Alicia Ault

The federal government published regulations June 18 that will allow for temporary certification of electronic health records - the first step in helping physicians and other providers get the software and hardware required to be eligible for bonus payments under federal health programs.

According to the Office of the National Coordinator for Health Information Technology (ONC), the rule "establishes processes that organizations will need to follow in order to be authorized by the National Coordinator to test and certify [electronic health record] technology."

"We hope that all [health information technology] stakeholders view this rule as the federal government's commitment to reduce uncertainty in the health IT marketplace and advance the successful implementation of EHR incentive programs," said Dr. David Blumenthal, national coordinator for health information technology, in a statement.

Certification means that the EHR package has been tested and includes the required capabilities to meet the "meaningful use" standards issued by ONC. Hospitals and physicians will have the assurance that the certified EHRs can help them improve the quality of care and qualify for bonus payments under Medicare or Medicaid.

The incentive payments were authorized by the Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the American Recovery and Reinvestment Act.

"By purchasing certified EHR technology, hospitals and eligible professionals and hospitals will be able to make EHR purchasing decisions knowing that the technology will allow them to become meaningful users of electronic health records, qualify for the payment incentives, and begin to use EHRs in a way that will improve quality and efficiency in our health care system," Dr. Blumenthal said.

The current rule was for a temporary certification program. A final rule on permanent certification of EHRs will be issued in the fall.

For more information about the temporary certification program and rule, please visit http://healthit.hhs.gov/certification.

The federal government published regulations June 18 that will allow for temporary certification of electronic health records - the first step in helping physicians and other providers get the software and hardware required to be eligible for bonus payments under federal health programs.

According to the Office of the National Coordinator for Health Information Technology (ONC), the rule "establishes processes that organizations will need to follow in order to be authorized by the National Coordinator to test and certify [electronic health record] technology."

"We hope that all [health information technology] stakeholders view this rule as the federal government's commitment to reduce uncertainty in the health IT marketplace and advance the successful implementation of EHR incentive programs," said Dr. David Blumenthal, national coordinator for health information technology, in a statement.

Certification means that the EHR package has been tested and includes the required capabilities to meet the "meaningful use" standards issued by ONC. Hospitals and physicians will have the assurance that the certified EHRs can help them improve the quality of care and qualify for bonus payments under Medicare or Medicaid.

The incentive payments were authorized by the Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the American Recovery and Reinvestment Act.

"By purchasing certified EHR technology, hospitals and eligible professionals and hospitals will be able to make EHR purchasing decisions knowing that the technology will allow them to become meaningful users of electronic health records, qualify for the payment incentives, and begin to use EHRs in a way that will improve quality and efficiency in our health care system," Dr. Blumenthal said.

The current rule was for a temporary certification program. A final rule on permanent certification of EHRs will be issued in the fall.

For more information about the temporary certification program and rule, please visit http://healthit.hhs.gov/certification.

The federal government published regulations June 18 that will allow for temporary certification of electronic health records - the first step in helping physicians and other providers get the software and hardware required to be eligible for bonus payments under federal health programs.

According to the Office of the National Coordinator for Health Information Technology (ONC), the rule "establishes processes that organizations will need to follow in order to be authorized by the National Coordinator to test and certify [electronic health record] technology."

"We hope that all [health information technology] stakeholders view this rule as the federal government's commitment to reduce uncertainty in the health IT marketplace and advance the successful implementation of EHR incentive programs," said Dr. David Blumenthal, national coordinator for health information technology, in a statement.

Certification means that the EHR package has been tested and includes the required capabilities to meet the "meaningful use" standards issued by ONC. Hospitals and physicians will have the assurance that the certified EHRs can help them improve the quality of care and qualify for bonus payments under Medicare or Medicaid.

The incentive payments were authorized by the Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the American Recovery and Reinvestment Act.

"By purchasing certified EHR technology, hospitals and eligible professionals and hospitals will be able to make EHR purchasing decisions knowing that the technology will allow them to become meaningful users of electronic health records, qualify for the payment incentives, and begin to use EHRs in a way that will improve quality and efficiency in our health care system," Dr. Blumenthal said.

The current rule was for a temporary certification program. A final rule on permanent certification of EHRs will be issued in the fall.

For more information about the temporary certification program and rule, please visit http://healthit.hhs.gov/certification.

WASHINGTON – The federal government is seeking to track acute and long-term health effects in individuals working to clean up the BP oil spill in the Gulf of Mexico and is enlisting health care providers to assist, the director of the National Institute for Occupational Safety and Health (NIOSH) testified at a hearing June 16.

Dr. John Howard said that the agency he leads had begun enrolling workers in what could end up becoming a formal registry. NIOSH is anxious to have a full list of anyone involved in the clean-up, he said, noting that no such list was compiled for volunteers and others who helped at Ground Zero in the wake of Sept. 11, 2001. The lack of such a list made it difficult to go back and correlate either acute or long-term health complaints with exposure, he said.

NIOSH is “trying to keep all health care professionals alerted to our rostering effort,” so that all workers who are potentially exposed to any hazards are included in the database, Dr. Howard said. He called on Gulf region physicians to refer to NIOSH any patients they might see who have worked on the clean-up effort.

NIOSH employees have gone into the field and to BP-operated training centers to ask workers to complete a simple one-page questionnaire. The questionnaire seeks demographic data, whether the worker is a contractor, BP employee, or volunteer. It includes specific questions relating to the type of work being done, duration of the work, and whether the person smokes or has been vaccinated for tetanus. Federal officials hope to post the questionnaire online shortly, and are asking physicians who encounter workers to direct them to NIOSH to complete the survey.

So far, 13,000 workers have completed forms, said Dr. Howard, but he estimates that at least another 15,000-20,000 people are working on the clean-up. NIOSH asked for but has yet to receive a full list of BP workers involved, Dr. Howard said. “It’s a simple request,” he said to reporters after the hearing. Dr. Howard expressed consternation that the oil company had yet to respond.

Clean-up workers will receive the most significant exposure to toxic substances, he said, adding that they would be the best group to study to determine long-term risks. Currently, there are little data on long-term health effects of exposures to oil and to the chemicals, such as dispersants, being used in the clean-up, Dr. Howard said.

The federal government also is attempting to track exposures in the general population. The American Association of Poison Control Centers has directed its 60 local centers in all 50 states to code any calls related to the oil spill so that the Centers for Disease Control and Prevention (CDC) can track them, said Dr. Howard. As of May 27, there were 93 calls, mostly from Louisiana and Mississippi. Thirty-four callers had been exposed to oil and reported symptoms including cough, nausea, headache, eye irritation, chest pain, and dizziness, according to data on the CDC’s Web site.

Health issues are also being tracked through BioSense, an existing network of health facilities that track health changes in real time and report back to the CDC. There are 86 participating facilities in the five Gulf states. So far, there have been some spikes in skin irritation and asthma in two states; investigations are continuing.

State health departments in Alabama, Florida, Louisiana, and Mississippi are also soliciting reports and tracking illnesses. At press time, the Louisiana Department of Health and Hospitals reported 109 spill-related illnesses – 74 from workers and 35 from the public. Thirty-three cases were reported through poison control centers; 43 through emergency departments; and others from urgent care centers, clinics, physician offices and a hotline. Most of the complaints were of odors or inhalation issues. There were nine hospitalizations, all in workers.

Many lawmakers at the hearing said they were concerned that both workers and residents of the Gulf states were being given confusing messages about health and safety and where to report exposures or problems. In addition to the state health departments, the CDC, NIOSH, and BP are also taking exposure reports.

Dr. Howard said that was one reason he was pushing BP to correlate its list with NIOSH. He also said that he supports a centralized Web site for all the spill-related data.

The Environmental Protection Agency is also monitoring the air, water, and soil and issuing reports on its Web site; the Food and Drug Administration is tracking seafood safety.

WASHINGTON – The federal government is seeking to track acute and long-term health effects in individuals working to clean up the BP oil spill in the Gulf of Mexico and is enlisting health care providers to assist, the director of the National Institute for Occupational Safety and Health (NIOSH) testified at a hearing June 16.

Dr. John Howard said that the agency he leads had begun enrolling workers in what could end up becoming a formal registry. NIOSH is anxious to have a full list of anyone involved in the clean-up, he said, noting that no such list was compiled for volunteers and others who helped at Ground Zero in the wake of Sept. 11, 2001. The lack of such a list made it difficult to go back and correlate either acute or long-term health complaints with exposure, he said.

NIOSH is “trying to keep all health care professionals alerted to our rostering effort,” so that all workers who are potentially exposed to any hazards are included in the database, Dr. Howard said. He called on Gulf region physicians to refer to NIOSH any patients they might see who have worked on the clean-up effort.

NIOSH employees have gone into the field and to BP-operated training centers to ask workers to complete a simple one-page questionnaire. The questionnaire seeks demographic data, whether the worker is a contractor, BP employee, or volunteer. It includes specific questions relating to the type of work being done, duration of the work, and whether the person smokes or has been vaccinated for tetanus. Federal officials hope to post the questionnaire online shortly, and are asking physicians who encounter workers to direct them to NIOSH to complete the survey.

So far, 13,000 workers have completed forms, said Dr. Howard, but he estimates that at least another 15,000-20,000 people are working on the clean-up. NIOSH asked for but has yet to receive a full list of BP workers involved, Dr. Howard said. “It’s a simple request,” he said to reporters after the hearing. Dr. Howard expressed consternation that the oil company had yet to respond.

Clean-up workers will receive the most significant exposure to toxic substances, he said, adding that they would be the best group to study to determine long-term risks. Currently, there are little data on long-term health effects of exposures to oil and to the chemicals, such as dispersants, being used in the clean-up, Dr. Howard said.

The federal government also is attempting to track exposures in the general population. The American Association of Poison Control Centers has directed its 60 local centers in all 50 states to code any calls related to the oil spill so that the Centers for Disease Control and Prevention (CDC) can track them, said Dr. Howard. As of May 27, there were 93 calls, mostly from Louisiana and Mississippi. Thirty-four callers had been exposed to oil and reported symptoms including cough, nausea, headache, eye irritation, chest pain, and dizziness, according to data on the CDC’s Web site.

Health issues are also being tracked through BioSense, an existing network of health facilities that track health changes in real time and report back to the CDC. There are 86 participating facilities in the five Gulf states. So far, there have been some spikes in skin irritation and asthma in two states; investigations are continuing.

State health departments in Alabama, Florida, Louisiana, and Mississippi are also soliciting reports and tracking illnesses. At press time, the Louisiana Department of Health and Hospitals reported 109 spill-related illnesses – 74 from workers and 35 from the public. Thirty-three cases were reported through poison control centers; 43 through emergency departments; and others from urgent care centers, clinics, physician offices and a hotline. Most of the complaints were of odors or inhalation issues. There were nine hospitalizations, all in workers.

Many lawmakers at the hearing said they were concerned that both workers and residents of the Gulf states were being given confusing messages about health and safety and where to report exposures or problems. In addition to the state health departments, the CDC, NIOSH, and BP are also taking exposure reports.

Dr. Howard said that was one reason he was pushing BP to correlate its list with NIOSH. He also said that he supports a centralized Web site for all the spill-related data.

The Environmental Protection Agency is also monitoring the air, water, and soil and issuing reports on its Web site; the Food and Drug Administration is tracking seafood safety.

WASHINGTON – The federal government is seeking to track acute and long-term health effects in individuals working to clean up the BP oil spill in the Gulf of Mexico and is enlisting health care providers to assist, the director of the National Institute for Occupational Safety and Health (NIOSH) testified at a hearing June 16.

Dr. John Howard said that the agency he leads had begun enrolling workers in what could end up becoming a formal registry. NIOSH is anxious to have a full list of anyone involved in the clean-up, he said, noting that no such list was compiled for volunteers and others who helped at Ground Zero in the wake of Sept. 11, 2001. The lack of such a list made it difficult to go back and correlate either acute or long-term health complaints with exposure, he said.

NIOSH is “trying to keep all health care professionals alerted to our rostering effort,” so that all workers who are potentially exposed to any hazards are included in the database, Dr. Howard said. He called on Gulf region physicians to refer to NIOSH any patients they might see who have worked on the clean-up effort.

NIOSH employees have gone into the field and to BP-operated training centers to ask workers to complete a simple one-page questionnaire. The questionnaire seeks demographic data, whether the worker is a contractor, BP employee, or volunteer. It includes specific questions relating to the type of work being done, duration of the work, and whether the person smokes or has been vaccinated for tetanus. Federal officials hope to post the questionnaire online shortly, and are asking physicians who encounter workers to direct them to NIOSH to complete the survey.

So far, 13,000 workers have completed forms, said Dr. Howard, but he estimates that at least another 15,000-20,000 people are working on the clean-up. NIOSH asked for but has yet to receive a full list of BP workers involved, Dr. Howard said. “It’s a simple request,” he said to reporters after the hearing. Dr. Howard expressed consternation that the oil company had yet to respond.

Clean-up workers will receive the most significant exposure to toxic substances, he said, adding that they would be the best group to study to determine long-term risks. Currently, there are little data on long-term health effects of exposures to oil and to the chemicals, such as dispersants, being used in the clean-up, Dr. Howard said.

The federal government also is attempting to track exposures in the general population. The American Association of Poison Control Centers has directed its 60 local centers in all 50 states to code any calls related to the oil spill so that the Centers for Disease Control and Prevention (CDC) can track them, said Dr. Howard. As of May 27, there were 93 calls, mostly from Louisiana and Mississippi. Thirty-four callers had been exposed to oil and reported symptoms including cough, nausea, headache, eye irritation, chest pain, and dizziness, according to data on the CDC’s Web site.

Health issues are also being tracked through BioSense, an existing network of health facilities that track health changes in real time and report back to the CDC. There are 86 participating facilities in the five Gulf states. So far, there have been some spikes in skin irritation and asthma in two states; investigations are continuing.

State health departments in Alabama, Florida, Louisiana, and Mississippi are also soliciting reports and tracking illnesses. At press time, the Louisiana Department of Health and Hospitals reported 109 spill-related illnesses – 74 from workers and 35 from the public. Thirty-three cases were reported through poison control centers; 43 through emergency departments; and others from urgent care centers, clinics, physician offices and a hotline. Most of the complaints were of odors or inhalation issues. There were nine hospitalizations, all in workers.

Many lawmakers at the hearing said they were concerned that both workers and residents of the Gulf states were being given confusing messages about health and safety and where to report exposures or problems. In addition to the state health departments, the CDC, NIOSH, and BP are also taking exposure reports.

Dr. Howard said that was one reason he was pushing BP to correlate its list with NIOSH. He also said that he supports a centralized Web site for all the spill-related data.

The Environmental Protection Agency is also monitoring the air, water, and soil and issuing reports on its Web site; the Food and Drug Administration is tracking seafood safety.

The number of uninsured Americans rose last year, with 21% of all adults aged 18-64 years reporting that they were uninsured at the time that they were interviewed for the National Health Interview Survey, federal officials reported June 16.

That’s up from 19.7% the previous year and reflects a trend over the past decade of an increasing lack of health insurance, at least among adults, according to a survey by the National Center for Health Statistics, a part of the Centers for Disease Control and Prevention. Rates of coverage for children, on the other hand, have mostly improved.

Since 1999, increasing proportions of people have reported that they were uninsured at the time of the annual survey, for part of the year prior to their interviews, and for a year or more, said the NCHS in its report, which was released early and will be published in CDC’s Morbidity and Mortality Weekly Report.

Overall, 46.3 million people–or 15.4% of the population–were uninsured at the time they were interviewed in 2009. The survey found that even greater numbers of people reported that they were uninsured for at least part of the year before the interview–some 58.5 million–but that a slightly smaller number, 32.8 million, had been uninsured for more than a year at the time they were queried.

A greater proportion of children than adults were covered by public health plans, which could explain the children’s higher rate of coverage, according to the survey. In 2009, 37.7% of children under age 18 were covered by a public plan, up from 34.2% the previous year. Rates of public coverage for low-income children increased. Federal officials in both the Obama and Bush administrations have emphasized enrolling more eligible children in the public Children’s Health Insurance Plan, which is administered by states.

Conversely, only 14.4% of adults aged 18- 64 years had public coverage. And private coverage for adults declined from 68% in 2008 to 66% in 2009, according to the survey. There was no significant change in private coverage for children of any income level.

Hispanics were least likely to have insurance, with one-third reporting no insurance at the time of the interview or for part of the past year. A quarter had had no coverage for more than a year.

Not surprisingly, states with larger Hispanic populations had greater proportions of uninsured. One-quarter of Texas and Florida residents under age 65 years were uninsured at the time of the interview. One-fifth did not have coverage in California and Georgia. In Florida, 13% of children lacked coverage when interviewed, and in Texas, that number was almost 17%.

Nine states had lower rates of uninsured than the national average of 17.5%: Illinois, Massachusetts, Michigan, New Jersey, New York, Ohio, Pennsylvania, Washington, and Wisconsin.

The number of uninsured Americans rose last year, with 21% of all adults aged 18-64 years reporting that they were uninsured at the time that they were interviewed for the National Health Interview Survey, federal officials reported June 16.

That’s up from 19.7% the previous year and reflects a trend over the past decade of an increasing lack of health insurance, at least among adults, according to a survey by the National Center for Health Statistics, a part of the Centers for Disease Control and Prevention. Rates of coverage for children, on the other hand, have mostly improved.

Since 1999, increasing proportions of people have reported that they were uninsured at the time of the annual survey, for part of the year prior to their interviews, and for a year or more, said the NCHS in its report, which was released early and will be published in CDC’s Morbidity and Mortality Weekly Report.

Overall, 46.3 million people–or 15.4% of the population–were uninsured at the time they were interviewed in 2009. The survey found that even greater numbers of people reported that they were uninsured for at least part of the year before the interview–some 58.5 million–but that a slightly smaller number, 32.8 million, had been uninsured for more than a year at the time they were queried.

A greater proportion of children than adults were covered by public health plans, which could explain the children’s higher rate of coverage, according to the survey. In 2009, 37.7% of children under age 18 were covered by a public plan, up from 34.2% the previous year. Rates of public coverage for low-income children increased. Federal officials in both the Obama and Bush administrations have emphasized enrolling more eligible children in the public Children’s Health Insurance Plan, which is administered by states.

Conversely, only 14.4% of adults aged 18- 64 years had public coverage. And private coverage for adults declined from 68% in 2008 to 66% in 2009, according to the survey. There was no significant change in private coverage for children of any income level.

Hispanics were least likely to have insurance, with one-third reporting no insurance at the time of the interview or for part of the past year. A quarter had had no coverage for more than a year.

Not surprisingly, states with larger Hispanic populations had greater proportions of uninsured. One-quarter of Texas and Florida residents under age 65 years were uninsured at the time of the interview. One-fifth did not have coverage in California and Georgia. In Florida, 13% of children lacked coverage when interviewed, and in Texas, that number was almost 17%.

Nine states had lower rates of uninsured than the national average of 17.5%: Illinois, Massachusetts, Michigan, New Jersey, New York, Ohio, Pennsylvania, Washington, and Wisconsin.

The number of uninsured Americans rose last year, with 21% of all adults aged 18-64 years reporting that they were uninsured at the time that they were interviewed for the National Health Interview Survey, federal officials reported June 16.

That’s up from 19.7% the previous year and reflects a trend over the past decade of an increasing lack of health insurance, at least among adults, according to a survey by the National Center for Health Statistics, a part of the Centers for Disease Control and Prevention. Rates of coverage for children, on the other hand, have mostly improved.

Since 1999, increasing proportions of people have reported that they were uninsured at the time of the annual survey, for part of the year prior to their interviews, and for a year or more, said the NCHS in its report, which was released early and will be published in CDC’s Morbidity and Mortality Weekly Report.

Overall, 46.3 million people–or 15.4% of the population–were uninsured at the time they were interviewed in 2009. The survey found that even greater numbers of people reported that they were uninsured for at least part of the year before the interview–some 58.5 million–but that a slightly smaller number, 32.8 million, had been uninsured for more than a year at the time they were queried.

A greater proportion of children than adults were covered by public health plans, which could explain the children’s higher rate of coverage, according to the survey. In 2009, 37.7% of children under age 18 were covered by a public plan, up from 34.2% the previous year. Rates of public coverage for low-income children increased. Federal officials in both the Obama and Bush administrations have emphasized enrolling more eligible children in the public Children’s Health Insurance Plan, which is administered by states.

Conversely, only 14.4% of adults aged 18- 64 years had public coverage. And private coverage for adults declined from 68% in 2008 to 66% in 2009, according to the survey. There was no significant change in private coverage for children of any income level.

Hispanics were least likely to have insurance, with one-third reporting no insurance at the time of the interview or for part of the past year. A quarter had had no coverage for more than a year.

Not surprisingly, states with larger Hispanic populations had greater proportions of uninsured. One-quarter of Texas and Florida residents under age 65 years were uninsured at the time of the interview. One-fifth did not have coverage in California and Georgia. In Florida, 13% of children lacked coverage when interviewed, and in Texas, that number was almost 17%.

Nine states had lower rates of uninsured than the national average of 17.5%: Illinois, Massachusetts, Michigan, New Jersey, New York, Ohio, Pennsylvania, Washington, and Wisconsin.

WASHINGTON — A group of 19 health systems are taking the first steps toward becoming accountable care organizations, joining together to share best practices, coordinate care, and improve quality.

The health systems are all members of Premier Inc., a nonprofit health purchasing and quality improvement alliance. Premier will provide the expertise and databases necessary for the systems to build the accountable care organizations (ACOs).

According to Premier, members of the ACO Implementation Collaborative may be ready in 2012 to start contracting with the Centers for Medicare and Medicaid Services under the shared savings program mandated under the health reform law (Affordable Care Act).

ACOs have been envisioned as the backbone of the new health care system, but they were not clearly defined in the law President Obama signed in March.

At a Capitol Hill briefing, Sen. Max Baucus (D-Mont.), and Rep. Earl Pomeroy (D-N.D.) and Rep. Charles Boustany (R-La.) praised the Premier effort, saying that it would help speed up the transformation of the health care system into one that values quality over quantity.

Sen. Baucus said that the ACOs in the Premier alliance “put the new and innovative ideas in the health care reform law into practice to improve health care quality while reducing inefficient and wasteful spending.”

Rep. Boustany, who is a cardiovascular surgeon, said that the reform law did not go far enough to align incentives among health providers or to foster care coordination.

The Premier alliance will address some of these issues, he said, but it still is not clear if the ACO model can work in rural areas where there may be great distances between facilities and disparate missions from urban or suburban counterparts.

According to Premier president and CEO Susan S. DeVore, all members of the ACO collaborative will build the “critical components of accountable care,” including a patient-centered foundation; medical homes that deliver primary care and wellness; incentives to reward coordination, efficiency, and productivity; tight integration among specialists, ancillary providers and hospitals; reimbursement models that reward value over volume; and health information technology systems that can be used to coordinate care across networks.

The 19 systems already have some of these elements in place and can pursue accountability for a portion of their population, according to Premier.

These hospitals and health systems have been participating in Premier's QUEST: High-Performing Hospitals collaborative. QUEST is a 3-year information and quality improvement sharing initiative involving 200 hospitals in 31 states. In the first year, hospitals reduced the cost of care by an average $343 per patient. The facilities delivered care according to evidence-based quality measures 86% of the time, according to Premier.

The ACO Implementation Collaborative aims to build on that success.

The first step is to define value. According to Premier, the agreed-upon definition so far is to optimize patient outcomes, the patient care experience, and the total cost of care.

Dr. Nicholas Wolter, the CEO of the Billings Clinic, which is part of the ACO collaborative, said although ACOs may seem to be a fad, much as managed care was in the early 1990s, more is known now about patient safety and delivering high quality care.

“In the ACO, patients are partners working with their care team to manage and improve their health. This is the real goal of health reform—the highest quality care at a more cost-effective price for patients and taxpayers,” Dr. Wolter said.

To view a video interview with Dr. Wolter, go to www.youtube.com/familypracticenews

Members of the Premier ACO

Aria Health, Philadelphia

AtlantiCare, Egg Harbor Township, N.J.Bay

Baystate Health, Springfield, Mass.

Billings Clinic, Mont.

Bon Secours Health System Inc., Greenville, S.C., and Richmond, Va.

CaroMont Health, Gastonia, N.C.

Fairview Health Services, Minneapolis

Geisinger Health System, Danville, Pa.

Heartland Health, St. Joseph, Mo.

Methodist Medical Center of Illinois, Peoria

North Shore-Long Island Jewish Health System, Long Island, N.Y.

Presbyterian Healthcare Services, Albuquerque, N.M.

Saint Francis Health System, Tulsa, Okla.

Southcoast Hospitals Group, Fall River, Mass.

SSM Health Care, St. Louis

Summa Health System, Akron, Ohio

Texas Health Resources, Arlington, Tex.

University Hospitals, Cleveland

WASHINGTON — A group of 19 health systems are taking the first steps toward becoming accountable care organizations, joining together to share best practices, coordinate care, and improve quality.

The health systems are all members of Premier Inc., a nonprofit health purchasing and quality improvement alliance. Premier will provide the expertise and databases necessary for the systems to build the accountable care organizations (ACOs).

According to Premier, members of the ACO Implementation Collaborative may be ready in 2012 to start contracting with the Centers for Medicare and Medicaid Services under the shared savings program mandated under the health reform law (Affordable Care Act).

ACOs have been envisioned as the backbone of the new health care system, but they were not clearly defined in the law President Obama signed in March.

At a Capitol Hill briefing, Sen. Max Baucus (D-Mont.), and Rep. Earl Pomeroy (D-N.D.) and Rep. Charles Boustany (R-La.) praised the Premier effort, saying that it would help speed up the transformation of the health care system into one that values quality over quantity.

Sen. Baucus said that the ACOs in the Premier alliance “put the new and innovative ideas in the health care reform law into practice to improve health care quality while reducing inefficient and wasteful spending.”

Rep. Boustany, who is a cardiovascular surgeon, said that the reform law did not go far enough to align incentives among health providers or to foster care coordination.

The Premier alliance will address some of these issues, he said, but it still is not clear if the ACO model can work in rural areas where there may be great distances between facilities and disparate missions from urban or suburban counterparts.

According to Premier president and CEO Susan S. DeVore, all members of the ACO collaborative will build the “critical components of accountable care,” including a patient-centered foundation; medical homes that deliver primary care and wellness; incentives to reward coordination, efficiency, and productivity; tight integration among specialists, ancillary providers and hospitals; reimbursement models that reward value over volume; and health information technology systems that can be used to coordinate care across networks.

The 19 systems already have some of these elements in place and can pursue accountability for a portion of their population, according to Premier.

These hospitals and health systems have been participating in Premier's QUEST: High-Performing Hospitals collaborative. QUEST is a 3-year information and quality improvement sharing initiative involving 200 hospitals in 31 states. In the first year, hospitals reduced the cost of care by an average $343 per patient. The facilities delivered care according to evidence-based quality measures 86% of the time, according to Premier.

The ACO Implementation Collaborative aims to build on that success.

The first step is to define value. According to Premier, the agreed-upon definition so far is to optimize patient outcomes, the patient care experience, and the total cost of care.

Dr. Nicholas Wolter, the CEO of the Billings Clinic, which is part of the ACO collaborative, said although ACOs may seem to be a fad, much as managed care was in the early 1990s, more is known now about patient safety and delivering high quality care.

“In the ACO, patients are partners working with their care team to manage and improve their health. This is the real goal of health reform—the highest quality care at a more cost-effective price for patients and taxpayers,” Dr. Wolter said.

To view a video interview with Dr. Wolter, go to www.youtube.com/familypracticenews

Members of the Premier ACO

Aria Health, Philadelphia

AtlantiCare, Egg Harbor Township, N.J.Bay

Baystate Health, Springfield, Mass.

Billings Clinic, Mont.

Bon Secours Health System Inc., Greenville, S.C., and Richmond, Va.

CaroMont Health, Gastonia, N.C.

Fairview Health Services, Minneapolis

Geisinger Health System, Danville, Pa.

Heartland Health, St. Joseph, Mo.

Methodist Medical Center of Illinois, Peoria

North Shore-Long Island Jewish Health System, Long Island, N.Y.

Presbyterian Healthcare Services, Albuquerque, N.M.

Saint Francis Health System, Tulsa, Okla.

Southcoast Hospitals Group, Fall River, Mass.

SSM Health Care, St. Louis

Summa Health System, Akron, Ohio

Texas Health Resources, Arlington, Tex.

University Hospitals, Cleveland

WASHINGTON — A group of 19 health systems are taking the first steps toward becoming accountable care organizations, joining together to share best practices, coordinate care, and improve quality.

The health systems are all members of Premier Inc., a nonprofit health purchasing and quality improvement alliance. Premier will provide the expertise and databases necessary for the systems to build the accountable care organizations (ACOs).

According to Premier, members of the ACO Implementation Collaborative may be ready in 2012 to start contracting with the Centers for Medicare and Medicaid Services under the shared savings program mandated under the health reform law (Affordable Care Act).

ACOs have been envisioned as the backbone of the new health care system, but they were not clearly defined in the law President Obama signed in March.

At a Capitol Hill briefing, Sen. Max Baucus (D-Mont.), and Rep. Earl Pomeroy (D-N.D.) and Rep. Charles Boustany (R-La.) praised the Premier effort, saying that it would help speed up the transformation of the health care system into one that values quality over quantity.

Sen. Baucus said that the ACOs in the Premier alliance “put the new and innovative ideas in the health care reform law into practice to improve health care quality while reducing inefficient and wasteful spending.”

Rep. Boustany, who is a cardiovascular surgeon, said that the reform law did not go far enough to align incentives among health providers or to foster care coordination.

The Premier alliance will address some of these issues, he said, but it still is not clear if the ACO model can work in rural areas where there may be great distances between facilities and disparate missions from urban or suburban counterparts.

According to Premier president and CEO Susan S. DeVore, all members of the ACO collaborative will build the “critical components of accountable care,” including a patient-centered foundation; medical homes that deliver primary care and wellness; incentives to reward coordination, efficiency, and productivity; tight integration among specialists, ancillary providers and hospitals; reimbursement models that reward value over volume; and health information technology systems that can be used to coordinate care across networks.

The 19 systems already have some of these elements in place and can pursue accountability for a portion of their population, according to Premier.

These hospitals and health systems have been participating in Premier's QUEST: High-Performing Hospitals collaborative. QUEST is a 3-year information and quality improvement sharing initiative involving 200 hospitals in 31 states. In the first year, hospitals reduced the cost of care by an average $343 per patient. The facilities delivered care according to evidence-based quality measures 86% of the time, according to Premier.

The ACO Implementation Collaborative aims to build on that success.

The first step is to define value. According to Premier, the agreed-upon definition so far is to optimize patient outcomes, the patient care experience, and the total cost of care.

Dr. Nicholas Wolter, the CEO of the Billings Clinic, which is part of the ACO collaborative, said although ACOs may seem to be a fad, much as managed care was in the early 1990s, more is known now about patient safety and delivering high quality care.

“In the ACO, patients are partners working with their care team to manage and improve their health. This is the real goal of health reform—the highest quality care at a more cost-effective price for patients and taxpayers,” Dr. Wolter said.

To view a video interview with Dr. Wolter, go to www.youtube.com/familypracticenews

Members of the Premier ACO

Aria Health, Philadelphia

AtlantiCare, Egg Harbor Township, N.J.Bay

Baystate Health, Springfield, Mass.

Billings Clinic, Mont.

Bon Secours Health System Inc., Greenville, S.C., and Richmond, Va.

CaroMont Health, Gastonia, N.C.

Fairview Health Services, Minneapolis

Geisinger Health System, Danville, Pa.

Heartland Health, St. Joseph, Mo.

Methodist Medical Center of Illinois, Peoria

North Shore-Long Island Jewish Health System, Long Island, N.Y.

Presbyterian Healthcare Services, Albuquerque, N.M.

Saint Francis Health System, Tulsa, Okla.

Southcoast Hospitals Group, Fall River, Mass.

SSM Health Care, St. Louis

Summa Health System, Akron, Ohio

Texas Health Resources, Arlington, Tex.

University Hospitals, Cleveland

The American Medical Association has called on health insurance companies to adopt its just-issued code of conduct.

The Health Insurer Code of Conduct Principles evolved out of a resolution put forward and unanimously adopted by the AMA House of Delegates in 2008. The New York Delegation called on the AMA to develop such a code, get insurers to sign on, and come up with a way to monitor compliance. The code has already been endorsed by nearly every state medical society as well as 19 specialty societies, according to the AMA.

The last time the insurance industry issued any kind of internal standards was 15 years ago, according to the AMA, which added in a statement that the industry has had a “questionable” record of compliance with those standards, known as the Philosophy of Care.

“The health insurance industry has a crisis of credibility,” Dr. J. James Rohack, AMA president, said in the statement. “With the enactment of federal health reform legislation, it's time for insurers to recommit to patients' best interests and the fair business practices necessary to reestablish trust with the patient and physician communities.”

Americas Health Insurance Plans, the industry trade organization, did not directly address the AMA code. But AHIP spokesperson Robert Zirkelbach said that many of the principles are covered under the Affordable Care Act.

“Health plans have pioneered innovative programs to reward quality, promote prevention and wellness, coordinate care for patients with chronic conditions, streamline administrative processes, and provide policyholders with greater peace of mind,” Mr. Zirkelbach said. “We will continue to work with policymakers and other health care stakeholders to improve the quality, safety, and efficiency of our health care system.”

The code's principles address topics including cancelations and recissions; open access to care; fairness in contract negotiations with physicians; and a call for more administrative simplification, fewer restrictions on benefits, and better risk adjustment mechanisms for “physician profiling” systems. Physicians should also have more opportunity to review and challenge their ratings, which are used to select doctors for preferential networks.

The AMA said that it has written to the eight largest health insurers seeking their pledge to comply with the code.

For more information, go to www.ama-assn.org

'It's time for insurers to recommit to patients' best interests.'

Source DR. ROHACK

The American Medical Association has called on health insurance companies to adopt its just-issued code of conduct.

The Health Insurer Code of Conduct Principles evolved out of a resolution put forward and unanimously adopted by the AMA House of Delegates in 2008. The New York Delegation called on the AMA to develop such a code, get insurers to sign on, and come up with a way to monitor compliance. The code has already been endorsed by nearly every state medical society as well as 19 specialty societies, according to the AMA.

The last time the insurance industry issued any kind of internal standards was 15 years ago, according to the AMA, which added in a statement that the industry has had a “questionable” record of compliance with those standards, known as the Philosophy of Care.

“The health insurance industry has a crisis of credibility,” Dr. J. James Rohack, AMA president, said in the statement. “With the enactment of federal health reform legislation, it's time for insurers to recommit to patients' best interests and the fair business practices necessary to reestablish trust with the patient and physician communities.”

Americas Health Insurance Plans, the industry trade organization, did not directly address the AMA code. But AHIP spokesperson Robert Zirkelbach said that many of the principles are covered under the Affordable Care Act.

“Health plans have pioneered innovative programs to reward quality, promote prevention and wellness, coordinate care for patients with chronic conditions, streamline administrative processes, and provide policyholders with greater peace of mind,” Mr. Zirkelbach said. “We will continue to work with policymakers and other health care stakeholders to improve the quality, safety, and efficiency of our health care system.”

The code's principles address topics including cancelations and recissions; open access to care; fairness in contract negotiations with physicians; and a call for more administrative simplification, fewer restrictions on benefits, and better risk adjustment mechanisms for “physician profiling” systems. Physicians should also have more opportunity to review and challenge their ratings, which are used to select doctors for preferential networks.

The AMA said that it has written to the eight largest health insurers seeking their pledge to comply with the code.

For more information, go to www.ama-assn.org

'It's time for insurers to recommit to patients' best interests.'

Source DR. ROHACK

The American Medical Association has called on health insurance companies to adopt its just-issued code of conduct.

The Health Insurer Code of Conduct Principles evolved out of a resolution put forward and unanimously adopted by the AMA House of Delegates in 2008. The New York Delegation called on the AMA to develop such a code, get insurers to sign on, and come up with a way to monitor compliance. The code has already been endorsed by nearly every state medical society as well as 19 specialty societies, according to the AMA.

The last time the insurance industry issued any kind of internal standards was 15 years ago, according to the AMA, which added in a statement that the industry has had a “questionable” record of compliance with those standards, known as the Philosophy of Care.

“The health insurance industry has a crisis of credibility,” Dr. J. James Rohack, AMA president, said in the statement. “With the enactment of federal health reform legislation, it's time for insurers to recommit to patients' best interests and the fair business practices necessary to reestablish trust with the patient and physician communities.”

Americas Health Insurance Plans, the industry trade organization, did not directly address the AMA code. But AHIP spokesperson Robert Zirkelbach said that many of the principles are covered under the Affordable Care Act.

“Health plans have pioneered innovative programs to reward quality, promote prevention and wellness, coordinate care for patients with chronic conditions, streamline administrative processes, and provide policyholders with greater peace of mind,” Mr. Zirkelbach said. “We will continue to work with policymakers and other health care stakeholders to improve the quality, safety, and efficiency of our health care system.”

The code's principles address topics including cancelations and recissions; open access to care; fairness in contract negotiations with physicians; and a call for more administrative simplification, fewer restrictions on benefits, and better risk adjustment mechanisms for “physician profiling” systems. Physicians should also have more opportunity to review and challenge their ratings, which are used to select doctors for preferential networks.

The AMA said that it has written to the eight largest health insurers seeking their pledge to comply with the code.

For more information, go to www.ama-assn.org

'It's time for insurers to recommit to patients' best interests.'

Source DR. ROHACK

President Obama in April issued a call for equal hospital visitation rights for all patients, a move he said would be beneficial especially to childless widows and widowers and to gays and lesbians.

Mr. Obama's memorandum will require the Department of Health and Human Services to create new rules for hospitals that participate in Medicare and Medicaid to make it clear that a patient's designated visitor has the same visitation rights as a family member. Hospitals will not be able to deny visitation privileges based on “race, color, national origin, sex, sexual orientation, gender identity, or disability.”

Visits can be restricted for medically appropriate reasons. The Centers for Medicare and Medicaid Services (CMS) will be charged with enforcing the new regulations, and with ensuring that patients' advance directives are respected.

For patients whose friends or partners are denied visitation rights, President Obama said in a statement, “the failure to have their wishes respected concerning who may visit them or make medical decisions on their behalf has real consequences,” including that physicians and nurses may not have current information about medications and medical histories.

“All too often, people are made to suffer or even to pass away alone, denied the comfort of companionship in their final moments while a loved one is left worrying and pacing down the hall,” he added.

The Human Rights Campaign, a Washington-based advocacy group for gays and lesbians, said that it had worked with the White House and HHS “in support” of the memorandum.

“Discrimination touches every facet of the lives of lesbian, gay, bisexual, and transgender people, including at times of crisis and illness, when we need our loved ones with us more than ever,” HRC President Joe Solmonese said in a statement.

In a statement issued in the wake of the memorandum, the American Hospital Association said “we recognize how important family support is to a patient's well-being, and we work hard to involve patients and their loved ones in their care.” The organization added that it “will look forward to details of the new regulations as well as direction on coordinating with state laws.”

President Obama in April issued a call for equal hospital visitation rights for all patients, a move he said would be beneficial especially to childless widows and widowers and to gays and lesbians.

Mr. Obama's memorandum will require the Department of Health and Human Services to create new rules for hospitals that participate in Medicare and Medicaid to make it clear that a patient's designated visitor has the same visitation rights as a family member. Hospitals will not be able to deny visitation privileges based on “race, color, national origin, sex, sexual orientation, gender identity, or disability.”

Visits can be restricted for medically appropriate reasons. The Centers for Medicare and Medicaid Services (CMS) will be charged with enforcing the new regulations, and with ensuring that patients' advance directives are respected.

For patients whose friends or partners are denied visitation rights, President Obama said in a statement, “the failure to have their wishes respected concerning who may visit them or make medical decisions on their behalf has real consequences,” including that physicians and nurses may not have current information about medications and medical histories.

“All too often, people are made to suffer or even to pass away alone, denied the comfort of companionship in their final moments while a loved one is left worrying and pacing down the hall,” he added.

The Human Rights Campaign, a Washington-based advocacy group for gays and lesbians, said that it had worked with the White House and HHS “in support” of the memorandum.

“Discrimination touches every facet of the lives of lesbian, gay, bisexual, and transgender people, including at times of crisis and illness, when we need our loved ones with us more than ever,” HRC President Joe Solmonese said in a statement.

In a statement issued in the wake of the memorandum, the American Hospital Association said “we recognize how important family support is to a patient's well-being, and we work hard to involve patients and their loved ones in their care.” The organization added that it “will look forward to details of the new regulations as well as direction on coordinating with state laws.”

President Obama in April issued a call for equal hospital visitation rights for all patients, a move he said would be beneficial especially to childless widows and widowers and to gays and lesbians.

Mr. Obama's memorandum will require the Department of Health and Human Services to create new rules for hospitals that participate in Medicare and Medicaid to make it clear that a patient's designated visitor has the same visitation rights as a family member. Hospitals will not be able to deny visitation privileges based on “race, color, national origin, sex, sexual orientation, gender identity, or disability.”

Visits can be restricted for medically appropriate reasons. The Centers for Medicare and Medicaid Services (CMS) will be charged with enforcing the new regulations, and with ensuring that patients' advance directives are respected.

For patients whose friends or partners are denied visitation rights, President Obama said in a statement, “the failure to have their wishes respected concerning who may visit them or make medical decisions on their behalf has real consequences,” including that physicians and nurses may not have current information about medications and medical histories.

“All too often, people are made to suffer or even to pass away alone, denied the comfort of companionship in their final moments while a loved one is left worrying and pacing down the hall,” he added.

The Human Rights Campaign, a Washington-based advocacy group for gays and lesbians, said that it had worked with the White House and HHS “in support” of the memorandum.

“Discrimination touches every facet of the lives of lesbian, gay, bisexual, and transgender people, including at times of crisis and illness, when we need our loved ones with us more than ever,” HRC President Joe Solmonese said in a statement.

In a statement issued in the wake of the memorandum, the American Hospital Association said “we recognize how important family support is to a patient's well-being, and we work hard to involve patients and their loved ones in their care.” The organization added that it “will look forward to details of the new regulations as well as direction on coordinating with state laws.”

Fourteen medical specialty societies have signed a voluntary pledge to be more transparent in dealings with pharmaceutical and medical device manufacturers and other for-profit companies in the health care field.

The pledge, issued by the Council of Medical Specialty Societies (CMSS), was the result of at least a year of negotiations, said Dr. Allen S. Lichter, who is chair of the CMSS Task Force on Professionalism and Conflict of Interest and the chief executive officer of the American Society of Clinical Oncology (ASCO).

The 14 societies adopting the CMSS Code for Interactions with Companies agree to establish and publish conflict of interest policies as well as policies and procedures to ensure separation of program development from sponsor influence.

They also must disclose corporate contributions, board members' financial relationships with companies, and prohibit financial relationships for key association leaders.

The initial signers included the Accreditation Council for Continuing Medical Education (ACCME), American Academy of Family Physicians (AAFP), American Academy of Neurology (AAN), American Academy of Ophthalmology (AAO), American Academy of Pediatrics (AAP), American Academy of Physical Medicine and Rehabilitation (AAPMR), American College of Cardiology (ACC), American College of Emergency Physicians (ACEP), American College of Obstetricians and Gynecologists (ACOG), American College of Physicians (ACP), American College of Preventive Medicine (ACPM), American College of Radiology (ACR), American Society for Radiation Oncology (ASTRO), and ASCO.

Dr. Lichter called the code a “very important milestone” because it will create consistency where there has been none.

Many previous efforts to reduce conflicts have been done in private, but this effort is very much a public undertaking, designed to reassure the public and regulators that professional societies are acting ethically..

It is also, however, just a first step, he said. The code is not meant to be the last word; it represents a minimum set of guidelines.

Some organizations may choose to be more restrictive.

According to the CMSS, the code was developed by a 30-member task force. More of the 32 members of the CMSS plan to adopt the code in the next few months.

The 25-page code is available on the CMSS Web site at www.cmss.org/codeforinteractions.aspx

Fourteen medical specialty societies have signed a voluntary pledge to be more transparent in dealings with pharmaceutical and medical device manufacturers and other for-profit companies in the health care field.

The pledge, issued by the Council of Medical Specialty Societies (CMSS), was the result of at least a year of negotiations, said Dr. Allen S. Lichter, who is chair of the CMSS Task Force on Professionalism and Conflict of Interest and the chief executive officer of the American Society of Clinical Oncology (ASCO).

The 14 societies adopting the CMSS Code for Interactions with Companies agree to establish and publish conflict of interest policies as well as policies and procedures to ensure separation of program development from sponsor influence.

They also must disclose corporate contributions, board members' financial relationships with companies, and prohibit financial relationships for key association leaders.

The initial signers included the Accreditation Council for Continuing Medical Education (ACCME), American Academy of Family Physicians (AAFP), American Academy of Neurology (AAN), American Academy of Ophthalmology (AAO), American Academy of Pediatrics (AAP), American Academy of Physical Medicine and Rehabilitation (AAPMR), American College of Cardiology (ACC), American College of Emergency Physicians (ACEP), American College of Obstetricians and Gynecologists (ACOG), American College of Physicians (ACP), American College of Preventive Medicine (ACPM), American College of Radiology (ACR), American Society for Radiation Oncology (ASTRO), and ASCO.

Dr. Lichter called the code a “very important milestone” because it will create consistency where there has been none.

Many previous efforts to reduce conflicts have been done in private, but this effort is very much a public undertaking, designed to reassure the public and regulators that professional societies are acting ethically..

It is also, however, just a first step, he said. The code is not meant to be the last word; it represents a minimum set of guidelines.

Some organizations may choose to be more restrictive.

According to the CMSS, the code was developed by a 30-member task force. More of the 32 members of the CMSS plan to adopt the code in the next few months.

The 25-page code is available on the CMSS Web site at www.cmss.org/codeforinteractions.aspx

Fourteen medical specialty societies have signed a voluntary pledge to be more transparent in dealings with pharmaceutical and medical device manufacturers and other for-profit companies in the health care field.

The pledge, issued by the Council of Medical Specialty Societies (CMSS), was the result of at least a year of negotiations, said Dr. Allen S. Lichter, who is chair of the CMSS Task Force on Professionalism and Conflict of Interest and the chief executive officer of the American Society of Clinical Oncology (ASCO).

The 14 societies adopting the CMSS Code for Interactions with Companies agree to establish and publish conflict of interest policies as well as policies and procedures to ensure separation of program development from sponsor influence.

They also must disclose corporate contributions, board members' financial relationships with companies, and prohibit financial relationships for key association leaders.

The initial signers included the Accreditation Council for Continuing Medical Education (ACCME), American Academy of Family Physicians (AAFP), American Academy of Neurology (AAN), American Academy of Ophthalmology (AAO), American Academy of Pediatrics (AAP), American Academy of Physical Medicine and Rehabilitation (AAPMR), American College of Cardiology (ACC), American College of Emergency Physicians (ACEP), American College of Obstetricians and Gynecologists (ACOG), American College of Physicians (ACP), American College of Preventive Medicine (ACPM), American College of Radiology (ACR), American Society for Radiation Oncology (ASTRO), and ASCO.

Dr. Lichter called the code a “very important milestone” because it will create consistency where there has been none.

Many previous efforts to reduce conflicts have been done in private, but this effort is very much a public undertaking, designed to reassure the public and regulators that professional societies are acting ethically..

It is also, however, just a first step, he said. The code is not meant to be the last word; it represents a minimum set of guidelines.

Some organizations may choose to be more restrictive.

According to the CMSS, the code was developed by a 30-member task force. More of the 32 members of the CMSS plan to adopt the code in the next few months.

The 25-page code is available on the CMSS Web site at www.cmss.org/codeforinteractions.aspx

WASHINGTON — A group of 19 health systems are taking the first steps toward becoming accountable care organizations, joining together to share best practices, coordinate care, and improve quality.

The health systems are all members of Premier Inc., a nonprofit health purchasing and quality improvement alliance. Premier will provide the expertise and databases necessary for the systems to build the accountable care organizations (ACOs).

According to Premier, members of the ACO Implementation Collaborative may be ready in 2012 to start contracting with the Centers for Medicare and Medicaid Services under the shared savings program mandated under the health reform law (Affordable Care Act).

Backbone of Health Reform

ACOs have been envisioned as the backbone of the new health care system, but they were not clearly defined in the law President Obama signed in March.

At a Capitol Hill briefing, Sen. Max Baucus (D-Mont.), Rep. Earl Pomeroy (D-N.D.), and Rep. Charles Boustany (R-La.) praised the Premier effort, saying that it would help speed up transformation of the health care system into one that values quality over quantity.

Sen. Baucus said that the accountable care organizations in the Premier alliance “put the new and innovative ideas in the health care reform law into practice to improve health care quality while reducing inefficient and wasteful spending.”

Rep. Boustany, who is a cardiovascular surgeon, said that the reform law did not go far enough to align incentives among health providers or to foster care coordination.

The Premier alliance will address some of these issues, he said, but it still is not clear if the accountable care organization model can work in rural areas where there may be great distances between facilities and disparate missions from urban or suburban counterparts.

According to Susan S. DeVore, the president and CEO of Premier, all of the members of the ACO collaborative will build the “critical components of accountable care,” including a patient-centered foundation; medical homes that deliver primary care and wellness; incentives to reward coordination, efficiency, and productivity; tight integration among specialists, ancillary providers and hospitals; reimbursement models that reward value over volume; and health information technology systems that can be used to coordinate care across networks.

The 19 systems already have some of these elements in place and can pursue accountability for a portion of their population, according to Premier.

These hospitals and health systems have been participating in Premier's QUEST: High-Performing Hospitals collaborative. QUEST is a 3-year information and quality improvement sharing initiative involving 200 hospitals in 31 states.

In the first year, member hospitals reduced the cost of care by an average $343 per patient. The facilities delivered care according to evidence-based quality measures 86% of the time, according to Premier.

The ACO Implementation Collaborative aims to build on that success.

The first step is to define value. According to Premier, the agreed-upon definition so far is to optimize patient outcomes, the patient care experience, and the total cost of care.

Patients Partner With Care Team

Dr. Nicholas Wolter, the CEO of the Billings Clinic, which is part of the ACO collaborative, said although accountable care organizations may seem to be a fad, much as managed care was in the early 1990s, more is known now about patient safety and delivering high quality care.

“In the ACO, patients are partners working with their care team to manage and improve their health. This is the real goal of health reform—the highest quality care at a more cost-effective price for patients and taxpayers,” he commented.

Members of the Collaborative

Aria Health, Philadelphia

AtlantiCare, Egg Harbor Township, N.J.

Baystate Health, Springfield, Mass.

Billings Clinic, Mont.

Bon Secours Health System Inc., Greenville, S.C. and Richmond, Va.

CaroMont Health, Gastonia, N.C.

Fairview Health Services, Minneapolis

Geisinger Health System, Danville, Pa.

Heartland Health, St. Joseph, Mo.

Methodist Medical Center of Illinois, Peoria

North Shore-LIJ Health System, Long Island, N.Y.

Presbyterian Healthcare Services, Albuquerque, N.M.

Saint Francis Health System, Tulsa, Okla.

Southcoast Hospitals Group, Fall River, Mass.

SSM Health Care, St. Louis, Mo.

Summa Health System, Akron, Ohio

Texas Health Resources, Arlington, Tex.

University Hospitals, Cleveland

WASHINGTON — A group of 19 health systems are taking the first steps toward becoming accountable care organizations, joining together to share best practices, coordinate care, and improve quality.

The health systems are all members of Premier Inc., a nonprofit health purchasing and quality improvement alliance. Premier will provide the expertise and databases necessary for the systems to build the accountable care organizations (ACOs).

According to Premier, members of the ACO Implementation Collaborative may be ready in 2012 to start contracting with the Centers for Medicare and Medicaid Services under the shared savings program mandated under the health reform law (Affordable Care Act).

Backbone of Health Reform

ACOs have been envisioned as the backbone of the new health care system, but they were not clearly defined in the law President Obama signed in March.

At a Capitol Hill briefing, Sen. Max Baucus (D-Mont.), Rep. Earl Pomeroy (D-N.D.), and Rep. Charles Boustany (R-La.) praised the Premier effort, saying that it would help speed up transformation of the health care system into one that values quality over quantity.

Sen. Baucus said that the accountable care organizations in the Premier alliance “put the new and innovative ideas in the health care reform law into practice to improve health care quality while reducing inefficient and wasteful spending.”

Rep. Boustany, who is a cardiovascular surgeon, said that the reform law did not go far enough to align incentives among health providers or to foster care coordination.

The Premier alliance will address some of these issues, he said, but it still is not clear if the accountable care organization model can work in rural areas where there may be great distances between facilities and disparate missions from urban or suburban counterparts.

According to Susan S. DeVore, the president and CEO of Premier, all of the members of the ACO collaborative will build the “critical components of accountable care,” including a patient-centered foundation; medical homes that deliver primary care and wellness; incentives to reward coordination, efficiency, and productivity; tight integration among specialists, ancillary providers and hospitals; reimbursement models that reward value over volume; and health information technology systems that can be used to coordinate care across networks.

The 19 systems already have some of these elements in place and can pursue accountability for a portion of their population, according to Premier.

These hospitals and health systems have been participating in Premier's QUEST: High-Performing Hospitals collaborative. QUEST is a 3-year information and quality improvement sharing initiative involving 200 hospitals in 31 states.

In the first year, member hospitals reduced the cost of care by an average $343 per patient. The facilities delivered care according to evidence-based quality measures 86% of the time, according to Premier.

The ACO Implementation Collaborative aims to build on that success.

The first step is to define value. According to Premier, the agreed-upon definition so far is to optimize patient outcomes, the patient care experience, and the total cost of care.

Patients Partner With Care Team

Dr. Nicholas Wolter, the CEO of the Billings Clinic, which is part of the ACO collaborative, said although accountable care organizations may seem to be a fad, much as managed care was in the early 1990s, more is known now about patient safety and delivering high quality care.

“In the ACO, patients are partners working with their care team to manage and improve their health. This is the real goal of health reform—the highest quality care at a more cost-effective price for patients and taxpayers,” he commented.

Members of the Collaborative

Aria Health, Philadelphia

AtlantiCare, Egg Harbor Township, N.J.

Baystate Health, Springfield, Mass.

Billings Clinic, Mont.

Bon Secours Health System Inc., Greenville, S.C. and Richmond, Va.

CaroMont Health, Gastonia, N.C.

Fairview Health Services, Minneapolis

Geisinger Health System, Danville, Pa.

Heartland Health, St. Joseph, Mo.

Methodist Medical Center of Illinois, Peoria

North Shore-LIJ Health System, Long Island, N.Y.

Presbyterian Healthcare Services, Albuquerque, N.M.

Saint Francis Health System, Tulsa, Okla.

Southcoast Hospitals Group, Fall River, Mass.

SSM Health Care, St. Louis, Mo.

Summa Health System, Akron, Ohio

Texas Health Resources, Arlington, Tex.

University Hospitals, Cleveland

WASHINGTON — A group of 19 health systems are taking the first steps toward becoming accountable care organizations, joining together to share best practices, coordinate care, and improve quality.

The health systems are all members of Premier Inc., a nonprofit health purchasing and quality improvement alliance. Premier will provide the expertise and databases necessary for the systems to build the accountable care organizations (ACOs).

According to Premier, members of the ACO Implementation Collaborative may be ready in 2012 to start contracting with the Centers for Medicare and Medicaid Services under the shared savings program mandated under the health reform law (Affordable Care Act).

Backbone of Health Reform

ACOs have been envisioned as the backbone of the new health care system, but they were not clearly defined in the law President Obama signed in March.

At a Capitol Hill briefing, Sen. Max Baucus (D-Mont.), Rep. Earl Pomeroy (D-N.D.), and Rep. Charles Boustany (R-La.) praised the Premier effort, saying that it would help speed up transformation of the health care system into one that values quality over quantity.

Sen. Baucus said that the accountable care organizations in the Premier alliance “put the new and innovative ideas in the health care reform law into practice to improve health care quality while reducing inefficient and wasteful spending.”

Rep. Boustany, who is a cardiovascular surgeon, said that the reform law did not go far enough to align incentives among health providers or to foster care coordination.

The Premier alliance will address some of these issues, he said, but it still is not clear if the accountable care organization model can work in rural areas where there may be great distances between facilities and disparate missions from urban or suburban counterparts.

According to Susan S. DeVore, the president and CEO of Premier, all of the members of the ACO collaborative will build the “critical components of accountable care,” including a patient-centered foundation; medical homes that deliver primary care and wellness; incentives to reward coordination, efficiency, and productivity; tight integration among specialists, ancillary providers and hospitals; reimbursement models that reward value over volume; and health information technology systems that can be used to coordinate care across networks.

The 19 systems already have some of these elements in place and can pursue accountability for a portion of their population, according to Premier.

These hospitals and health systems have been participating in Premier's QUEST: High-Performing Hospitals collaborative. QUEST is a 3-year information and quality improvement sharing initiative involving 200 hospitals in 31 states.

In the first year, member hospitals reduced the cost of care by an average $343 per patient. The facilities delivered care according to evidence-based quality measures 86% of the time, according to Premier.

The ACO Implementation Collaborative aims to build on that success.

The first step is to define value. According to Premier, the agreed-upon definition so far is to optimize patient outcomes, the patient care experience, and the total cost of care.

Patients Partner With Care Team

Dr. Nicholas Wolter, the CEO of the Billings Clinic, which is part of the ACO collaborative, said although accountable care organizations may seem to be a fad, much as managed care was in the early 1990s, more is known now about patient safety and delivering high quality care.

“In the ACO, patients are partners working with their care team to manage and improve their health. This is the real goal of health reform—the highest quality care at a more cost-effective price for patients and taxpayers,” he commented.

Members of the Collaborative

Aria Health, Philadelphia

AtlantiCare, Egg Harbor Township, N.J.

Baystate Health, Springfield, Mass.

Billings Clinic, Mont.

Bon Secours Health System Inc., Greenville, S.C. and Richmond, Va.

CaroMont Health, Gastonia, N.C.

Fairview Health Services, Minneapolis

Geisinger Health System, Danville, Pa.

Heartland Health, St. Joseph, Mo.

Methodist Medical Center of Illinois, Peoria

North Shore-LIJ Health System, Long Island, N.Y.

Presbyterian Healthcare Services, Albuquerque, N.M.

Saint Francis Health System, Tulsa, Okla.

Southcoast Hospitals Group, Fall River, Mass.

SSM Health Care, St. Louis, Mo.

Summa Health System, Akron, Ohio

Texas Health Resources, Arlington, Tex.

University Hospitals, Cleveland

The American Medical Association on May 25 called on U.S. health insurance companies to adopt its just-issued code of conduct.

The Health Insurer Code of Conduct Principles evolved out of a resolution put forward and unanimously adopted by the AMA House of Delegates at its 2008 Interim Meeting. The New York Delegation called on the AMA to develop such a code, get insurers to sign on, and come up with a way to monitor compliance. The code has already been endorsed by nearly every state medical society as well as 19 specialty societies, according to the AMA.

The last time the insurance industry issued any kind of internal standards was 15 years ago, according to the AMA.

“The health insurance industry has a crisis of credibility,” Dr. J. James Rohack, AMA president, said in the statement. “With the enactment of federal health reform legislation, it's time for insurers to re-commit to patients' best interests and the fair business practices necessary to re-establish trust with the patient and physician communities.”

Americas Health Insurance Plans, the industry trade organization, did not directly address the AMA code. But AHIP spokesman Robert Zirkelbach said that many of the principles are covered under the health reform law—formally, the Affordable Care Act.

“Health plans have pioneered innovative programs to reward quality, promote prevention and wellness, coordinate care for patients with chronic conditions, streamline administrative processes, and provide policyholders with greater peace of mind,” Mr. Zirkelbach said.

“We will continue to work with policymakers and other health care stakeholders to improve the quality, safety, and efficiency of our health care system.”

The code addresses topics including cancellations and recissions; medical loss ratios and calculating fair premiums; open access to care, including transparent rules on provider networks and benefit limitations; fairness in contract negotiations with physicians; medical necessity and who can define it; and a call for more administrative simplification, fewer restrictions on benefits, and better risk adjustment mechanisms for “physician profiling” systems.

For more information, visit www.ama-assn.org/ama/pub/advocacy/current-topics-advocacy/private-sector-advocacy/code-of-conduct-principles.shtml

The health insurance industry has a crisis of credibility and needs to recommit to fair business practices.

Source DR. ROHACK

The American Medical Association on May 25 called on U.S. health insurance companies to adopt its just-issued code of conduct.

The Health Insurer Code of Conduct Principles evolved out of a resolution put forward and unanimously adopted by the AMA House of Delegates at its 2008 Interim Meeting. The New York Delegation called on the AMA to develop such a code, get insurers to sign on, and come up with a way to monitor compliance. The code has already been endorsed by nearly every state medical society as well as 19 specialty societies, according to the AMA.

The last time the insurance industry issued any kind of internal standards was 15 years ago, according to the AMA.

“The health insurance industry has a crisis of credibility,” Dr. J. James Rohack, AMA president, said in the statement. “With the enactment of federal health reform legislation, it's time for insurers to re-commit to patients' best interests and the fair business practices necessary to re-establish trust with the patient and physician communities.”

Americas Health Insurance Plans, the industry trade organization, did not directly address the AMA code. But AHIP spokesman Robert Zirkelbach said that many of the principles are covered under the health reform law—formally, the Affordable Care Act.

“Health plans have pioneered innovative programs to reward quality, promote prevention and wellness, coordinate care for patients with chronic conditions, streamline administrative processes, and provide policyholders with greater peace of mind,” Mr. Zirkelbach said.

“We will continue to work with policymakers and other health care stakeholders to improve the quality, safety, and efficiency of our health care system.”

The code addresses topics including cancellations and recissions; medical loss ratios and calculating fair premiums; open access to care, including transparent rules on provider networks and benefit limitations; fairness in contract negotiations with physicians; medical necessity and who can define it; and a call for more administrative simplification, fewer restrictions on benefits, and better risk adjustment mechanisms for “physician profiling” systems.

For more information, visit www.ama-assn.org/ama/pub/advocacy/current-topics-advocacy/private-sector-advocacy/code-of-conduct-principles.shtml

The health insurance industry has a crisis of credibility and needs to recommit to fair business practices.

Source DR. ROHACK

The American Medical Association on May 25 called on U.S. health insurance companies to adopt its just-issued code of conduct.

The Health Insurer Code of Conduct Principles evolved out of a resolution put forward and unanimously adopted by the AMA House of Delegates at its 2008 Interim Meeting. The New York Delegation called on the AMA to develop such a code, get insurers to sign on, and come up with a way to monitor compliance. The code has already been endorsed by nearly every state medical society as well as 19 specialty societies, according to the AMA.

The last time the insurance industry issued any kind of internal standards was 15 years ago, according to the AMA.

“The health insurance industry has a crisis of credibility,” Dr. J. James Rohack, AMA president, said in the statement. “With the enactment of federal health reform legislation, it's time for insurers to re-commit to patients' best interests and the fair business practices necessary to re-establish trust with the patient and physician communities.”

Americas Health Insurance Plans, the industry trade organization, did not directly address the AMA code. But AHIP spokesman Robert Zirkelbach said that many of the principles are covered under the health reform law—formally, the Affordable Care Act.

“Health plans have pioneered innovative programs to reward quality, promote prevention and wellness, coordinate care for patients with chronic conditions, streamline administrative processes, and provide policyholders with greater peace of mind,” Mr. Zirkelbach said.

“We will continue to work with policymakers and other health care stakeholders to improve the quality, safety, and efficiency of our health care system.”

The code addresses topics including cancellations and recissions; medical loss ratios and calculating fair premiums; open access to care, including transparent rules on provider networks and benefit limitations; fairness in contract negotiations with physicians; medical necessity and who can define it; and a call for more administrative simplification, fewer restrictions on benefits, and better risk adjustment mechanisms for “physician profiling” systems.

For more information, visit www.ama-assn.org/ama/pub/advocacy/current-topics-advocacy/private-sector-advocacy/code-of-conduct-principles.shtml

The health insurance industry has a crisis of credibility and needs to recommit to fair business practices.

Source DR. ROHACK

Fourteen medical specialty societies have signed a voluntary pledge to be more transparent in dealings with pharmaceutical and medical device manufacturers and other for-profit companies in the health care field.

The pledge, issued by the Council of Medical Specialty Societies (CMSS), was the result of at least a year of negotiations, said Dr. Allen S. Lichter, who is chair of the CMSS Task Force on Professionalism and Conflict of Interest and the chief executive officer of the American Society of Clinical Oncology (ASCO).

“CMSS is committed to encouraging and supporting a culture of integrity, voluntary self-regulation, and transparency,” said Dr. James H. Scully Jr., CMSS president and chief executive officer of the American Psychiatric Association. “This code provides a clear benchmark for maintaining integrity and independence.”

The 14 societies adopting the CMSS Code for Interactions with Companies agree to establish and publish conflict of interest policies as well as policies and procedures to ensure separation of program development from sponsor influence. They also must disclose corporate contributions, board members' financial relationships with companies, and prohibit financial relationships for key association leaders.

The initial signers included the American Academy of Family Physicians (AAFP), American Academy of Neurology (AAN), American Academy of Ophthalmology (AAO), American Academy of Pediatrics (AAP), American College of Cardiology (ACC), Accreditation Council for Continuing Medical Education (ACCME), American College of Emergency Physicians (ACEP), American College of Obstetricians and Gynecologists (ACOG), American College of Physicians (ACP), American College of Preventive Medicine (ACPM), American Academy of Physical Medicine and Rehabilitation (AAPMR), American College of Radiology (ACR), American Society for Radiation Oncology (ASTRO), and ASCO.

Dr. Daniel J. Ostergaard, the AAFP's vice president for professional activities, said that the CMSS code gives his organization a chance to see where it might improve its current policies on disclosure and ethical conflicts. He said that the AAFP has a long history of seeking to conduct itself ethically. “I feel very confident that my academy has always been addressing the issues pretty directly and with transparency,” Dr. Ostergaard said in an interview.

The AAFP's board members and counsel will spend the next few months determining how to bring its policies into compliance with the CMSS code, he added.

Adoption of the code will not impact the controversial alliance the AAFP struck with Coca-Cola in the fall of 2009 to conduct a consumer awareness campaign about beverages and sweeteners. Dr. Ostergaard said that the code related specifically to health-related companies and that Coca-Cola did not purport to be health related.

Dr. Lichter called the code a “very important milestone” because it will create consistency where there has been none. Many previous efforts to reduce conflicts have been done in private, but this effort is very much a public undertaking, designed to reassure the public and regulators that professional societies are acting ethically, Dr. Lichter said.

It is also, however, just a first step, he said. The code is not meant to be the last word; it represents a minimum set of guidelines. Some organizations may choose to be more restrictive, Dr. Lichter said.

According to the CMSS, the code was developed by a 30-member task force. More of the 32 members of the CMSS plan to adopt the code in the next few months.

The 25-page code is available on the CMSS Web site at www.cmss.org/codeforinteractions.aspx

Fourteen medical specialty societies have signed a voluntary pledge to be more transparent in dealings with pharmaceutical and medical device manufacturers and other for-profit companies in the health care field.

The pledge, issued by the Council of Medical Specialty Societies (CMSS), was the result of at least a year of negotiations, said Dr. Allen S. Lichter, who is chair of the CMSS Task Force on Professionalism and Conflict of Interest and the chief executive officer of the American Society of Clinical Oncology (ASCO).

“CMSS is committed to encouraging and supporting a culture of integrity, voluntary self-regulation, and transparency,” said Dr. James H. Scully Jr., CMSS president and chief executive officer of the American Psychiatric Association. “This code provides a clear benchmark for maintaining integrity and independence.”

The 14 societies adopting the CMSS Code for Interactions with Companies agree to establish and publish conflict of interest policies as well as policies and procedures to ensure separation of program development from sponsor influence. They also must disclose corporate contributions, board members' financial relationships with companies, and prohibit financial relationships for key association leaders.

The initial signers included the American Academy of Family Physicians (AAFP), American Academy of Neurology (AAN), American Academy of Ophthalmology (AAO), American Academy of Pediatrics (AAP), American College of Cardiology (ACC), Accreditation Council for Continuing Medical Education (ACCME), American College of Emergency Physicians (ACEP), American College of Obstetricians and Gynecologists (ACOG), American College of Physicians (ACP), American College of Preventive Medicine (ACPM), American Academy of Physical Medicine and Rehabilitation (AAPMR), American College of Radiology (ACR), American Society for Radiation Oncology (ASTRO), and ASCO.

Dr. Daniel J. Ostergaard, the AAFP's vice president for professional activities, said that the CMSS code gives his organization a chance to see where it might improve its current policies on disclosure and ethical conflicts. He said that the AAFP has a long history of seeking to conduct itself ethically. “I feel very confident that my academy has always been addressing the issues pretty directly and with transparency,” Dr. Ostergaard said in an interview.

The AAFP's board members and counsel will spend the next few months determining how to bring its policies into compliance with the CMSS code, he added.

Adoption of the code will not impact the controversial alliance the AAFP struck with Coca-Cola in the fall of 2009 to conduct a consumer awareness campaign about beverages and sweeteners. Dr. Ostergaard said that the code related specifically to health-related companies and that Coca-Cola did not purport to be health related.

Dr. Lichter called the code a “very important milestone” because it will create consistency where there has been none. Many previous efforts to reduce conflicts have been done in private, but this effort is very much a public undertaking, designed to reassure the public and regulators that professional societies are acting ethically, Dr. Lichter said.

It is also, however, just a first step, he said. The code is not meant to be the last word; it represents a minimum set of guidelines. Some organizations may choose to be more restrictive, Dr. Lichter said.

According to the CMSS, the code was developed by a 30-member task force. More of the 32 members of the CMSS plan to adopt the code in the next few months.

The 25-page code is available on the CMSS Web site at www.cmss.org/codeforinteractions.aspx

Fourteen medical specialty societies have signed a voluntary pledge to be more transparent in dealings with pharmaceutical and medical device manufacturers and other for-profit companies in the health care field.

The pledge, issued by the Council of Medical Specialty Societies (CMSS), was the result of at least a year of negotiations, said Dr. Allen S. Lichter, who is chair of the CMSS Task Force on Professionalism and Conflict of Interest and the chief executive officer of the American Society of Clinical Oncology (ASCO).

“CMSS is committed to encouraging and supporting a culture of integrity, voluntary self-regulation, and transparency,” said Dr. James H. Scully Jr., CMSS president and chief executive officer of the American Psychiatric Association. “This code provides a clear benchmark for maintaining integrity and independence.”

The 14 societies adopting the CMSS Code for Interactions with Companies agree to establish and publish conflict of interest policies as well as policies and procedures to ensure separation of program development from sponsor influence. They also must disclose corporate contributions, board members' financial relationships with companies, and prohibit financial relationships for key association leaders.

The initial signers included the American Academy of Family Physicians (AAFP), American Academy of Neurology (AAN), American Academy of Ophthalmology (AAO), American Academy of Pediatrics (AAP), American College of Cardiology (ACC), Accreditation Council for Continuing Medical Education (ACCME), American College of Emergency Physicians (ACEP), American College of Obstetricians and Gynecologists (ACOG), American College of Physicians (ACP), American College of Preventive Medicine (ACPM), American Academy of Physical Medicine and Rehabilitation (AAPMR), American College of Radiology (ACR), American Society for Radiation Oncology (ASTRO), and ASCO.

Dr. Daniel J. Ostergaard, the AAFP's vice president for professional activities, said that the CMSS code gives his organization a chance to see where it might improve its current policies on disclosure and ethical conflicts. He said that the AAFP has a long history of seeking to conduct itself ethically. “I feel very confident that my academy has always been addressing the issues pretty directly and with transparency,” Dr. Ostergaard said in an interview.

The AAFP's board members and counsel will spend the next few months determining how to bring its policies into compliance with the CMSS code, he added.

Adoption of the code will not impact the controversial alliance the AAFP struck with Coca-Cola in the fall of 2009 to conduct a consumer awareness campaign about beverages and sweeteners. Dr. Ostergaard said that the code related specifically to health-related companies and that Coca-Cola did not purport to be health related.

Dr. Lichter called the code a “very important milestone” because it will create consistency where there has been none. Many previous efforts to reduce conflicts have been done in private, but this effort is very much a public undertaking, designed to reassure the public and regulators that professional societies are acting ethically, Dr. Lichter said.

It is also, however, just a first step, he said. The code is not meant to be the last word; it represents a minimum set of guidelines. Some organizations may choose to be more restrictive, Dr. Lichter said.

According to the CMSS, the code was developed by a 30-member task force. More of the 32 members of the CMSS plan to adopt the code in the next few months.

The 25-page code is available on the CMSS Web site at www.cmss.org/codeforinteractions.aspx