Dig deeper when assessing pain in the elderly

This issue includes stories on assessing and managing pain in the elderly, the pros and cons of ACOs, and details on the Physician Payments Sunshine Act.

Internists have various tools at their disposal for assessing pain, but in elderly patients, unfortunately, a lot of them don't work. Research has shown that scales of zero to 10 as well as pictorial representations aren't always accurate in the elderly and can lead to distorted readings of distress. But there are ways around this, experts say, including using larger scales, such as zero to 100, and asking specific questions with yes/no answers. Stacey Butterfield details what works in the elderly, what doesn't, and how to ensure that elderly patients' pain is dealt with appropriately.

In our May issue, we discussed the risks and benefits of joining a large health system. This month, we cover the basics of accountable care organizations (ACOs), which have been growing in popularity in recent years. ACOs can be an attractive option because they allow physicians to join together to improve quality of care, but they also have their own pitfalls. Our story dissects the types of ACOs available and what physicians need to consider before jumping in, namely the ACO's culture and priorities, the level of autonomy physicians can retain, and the resources and technology that will be offered. And also read about the nitty-gritty of negotiating contracts with an ACO, including how to dissolve a partnership in the future if it doesn't work out.

Beginning Aug. 1, the Physician Payments Sunshine Act, part of the Patient Protection and Affordable Care Act, will go into effect. This means that drug and device manufacturers and group purchasing organizations are required by law to begin collecting data on gifts or transfers of value to physicians. CMS will start publicly reporting the data on the Web on Sept. 30, 2014, and will perform annual updates thereafter each June 30. Although physicians don't have to do the reporting themselves, they should still be aware of what's being reported and how. Our story tells you what you need to know.

Also in this issue, Joshua M. Liao, MD, an ACP Resident/Fellow Member, reflects on his just-concluded intern year at Boston's Brigham and Women's Hospital. And learn about the College's annual Leadership Day, when ACP members visit Capitol Hill to talk to senators and representatives about pressing priorities in health care.

We hope you enjoy this issue. Let us know what you think.


Jennifer Kearney-Strouse