever, investigators have found allopurinol use is associated with a decreased risk of first-ever acute coronary syndromen(ACS) for patients with 

A team, led by Panagiota Drivelegka, Department of Rheumatology, Sahlgrenska University Hospital, examined whether allopurinol use impacts the risk of first-ever acute coronary syndrome in patients with incident gout in data presented during the 

American College of Rheumatology Convergence 2022

Patients with gout are at an increased risk of cardiovascular disease, with more and more evidence identifying gout as an independent risk factor.

In the study, the investigators identified data from regional and national population-based registered for 19,054 patients in Western Sweden with first ICD-coded diagnosis for gout between 2007-2017. The participants did not have previous exposure to allopurinol or a prior history of coronary heart disease.

The investigators sought outcomes of interest of the occurrence of a first-ever ACS event. The investigators began follow-up from the first ICD-coded diagnosis for gout and ended after either the outcome, death, emigration, or the end of study on December 31, 2017.

They defined exposure to allopurinol as none (no dispensed prescription within 125 days from the end of follow-up) (reference group), 100mg, or >100mg, according to the last dispensed prescription within 125 days from the end of follow-up.

The team used logistic regression models with adjustments for age, sex, education level, comorbidity index, dispended prescriptions for cardiovascular drugs, anticoagulants/platelet aggregation inhibitors, and/or cortisone within 6 months from the end follow-up, and follow-up time.

Overall, women were older than men in all exposure categories, while exposure to allopurinol was linked to older age, longer follow-up time, and more comorbidities.

There were lower odds ratios for first-ever ACS events in groups exposed to 100 mg and >100mg allopurinol compared to those not exposed (OR, 0.72; 95% CI, 0.59-0.88; and OR, 0.54; 95% CI, 0.40-0.72, respectively). This was also true for just male patients (OR, 0.72; 95% CI, 0.57-0.92; and OR, 0.57; 95% CI, 0.40-0.79, respectively).

For women, exposure to more than 100 mg was linked to significantly lower odds ratios for first-ever ACS event (OR, 0.46; 95% CI, 0.25-0.85). On the other hand, exposure to 100 mg was not associated with a lower risk of first-ever ACS event (OR, 0.72; 95% CI, 0.50-1.02).

Exposure to more than 100 mg allopurinol was associated with lower odds ratios for first-ever ACS event than exposure to 100mg in both men and women.Finally, the risk of first-ever ACS event was similar between men and women.

“Current allopurinol use was associated with significantly lower risk of first-ever ACS event in patients with incident gout in a dose-dependent fashion, suggesting a protective effect for allopurinol,” the authors wrote. “The effect of allopurinol was similar in men and women.”

Allopurinol Use and Risk of Acute Coronary Syndrome in Patients with Incident Gout: A Population-based Study in Sweden

Exposure to more than 100 mg was linked to significantly lower odds ratios for first-ever ACS event for women.

Allopurinol use linked to lower risk of first-ever coronary event

 and joined the MJH Life Sciences team in December 2019. She graduated from Youngstown State University in 2019 with a bachelor's degree in journalism and a minor in political science. Prior to graduating, Morgan worked as the editor-in-chief of her college newspaper. She went on to work as an assignment editor at a broadcast news station in Youngstown, Ohio before joining 


Moawad is the chair of the American Association of Gynecologic Laparoscopists (AAGL)Steering Committee of EMIGS, and chief of the Division of MIGS at the Unversity of Florida.

In this bonus episode, Nash Moawad, MD, MS, FACOG, FACS, sits down to discuss the recent standardization of Essentials of Minimally Invasive Gynecologic Surgery (EMIGS) training program for minimally invasive gynecologic surgeons and how it's shaping the way this subspecialty delivers care.

Pap Talk: Bonus episode S4E11: EMIGS with Dr. Nash Moawad

Consensus statement on Rh pregnancy testing

Rhesus (Rh) immunoglobulin should be given only after 12 weeks gestation for spontaneous abortion, or for medication or uterine aspiration abortion, according to a new consensus statement from the Society of Family Planning (SFP).

Prenatal care limited among immigrant groups

In a recent study, immigrant women were less likely to receive access to timely prenatal care than women born in the United States.

Pfizer announces topline data for its bivalent RSV vaccine candidate

Pfizer announced that its bivalent respiratory syncytial virus vaccine—when given to women during pregnancy—has shown effective in protecting infants from reducing severe symptoms during their first 6 months of birth.

Hospitals, health systems, and providers having one of the most difficult financial years on record

Declining volume and revenue with increasing expenses mean many systems are ending the year in the red.

Endometrial ablation in the office setting

Breaking down barriers through patient selection, new devices, and the latest techniques.

In an exclusive interview, Nash Moawad, MD, MS, FACOG, FACS, discussed the recent implementation of the Essentials of Minimally Invasive Gynecologic Surgery (EMIGS) training program, which helps physicians provide the best care and ensure optimal safety for their patients.

CDC updates opioid prescribing guidelines

Revisions to 2016 document focus on provider flexibility and unique circumstances of every prescribing decision.

Diagnosing and treating the adolescent with irregular menstruation

At the 2022 AAP National Conference & Exhibition, a professor from the Baylor College of Medicine discusses how to develop an approach to investigate menstrual disturbances for adolescent patients and understand treatment options.

Highlights from the 25th Annual Premier Women’s Healthcare Conference

Houston, Texas, was buzzing with the latest updates in women’s health at the 25th Annual Nurse Practitioners in Women’s Health Premier Women’s Healthcare Conference held from September 29 to October 2, 2022.

Chemical hair straightening may increase uterine cancer risk

A new NIH study found women who used chemical hair straightening products to be at a higher risk for uterine cancer than women who didn’t use these products.

FDA approves IUD to prevent pregnancy for up to 8 years

The Food and Drug Administration (FDA) has approved Medicine360’s supplemental new drug application to extend the use of its levongestrel-releasing intrauterine system 52mg (LILETTA) to prevent pregnancy for up to 8 years.

Iranian hackers emerge as cyberthreat to health care computer networks

‘Charming Kitten’ believed to be a front for Islamic Revolutionary Guard Corps, according to HHS’ cybersecurity agency.

Dare Bioscience announces grant to develop vaginal thermosetting gel for delivery of live biotherapeutics

Daré Bioscience announced yesterday that it has received a grant from the Bill & Melinda Gates Foundation of $584,986 to support its efforts related to the development of a vaginal thermosetting gel formulation for the delivery of live biotherapeutics that can be reconstituted at the point of care.

Amazon Clinic to offer online primary care services in 32 states

Telehealth store doesn’t accept insurance yet, but Amazon Pharmacy will deliver prescriptions.

FDA grants accelerated approval to mirvetuximab soravtansine-gynx for ovarian cancer

This is the first FDA-approved ADC for platinum-resistant disease, according to ImmunoGen.