Alicia Ault

The National Committee for Quality Assurance has issued draft criteria to define the core capabilities of an accountable care organization.

The accountable care organization (ACO) concept is central to the health system reform envisioned by the Affordable Care Act, but what it would look like or how it would work has been variously and loosely defined. The nonprofit NCQA has stepped in to offer a set of parameters that might standardize the ACO model.

“Our goal is to help people be confident that ACOs meeting the final criteria actually can contain costs without compromising quality,” said NCQA President Margaret O'Kane in a statement.

The NCQA has been a leader in establishing quality performance measurement tools that are widely used by health care providers, insurers, and employers. The group receives funding and support from a variety of organizations, including the American College of Physicians and the American Academy of Family Physicians; insurers and pharmaceutical companies also contribute.

The organization has posted the ACO criteria on its Web site and is accepting public comments until Nov. 19. According to the NCQA, each ACO should have core capabilities in seven categories: program structure operations; access and availability; primary care; care management; care coordination and transitions; patient rights and responsibilities; and performance reporting.

The criteria were developed by the organization's ACO task force, which was headed by Dr. Robert Margolis, CEO of the California-based HealthCare Partners Medical Group; the 18 other task force members included Dr. Duane Davis, vice president and chief medical officer of the Pennsylvania-based Geisinger Health Plan, and Dr. Nicholas Wolter, CEO of the Billings (Mont.) Clinic.

ACOs that participate in the NCQA process also will eventually report outcomes on performance measurements. That is important, Dr. Margolis said in a statement, adding that, “most potential ACOs do not have data that can be used from the start to evaluate performance.”

He added that “public feedback will help with finalizing the criteria that will start these organizations to a firm foundation.”

After the comment period closes, the task force led by Dr. Margolis will review the comments and make revisions, as appropriate, according to a spokesperson for NCQA.

The group will also align the criteria with any regulations pertaining to ACOs. The criteria will likely be made final by March 2011 and then will be released in the second quarter of 2011, the spokesperson said.

The National Committee for Quality Assurance has issued draft criteria to define the core capabilities of an accountable care organization.

The accountable care organization (ACO) concept is central to the health system reform envisioned by the Affordable Care Act, but what it would look like or how it would work has been variously and loosely defined. The nonprofit NCQA has stepped in to offer a set of parameters that might standardize the ACO model.

“Our goal is to help people be confident that ACOs meeting the final criteria actually can contain costs without compromising quality,” said NCQA President Margaret O'Kane in a statement.

The NCQA has been a leader in establishing quality performance measurement tools that are widely used by health care providers, insurers, and employers. The group receives funding and support from a variety of organizations, including the American College of Physicians and the American Academy of Family Physicians; insurers and pharmaceutical companies also contribute.

The organization has posted the ACO criteria on its Web site and is accepting public comments until Nov. 19. According to the NCQA, each ACO should have core capabilities in seven categories: program structure operations; access and availability; primary care; care management; care coordination and transitions; patient rights and responsibilities; and performance reporting.

The criteria were developed by the organization's ACO task force, which was headed by Dr. Robert Margolis, CEO of the California-based HealthCare Partners Medical Group; the 18 other task force members included Dr. Duane Davis, vice president and chief medical officer of the Pennsylvania-based Geisinger Health Plan, and Dr. Nicholas Wolter, CEO of the Billings (Mont.) Clinic.

ACOs that participate in the NCQA process also will eventually report outcomes on performance measurements. That is important, Dr. Margolis said in a statement, adding that, “most potential ACOs do not have data that can be used from the start to evaluate performance.”

He added that “public feedback will help with finalizing the criteria that will start these organizations to a firm foundation.”

After the comment period closes, the task force led by Dr. Margolis will review the comments and make revisions, as appropriate, according to a spokesperson for NCQA.

The group will also align the criteria with any regulations pertaining to ACOs. The criteria will likely be made final by March 2011 and then will be released in the second quarter of 2011, the spokesperson said.

The National Committee for Quality Assurance has issued draft criteria to define the core capabilities of an accountable care organization.

The accountable care organization (ACO) concept is central to the health system reform envisioned by the Affordable Care Act, but what it would look like or how it would work has been variously and loosely defined. The nonprofit NCQA has stepped in to offer a set of parameters that might standardize the ACO model.

“Our goal is to help people be confident that ACOs meeting the final criteria actually can contain costs without compromising quality,” said NCQA President Margaret O'Kane in a statement.

The NCQA has been a leader in establishing quality performance measurement tools that are widely used by health care providers, insurers, and employers. The group receives funding and support from a variety of organizations, including the American College of Physicians and the American Academy of Family Physicians; insurers and pharmaceutical companies also contribute.

The organization has posted the ACO criteria on its Web site and is accepting public comments until Nov. 19. According to the NCQA, each ACO should have core capabilities in seven categories: program structure operations; access and availability; primary care; care management; care coordination and transitions; patient rights and responsibilities; and performance reporting.

The criteria were developed by the organization's ACO task force, which was headed by Dr. Robert Margolis, CEO of the California-based HealthCare Partners Medical Group; the 18 other task force members included Dr. Duane Davis, vice president and chief medical officer of the Pennsylvania-based Geisinger Health Plan, and Dr. Nicholas Wolter, CEO of the Billings (Mont.) Clinic.

ACOs that participate in the NCQA process also will eventually report outcomes on performance measurements. That is important, Dr. Margolis said in a statement, adding that, “most potential ACOs do not have data that can be used from the start to evaluate performance.”

He added that “public feedback will help with finalizing the criteria that will start these organizations to a firm foundation.”

After the comment period closes, the task force led by Dr. Margolis will review the comments and make revisions, as appropriate, according to a spokesperson for NCQA.

The group will also align the criteria with any regulations pertaining to ACOs. The criteria will likely be made final by March 2011 and then will be released in the second quarter of 2011, the spokesperson said.

WASHINGTON — More than a quarter (28%) of all acute care visits in the United States are made to the emergency department, while slightly less than half (42%) take place in primary care physicians' offices.

Another 20% of acute care visits are made to subspecialist offices, lead study author Dr. Stephen R. Pitts said.

It appears that the more severe a complaint, the more likely a patient will seek care in the ED, said Dr. Pitts of the department of medicine at Emory University, Atlanta. However, the ED is frequently the only option for care, he said, noting that, “too often, patients can't get the care they need, when they need it, from their family doctor.”

Two-thirds of ED acute care occurred on weekends or on weekdays after office hours. Uninsured patients received more than half their acute care in EDs, Dr. Pitts and his colleagues said (Health Aff. 2010;29:1620–9).

The authors used data from three federal surveys of ambulatory medical care in the outpatient, ED, and physician office setting. Presenting complaints including stomach and abdominal pain, chest pain, and fever dominated the list of what brought patients to the ED. Conversely, patients who presented to their primary care physician's office for acute care most frequently complained of cough, throat symptoms, rash, and earache.

Overall, emergency physicians took care of 11% of all ambulatory care visits, yet they make up only 4% of the physician workforce, the authors said.

Studies have shown that emergency care accounts for only 3% of all health spending, Dr. Arthur L. Kellermann, a study coauthor, said at the briefing.

“The fact that 3% of our dollars and 4% of our doctors are delivering that percentage of care is not such a bad deal,” said Dr. Kellermann, an emergency physician and the Paul O'Neill Alcoa Chair in Policy Analysis at the Rand Corp. But, he said, it might not be the best possible care for patients or the optimum use of dollars for the health system.

One of Dr. Pitts' coauthors disclosed that she received a training grant from the Centers for Disease Control and Prevention; others reported no conflicts.

WASHINGTON — More than a quarter (28%) of all acute care visits in the United States are made to the emergency department, while slightly less than half (42%) take place in primary care physicians' offices.

Another 20% of acute care visits are made to subspecialist offices, lead study author Dr. Stephen R. Pitts said.

It appears that the more severe a complaint, the more likely a patient will seek care in the ED, said Dr. Pitts of the department of medicine at Emory University, Atlanta. However, the ED is frequently the only option for care, he said, noting that, “too often, patients can't get the care they need, when they need it, from their family doctor.”

Two-thirds of ED acute care occurred on weekends or on weekdays after office hours. Uninsured patients received more than half their acute care in EDs, Dr. Pitts and his colleagues said (Health Aff. 2010;29:1620–9).

The authors used data from three federal surveys of ambulatory medical care in the outpatient, ED, and physician office setting. Presenting complaints including stomach and abdominal pain, chest pain, and fever dominated the list of what brought patients to the ED. Conversely, patients who presented to their primary care physician's office for acute care most frequently complained of cough, throat symptoms, rash, and earache.

Overall, emergency physicians took care of 11% of all ambulatory care visits, yet they make up only 4% of the physician workforce, the authors said.

Studies have shown that emergency care accounts for only 3% of all health spending, Dr. Arthur L. Kellermann, a study coauthor, said at the briefing.

“The fact that 3% of our dollars and 4% of our doctors are delivering that percentage of care is not such a bad deal,” said Dr. Kellermann, an emergency physician and the Paul O'Neill Alcoa Chair in Policy Analysis at the Rand Corp. But, he said, it might not be the best possible care for patients or the optimum use of dollars for the health system.

One of Dr. Pitts' coauthors disclosed that she received a training grant from the Centers for Disease Control and Prevention; others reported no conflicts.

WASHINGTON — More than a quarter (28%) of all acute care visits in the United States are made to the emergency department, while slightly less than half (42%) take place in primary care physicians' offices.

Another 20% of acute care visits are made to subspecialist offices, lead study author Dr. Stephen R. Pitts said.

It appears that the more severe a complaint, the more likely a patient will seek care in the ED, said Dr. Pitts of the department of medicine at Emory University, Atlanta. However, the ED is frequently the only option for care, he said, noting that, “too often, patients can't get the care they need, when they need it, from their family doctor.”

Two-thirds of ED acute care occurred on weekends or on weekdays after office hours. Uninsured patients received more than half their acute care in EDs, Dr. Pitts and his colleagues said (Health Aff. 2010;29:1620–9).

The authors used data from three federal surveys of ambulatory medical care in the outpatient, ED, and physician office setting. Presenting complaints including stomach and abdominal pain, chest pain, and fever dominated the list of what brought patients to the ED. Conversely, patients who presented to their primary care physician's office for acute care most frequently complained of cough, throat symptoms, rash, and earache.

Overall, emergency physicians took care of 11% of all ambulatory care visits, yet they make up only 4% of the physician workforce, the authors said.

Studies have shown that emergency care accounts for only 3% of all health spending, Dr. Arthur L. Kellermann, a study coauthor, said at the briefing.

“The fact that 3% of our dollars and 4% of our doctors are delivering that percentage of care is not such a bad deal,” said Dr. Kellermann, an emergency physician and the Paul O'Neill Alcoa Chair in Policy Analysis at the Rand Corp. But, he said, it might not be the best possible care for patients or the optimum use of dollars for the health system.

One of Dr. Pitts' coauthors disclosed that she received a training grant from the Centers for Disease Control and Prevention; others reported no conflicts.

Washington — Dr. Donald Berwick, administrator of the Centers for Medicare and Medicaid Services, largely escaped criticism from Republican senators during his first official appearance on Capitol Hill on Nov. 17, but several senators vowed that they would ensure that he answered all their questions in writing or at another hearing.

Dr. Berwick was appointed by President Obama in July while Congress was in recess. Thus, Dr. Berwick was never subject to confirmation hearings, leaving most Republicans and some Democrats saying that the legislative authority to confirm high-level executive branch appointments had been bypassed.

Speaking before the Finance committee on Nov. 17, Dr. Berwick tried to soothe his potential critics by discussing the potential he sees in addressing the wrongs of the American health care system.

“I feel incredibly lucky to be able to join CMS at a historic time, a time of enormous promise for the future of our nation's health care,” he said. He added that he thought the federal government “should aim for three goals simultaneously: better care for individuals, better health for the American people, and lower costs through improvement.”

The Affordable Care Act (ACA) is “the best opportunity we've had in a generation or more to make progress,” said Dr. Berwick.

The hearing was led by Chairman Max Baucus (D-Mont.), who scheduled 1 hour for opening statements, testimony, and questioning – an unusually short duration for any congressional committee hearing.

Democratic members of the panel used their allotted 5 minutes of questioning to express enthusiasm for various parts of the ACA and to give Dr. Berwick the opportunity to do the same. Republicans mainly expressed concern that they did not have the ability to properly question Dr. Berwick, given the hearing's tight timeline.

During his turn to question the CMS administrator, the committee's ranking minority member, Sen. Chuck Grassley (R-Iowa), wanted to know whether Dr. Berwick supported the conclusions of an April report issued by Rick Foster, the Medicare Chief Actuary. According to Sen. Grassley, that report said that the reductions envisioned in the ACA would threaten beneficiaries' access to care.

Dr. Berwick countered that Mr. Foster's estimates were just that – estimates based on his best judgment. “Our intention is to increase access to care,” he told Sen. Grassley. Beneficiaries will “find themselves in better shape after implementation of this act is fully engaged,” he added.

Sen. Orrin Hatch (R-Utah) also asked Dr. Berwick about the actuary's report. But he used most of his time to complain that the CMS Administrator – in charge of a budget larger than the Pentagon's, as he noted – had not been available until that day.

“Obviously, asking us to cover all of our concerns in this hour-long hearing with only 5 minutes…per person, is like asking us to drain the Pacific Ocean with a thimble,” Sen. Hatch said.

He said that he hoped that Dr. Berwick would answer any and all questions put to him in writing and that the administration would allow him to fully answer the queries.

Sen. Hatch and Sen. Grassley and other Republicans asked for additional hearings with Dr. Berwick after the Thanksgiving break, but Chairman Baucus was noncommittal about scheduling such an event.

That prompted a blunt assessment from Sen. Jim Bunning (R-Ky.), who is not returning for the next Congress.

“I can assure you that you will not get special treatment next year,” when Republicans hold the majority in the House. “I suspect that you will be spending a lot of time testifying before the House of Representatives, partly because we in the Senate have been shut out,” Sen. Bunning said.

Washington — Dr. Donald Berwick, administrator of the Centers for Medicare and Medicaid Services, largely escaped criticism from Republican senators during his first official appearance on Capitol Hill on Nov. 17, but several senators vowed that they would ensure that he answered all their questions in writing or at another hearing.

Dr. Berwick was appointed by President Obama in July while Congress was in recess. Thus, Dr. Berwick was never subject to confirmation hearings, leaving most Republicans and some Democrats saying that the legislative authority to confirm high-level executive branch appointments had been bypassed.

Speaking before the Finance committee on Nov. 17, Dr. Berwick tried to soothe his potential critics by discussing the potential he sees in addressing the wrongs of the American health care system.

“I feel incredibly lucky to be able to join CMS at a historic time, a time of enormous promise for the future of our nation's health care,” he said. He added that he thought the federal government “should aim for three goals simultaneously: better care for individuals, better health for the American people, and lower costs through improvement.”

The Affordable Care Act (ACA) is “the best opportunity we've had in a generation or more to make progress,” said Dr. Berwick.

The hearing was led by Chairman Max Baucus (D-Mont.), who scheduled 1 hour for opening statements, testimony, and questioning – an unusually short duration for any congressional committee hearing.

Democratic members of the panel used their allotted 5 minutes of questioning to express enthusiasm for various parts of the ACA and to give Dr. Berwick the opportunity to do the same. Republicans mainly expressed concern that they did not have the ability to properly question Dr. Berwick, given the hearing's tight timeline.

During his turn to question the CMS administrator, the committee's ranking minority member, Sen. Chuck Grassley (R-Iowa), wanted to know whether Dr. Berwick supported the conclusions of an April report issued by Rick Foster, the Medicare Chief Actuary. According to Sen. Grassley, that report said that the reductions envisioned in the ACA would threaten beneficiaries' access to care.

Dr. Berwick countered that Mr. Foster's estimates were just that – estimates based on his best judgment. “Our intention is to increase access to care,” he told Sen. Grassley. Beneficiaries will “find themselves in better shape after implementation of this act is fully engaged,” he added.

Sen. Orrin Hatch (R-Utah) also asked Dr. Berwick about the actuary's report. But he used most of his time to complain that the CMS Administrator – in charge of a budget larger than the Pentagon's, as he noted – had not been available until that day.

“Obviously, asking us to cover all of our concerns in this hour-long hearing with only 5 minutes…per person, is like asking us to drain the Pacific Ocean with a thimble,” Sen. Hatch said.

He said that he hoped that Dr. Berwick would answer any and all questions put to him in writing and that the administration would allow him to fully answer the queries.

Sen. Hatch and Sen. Grassley and other Republicans asked for additional hearings with Dr. Berwick after the Thanksgiving break, but Chairman Baucus was noncommittal about scheduling such an event.

That prompted a blunt assessment from Sen. Jim Bunning (R-Ky.), who is not returning for the next Congress.

“I can assure you that you will not get special treatment next year,” when Republicans hold the majority in the House. “I suspect that you will be spending a lot of time testifying before the House of Representatives, partly because we in the Senate have been shut out,” Sen. Bunning said.

Washington — Dr. Donald Berwick, administrator of the Centers for Medicare and Medicaid Services, largely escaped criticism from Republican senators during his first official appearance on Capitol Hill on Nov. 17, but several senators vowed that they would ensure that he answered all their questions in writing or at another hearing.

Dr. Berwick was appointed by President Obama in July while Congress was in recess. Thus, Dr. Berwick was never subject to confirmation hearings, leaving most Republicans and some Democrats saying that the legislative authority to confirm high-level executive branch appointments had been bypassed.

Speaking before the Finance committee on Nov. 17, Dr. Berwick tried to soothe his potential critics by discussing the potential he sees in addressing the wrongs of the American health care system.

“I feel incredibly lucky to be able to join CMS at a historic time, a time of enormous promise for the future of our nation's health care,” he said. He added that he thought the federal government “should aim for three goals simultaneously: better care for individuals, better health for the American people, and lower costs through improvement.”

The Affordable Care Act (ACA) is “the best opportunity we've had in a generation or more to make progress,” said Dr. Berwick.

The hearing was led by Chairman Max Baucus (D-Mont.), who scheduled 1 hour for opening statements, testimony, and questioning – an unusually short duration for any congressional committee hearing.

Democratic members of the panel used their allotted 5 minutes of questioning to express enthusiasm for various parts of the ACA and to give Dr. Berwick the opportunity to do the same. Republicans mainly expressed concern that they did not have the ability to properly question Dr. Berwick, given the hearing's tight timeline.

During his turn to question the CMS administrator, the committee's ranking minority member, Sen. Chuck Grassley (R-Iowa), wanted to know whether Dr. Berwick supported the conclusions of an April report issued by Rick Foster, the Medicare Chief Actuary. According to Sen. Grassley, that report said that the reductions envisioned in the ACA would threaten beneficiaries' access to care.

Dr. Berwick countered that Mr. Foster's estimates were just that – estimates based on his best judgment. “Our intention is to increase access to care,” he told Sen. Grassley. Beneficiaries will “find themselves in better shape after implementation of this act is fully engaged,” he added.

Sen. Orrin Hatch (R-Utah) also asked Dr. Berwick about the actuary's report. But he used most of his time to complain that the CMS Administrator – in charge of a budget larger than the Pentagon's, as he noted – had not been available until that day.

“Obviously, asking us to cover all of our concerns in this hour-long hearing with only 5 minutes…per person, is like asking us to drain the Pacific Ocean with a thimble,” Sen. Hatch said.

He said that he hoped that Dr. Berwick would answer any and all questions put to him in writing and that the administration would allow him to fully answer the queries.

Sen. Hatch and Sen. Grassley and other Republicans asked for additional hearings with Dr. Berwick after the Thanksgiving break, but Chairman Baucus was noncommittal about scheduling such an event.

That prompted a blunt assessment from Sen. Jim Bunning (R-Ky.), who is not returning for the next Congress.

“I can assure you that you will not get special treatment next year,” when Republicans hold the majority in the House. “I suspect that you will be spending a lot of time testifying before the House of Representatives, partly because we in the Senate have been shut out,” Sen. Bunning said.

AHA Merges Guidelines

The American Heart Association has combined its quality improvement programs on cardiopulmonary resuscitation and postresuscitation care. The melding of the association's National Registry of CardioPulmonary Resuscitation program with its Get With the Guidelines effort was spurred by recently released recommendations on CPR and emergency cardiovascular care (ECC). The registry is a database of resuscitation events in 500 hospitals that have used the data to improve outcomes, according to an AHA statement. Get With the Guidelines has offered in-hospital quality improvement modules for heart failure, stroke, and outpatient care. Incorporating CPR quality improvement, the new product is called Get With the Guidelines–Resuscitation.

Women's Stroke Survival Lags

Although in-hospital stroke death is falling for both men and women, it is declining faster for men, according to the Agency for Healthcare Research and Quality. The death rate per 1,000 admissions for men with stroke declined from 123 in 2000 to 87 in 2007. For women, deaths declined from 127 per 1,000 in 2000 to 96 per 1,000 in 2007. The death rate from heart failure fell by 52% for men and 46% for women, but they were equally as likely to die in-hospital. Women's death rate from heart attack declined slightly more than did men's but still showed the former much more likely to die as inpatients: In 2007, 77 women died per 1,000 admissions, compared with only 58 men per 1,000 admissions. The data come from the agency's Trends in Hospital Risk-Adjusted Mortality for Selected Diagnoses by Patient Subgroups, 2000-2007.

Red Flag for A Fib Drug

The Institute for Safe Medication Practices reported that the Food and Drug Administration has been receiving increasing numbers of reports that dronedarone (Multaq) may cause or worsen heart failure or trigger irregular heartbeats. There were also incidents of kidney failure or impairment, according to the watchdog group, which analyzes case reports submitted to the FDA. The review of dronedarone identified 387 serious adverse events associated with the drug since its approval in 2009, including 24 deaths. The group also flagged the patient medication guide for dronedarone, saying that it contains a misleading reassurance about the drug's potential as a teratogen, even though it was included in the FDA's Category X for pregnant women. “We have seldom seen a drug with so many issues in so many areas of its safety profile,” the institute noted in its QuarterWatch report.

Glaxo Pays Huge Fine

GlaxoSmithKline pled guilty to charges that it manufactured and distributed adulterated drugs. The company will pay $750 million to settle federal and state government claims. The drugs in question were manufactured in Puerto Rico between 2001 and 2005 and included the antinausea drug Kytril, the antidepressant Paxil CR, the diabetes medication Avandamet, and the anti-infection ointment Bactroban. The complaint alleged that the drugmaker failed to prove that Bactroban and Kytril were not contaminated with microorganisms. GlaxoSmithKline will pay the federal government $600 million, and a whistle-blower will receive $96 million for having tipped the federal government to the manufacturing issues. The states are eligible to receive up to $163 million from GSK. The complaint alleged that the company knowingly caused false claims to be submitted to state Medicaid programs.

Top Fraud Cases All Involve Health

Pharmaceutical companies paid large fines in 8 of the top 10 fraud cases settled by the Department of Justice in 2010, according to the Taxpayers Against Fraud Education Fund. An insurer and a hospital rounded out the top 10 largest fine payers, making all 10 of the top settlements health care related, the advocacy group said. Allergan Inc., which in September settled allegations that it had marketed Botox (onabotulinumtoxinA) for off-label uses, accounted for the largest settlement ($600 million). AstraZeneca International came in second with its $520 million payment for illegally marketing the antipsychotic Seroquel (quetiapine). About 80% of all fraud recoveries under the False Claims Act occur in the health care area, the group said.

Wired Practices Make More Money

Medical practices that have adopted electronic health records perform better financially than do practices that still use paper, according to the Medical Group Management Association. The group looked at the technology's impact on revenue, costs, and staffing and found that it correlated with $50,000 more net revenue per full-time physician in practices that were not owned by hospitals or integrated delivery systems. The wired practices reported $105,591 higher expenses per full-time physician, but had significantly more revenue per physician, the association said. “These data indicate that there are financial benefits to practices that implement an EHR system,” Dr. William Jessee, the association's president and CEO, said in a statement.

AHA Merges Guidelines

The American Heart Association has combined its quality improvement programs on cardiopulmonary resuscitation and postresuscitation care. The melding of the association's National Registry of CardioPulmonary Resuscitation program with its Get With the Guidelines effort was spurred by recently released recommendations on CPR and emergency cardiovascular care (ECC). The registry is a database of resuscitation events in 500 hospitals that have used the data to improve outcomes, according to an AHA statement. Get With the Guidelines has offered in-hospital quality improvement modules for heart failure, stroke, and outpatient care. Incorporating CPR quality improvement, the new product is called Get With the Guidelines–Resuscitation.

Women's Stroke Survival Lags

Although in-hospital stroke death is falling for both men and women, it is declining faster for men, according to the Agency for Healthcare Research and Quality. The death rate per 1,000 admissions for men with stroke declined from 123 in 2000 to 87 in 2007. For women, deaths declined from 127 per 1,000 in 2000 to 96 per 1,000 in 2007. The death rate from heart failure fell by 52% for men and 46% for women, but they were equally as likely to die in-hospital. Women's death rate from heart attack declined slightly more than did men's but still showed the former much more likely to die as inpatients: In 2007, 77 women died per 1,000 admissions, compared with only 58 men per 1,000 admissions. The data come from the agency's Trends in Hospital Risk-Adjusted Mortality for Selected Diagnoses by Patient Subgroups, 2000-2007.

Red Flag for A Fib Drug

The Institute for Safe Medication Practices reported that the Food and Drug Administration has been receiving increasing numbers of reports that dronedarone (Multaq) may cause or worsen heart failure or trigger irregular heartbeats. There were also incidents of kidney failure or impairment, according to the watchdog group, which analyzes case reports submitted to the FDA. The review of dronedarone identified 387 serious adverse events associated with the drug since its approval in 2009, including 24 deaths. The group also flagged the patient medication guide for dronedarone, saying that it contains a misleading reassurance about the drug's potential as a teratogen, even though it was included in the FDA's Category X for pregnant women. “We have seldom seen a drug with so many issues in so many areas of its safety profile,” the institute noted in its QuarterWatch report.

Glaxo Pays Huge Fine

GlaxoSmithKline pled guilty to charges that it manufactured and distributed adulterated drugs. The company will pay $750 million to settle federal and state government claims. The drugs in question were manufactured in Puerto Rico between 2001 and 2005 and included the antinausea drug Kytril, the antidepressant Paxil CR, the diabetes medication Avandamet, and the anti-infection ointment Bactroban. The complaint alleged that the drugmaker failed to prove that Bactroban and Kytril were not contaminated with microorganisms. GlaxoSmithKline will pay the federal government $600 million, and a whistle-blower will receive $96 million for having tipped the federal government to the manufacturing issues. The states are eligible to receive up to $163 million from GSK. The complaint alleged that the company knowingly caused false claims to be submitted to state Medicaid programs.

Top Fraud Cases All Involve Health

Pharmaceutical companies paid large fines in 8 of the top 10 fraud cases settled by the Department of Justice in 2010, according to the Taxpayers Against Fraud Education Fund. An insurer and a hospital rounded out the top 10 largest fine payers, making all 10 of the top settlements health care related, the advocacy group said. Allergan Inc., which in September settled allegations that it had marketed Botox (onabotulinumtoxinA) for off-label uses, accounted for the largest settlement ($600 million). AstraZeneca International came in second with its $520 million payment for illegally marketing the antipsychotic Seroquel (quetiapine). About 80% of all fraud recoveries under the False Claims Act occur in the health care area, the group said.

Wired Practices Make More Money

Medical practices that have adopted electronic health records perform better financially than do practices that still use paper, according to the Medical Group Management Association. The group looked at the technology's impact on revenue, costs, and staffing and found that it correlated with $50,000 more net revenue per full-time physician in practices that were not owned by hospitals or integrated delivery systems. The wired practices reported $105,591 higher expenses per full-time physician, but had significantly more revenue per physician, the association said. “These data indicate that there are financial benefits to practices that implement an EHR system,” Dr. William Jessee, the association's president and CEO, said in a statement.

AHA Merges Guidelines

The American Heart Association has combined its quality improvement programs on cardiopulmonary resuscitation and postresuscitation care. The melding of the association's National Registry of CardioPulmonary Resuscitation program with its Get With the Guidelines effort was spurred by recently released recommendations on CPR and emergency cardiovascular care (ECC). The registry is a database of resuscitation events in 500 hospitals that have used the data to improve outcomes, according to an AHA statement. Get With the Guidelines has offered in-hospital quality improvement modules for heart failure, stroke, and outpatient care. Incorporating CPR quality improvement, the new product is called Get With the Guidelines–Resuscitation.

Women's Stroke Survival Lags

Although in-hospital stroke death is falling for both men and women, it is declining faster for men, according to the Agency for Healthcare Research and Quality. The death rate per 1,000 admissions for men with stroke declined from 123 in 2000 to 87 in 2007. For women, deaths declined from 127 per 1,000 in 2000 to 96 per 1,000 in 2007. The death rate from heart failure fell by 52% for men and 46% for women, but they were equally as likely to die in-hospital. Women's death rate from heart attack declined slightly more than did men's but still showed the former much more likely to die as inpatients: In 2007, 77 women died per 1,000 admissions, compared with only 58 men per 1,000 admissions. The data come from the agency's Trends in Hospital Risk-Adjusted Mortality for Selected Diagnoses by Patient Subgroups, 2000-2007.

Red Flag for A Fib Drug

The Institute for Safe Medication Practices reported that the Food and Drug Administration has been receiving increasing numbers of reports that dronedarone (Multaq) may cause or worsen heart failure or trigger irregular heartbeats. There were also incidents of kidney failure or impairment, according to the watchdog group, which analyzes case reports submitted to the FDA. The review of dronedarone identified 387 serious adverse events associated with the drug since its approval in 2009, including 24 deaths. The group also flagged the patient medication guide for dronedarone, saying that it contains a misleading reassurance about the drug's potential as a teratogen, even though it was included in the FDA's Category X for pregnant women. “We have seldom seen a drug with so many issues in so many areas of its safety profile,” the institute noted in its QuarterWatch report.

Glaxo Pays Huge Fine

GlaxoSmithKline pled guilty to charges that it manufactured and distributed adulterated drugs. The company will pay $750 million to settle federal and state government claims. The drugs in question were manufactured in Puerto Rico between 2001 and 2005 and included the antinausea drug Kytril, the antidepressant Paxil CR, the diabetes medication Avandamet, and the anti-infection ointment Bactroban. The complaint alleged that the drugmaker failed to prove that Bactroban and Kytril were not contaminated with microorganisms. GlaxoSmithKline will pay the federal government $600 million, and a whistle-blower will receive $96 million for having tipped the federal government to the manufacturing issues. The states are eligible to receive up to $163 million from GSK. The complaint alleged that the company knowingly caused false claims to be submitted to state Medicaid programs.

Top Fraud Cases All Involve Health

Pharmaceutical companies paid large fines in 8 of the top 10 fraud cases settled by the Department of Justice in 2010, according to the Taxpayers Against Fraud Education Fund. An insurer and a hospital rounded out the top 10 largest fine payers, making all 10 of the top settlements health care related, the advocacy group said. Allergan Inc., which in September settled allegations that it had marketed Botox (onabotulinumtoxinA) for off-label uses, accounted for the largest settlement ($600 million). AstraZeneca International came in second with its $520 million payment for illegally marketing the antipsychotic Seroquel (quetiapine). About 80% of all fraud recoveries under the False Claims Act occur in the health care area, the group said.

Wired Practices Make More Money

Medical practices that have adopted electronic health records perform better financially than do practices that still use paper, according to the Medical Group Management Association. The group looked at the technology's impact on revenue, costs, and staffing and found that it correlated with $50,000 more net revenue per full-time physician in practices that were not owned by hospitals or integrated delivery systems. The wired practices reported $105,591 higher expenses per full-time physician, but had significantly more revenue per physician, the association said. “These data indicate that there are financial benefits to practices that implement an EHR system,” Dr. William Jessee, the association's president and CEO, said in a statement.

The use of comparative effectiveness research would give Medicare a sophisticated tool for making coverage decisions on the basis of quality, but its ability to use such data is hamstrung by political interests and the health reform law, according to two researchers.

Dr. Steven D. Pearson, president of the Institute for Clinical and Economic Review in Boston, and Dr. Peter B. Bach, an attending physician at Memorial Sloan-Kettering Cancer Center in New York, say that Medicare can take advantage of the burgeoning comparative effectiveness movement to change its ways (Health Affairs 2010;29:1796-804).

Some $1.1 billion was set aside as part of the American Recovery and Reinvestment Act of 2009, and the Department of Health and Human Services announced that 15 experts would guide investments and coordinate research through the Federal Coordinating Council for Comparative Effectiveness Research. However, the council's role is limited in that it will not set clinical guidelines, or establish payment rates or tell Medicare what to cover. The Affordable Care Act further spelled out restrictions on how comparative effectiveness findings could be used by the federal government.

Currently, Medicare covers a drug, device, product, or service if the evidence supports its effectiveness. No comparisons are made to comparable technologies. Payment is set separately, based on arcane formulas that cover cost and maybe a small profit.

The authors propose that Medicare instead link coverage and payment decisions at the outset. The program could still use the “reasonable and necessary” threshold in deciding when to cover a product or service. But regulators could adopt a three-tiered effectiveness scale that would let them assign differing reimbursement to each level.

A “superior” rating for products with the fewest side effects, or those that offer the most effective treatment when compared with similar treatments, would garner the highest payment.

Payment for a “comparable” product or service would be slightly less than that for the superior product, as in the difference between what is paid for a brand name and a generic pharmaceutical.

The lowest rating would be “insufficient evidence.” The service would be covered and reimbursed at the conventional cost plus a small profit, but the payment level would be reevaluated every 3 years.

The authors said that a 3-year time frame can act as both a carrot and a stick. Having coverage – at current Medicare rates – is better than not having coverage, so innovation will not be stifled. But limiting that rate to only 3 years gives manufacturers and clinicians greater incentives to conduct comparative effectiveness studies, they said.

This scheme might restrict access to new services, but the authors said they believe the “trade-off would be justifiable” because the services being reimbursed at the lower rate would have the least amount of evidence supporting their use.

They also said that using comparative effectiveness data, although threatening to manufacturers, might actually end up encouraging the development of superior products and services.

The new approach raises many conundrums, they acknowledge. It could be difficult to rate a service if comparative effectiveness differed across patient subgroups. And there is the question of whether previously covered services should be grandfathered in.

But overall, said Dr. Pearson and Dr. Bach, using comparative effectiveness data to guide payment would benefit both Medicare and physicians, who would no longer have “perverse incentives to invest in and deliver services that add to the cost but not the quality of care.”

Dr. Pearson reported no conflicts. He is a member of the National Institutes of Health's Comparative Effectiveness Research Steering Committee. Dr. Bach made no disclosures. He serves on the Committee on Performance Management of the National Committee for Quality Assurance and the Institute of Medicine's National Cancer Policy Forum.

The use of comparative effectiveness research would give Medicare a sophisticated tool for making coverage decisions on the basis of quality, but its ability to use such data is hamstrung by political interests and the health reform law, according to two researchers.

Dr. Steven D. Pearson, president of the Institute for Clinical and Economic Review in Boston, and Dr. Peter B. Bach, an attending physician at Memorial Sloan-Kettering Cancer Center in New York, say that Medicare can take advantage of the burgeoning comparative effectiveness movement to change its ways (Health Affairs 2010;29:1796-804).

Some $1.1 billion was set aside as part of the American Recovery and Reinvestment Act of 2009, and the Department of Health and Human Services announced that 15 experts would guide investments and coordinate research through the Federal Coordinating Council for Comparative Effectiveness Research. However, the council's role is limited in that it will not set clinical guidelines, or establish payment rates or tell Medicare what to cover. The Affordable Care Act further spelled out restrictions on how comparative effectiveness findings could be used by the federal government.

Currently, Medicare covers a drug, device, product, or service if the evidence supports its effectiveness. No comparisons are made to comparable technologies. Payment is set separately, based on arcane formulas that cover cost and maybe a small profit.

The authors propose that Medicare instead link coverage and payment decisions at the outset. The program could still use the “reasonable and necessary” threshold in deciding when to cover a product or service. But regulators could adopt a three-tiered effectiveness scale that would let them assign differing reimbursement to each level.

A “superior” rating for products with the fewest side effects, or those that offer the most effective treatment when compared with similar treatments, would garner the highest payment.

Payment for a “comparable” product or service would be slightly less than that for the superior product, as in the difference between what is paid for a brand name and a generic pharmaceutical.

The lowest rating would be “insufficient evidence.” The service would be covered and reimbursed at the conventional cost plus a small profit, but the payment level would be reevaluated every 3 years.

The authors said that a 3-year time frame can act as both a carrot and a stick. Having coverage – at current Medicare rates – is better than not having coverage, so innovation will not be stifled. But limiting that rate to only 3 years gives manufacturers and clinicians greater incentives to conduct comparative effectiveness studies, they said.

This scheme might restrict access to new services, but the authors said they believe the “trade-off would be justifiable” because the services being reimbursed at the lower rate would have the least amount of evidence supporting their use.

They also said that using comparative effectiveness data, although threatening to manufacturers, might actually end up encouraging the development of superior products and services.

The new approach raises many conundrums, they acknowledge. It could be difficult to rate a service if comparative effectiveness differed across patient subgroups. And there is the question of whether previously covered services should be grandfathered in.

But overall, said Dr. Pearson and Dr. Bach, using comparative effectiveness data to guide payment would benefit both Medicare and physicians, who would no longer have “perverse incentives to invest in and deliver services that add to the cost but not the quality of care.”

Dr. Pearson reported no conflicts. He is a member of the National Institutes of Health's Comparative Effectiveness Research Steering Committee. Dr. Bach made no disclosures. He serves on the Committee on Performance Management of the National Committee for Quality Assurance and the Institute of Medicine's National Cancer Policy Forum.

The use of comparative effectiveness research would give Medicare a sophisticated tool for making coverage decisions on the basis of quality, but its ability to use such data is hamstrung by political interests and the health reform law, according to two researchers.

Dr. Steven D. Pearson, president of the Institute for Clinical and Economic Review in Boston, and Dr. Peter B. Bach, an attending physician at Memorial Sloan-Kettering Cancer Center in New York, say that Medicare can take advantage of the burgeoning comparative effectiveness movement to change its ways (Health Affairs 2010;29:1796-804).

Some $1.1 billion was set aside as part of the American Recovery and Reinvestment Act of 2009, and the Department of Health and Human Services announced that 15 experts would guide investments and coordinate research through the Federal Coordinating Council for Comparative Effectiveness Research. However, the council's role is limited in that it will not set clinical guidelines, or establish payment rates or tell Medicare what to cover. The Affordable Care Act further spelled out restrictions on how comparative effectiveness findings could be used by the federal government.

Currently, Medicare covers a drug, device, product, or service if the evidence supports its effectiveness. No comparisons are made to comparable technologies. Payment is set separately, based on arcane formulas that cover cost and maybe a small profit.

The authors propose that Medicare instead link coverage and payment decisions at the outset. The program could still use the “reasonable and necessary” threshold in deciding when to cover a product or service. But regulators could adopt a three-tiered effectiveness scale that would let them assign differing reimbursement to each level.

A “superior” rating for products with the fewest side effects, or those that offer the most effective treatment when compared with similar treatments, would garner the highest payment.

Payment for a “comparable” product or service would be slightly less than that for the superior product, as in the difference between what is paid for a brand name and a generic pharmaceutical.

The lowest rating would be “insufficient evidence.” The service would be covered and reimbursed at the conventional cost plus a small profit, but the payment level would be reevaluated every 3 years.

The authors said that a 3-year time frame can act as both a carrot and a stick. Having coverage – at current Medicare rates – is better than not having coverage, so innovation will not be stifled. But limiting that rate to only 3 years gives manufacturers and clinicians greater incentives to conduct comparative effectiveness studies, they said.

This scheme might restrict access to new services, but the authors said they believe the “trade-off would be justifiable” because the services being reimbursed at the lower rate would have the least amount of evidence supporting their use.

They also said that using comparative effectiveness data, although threatening to manufacturers, might actually end up encouraging the development of superior products and services.

The new approach raises many conundrums, they acknowledge. It could be difficult to rate a service if comparative effectiveness differed across patient subgroups. And there is the question of whether previously covered services should be grandfathered in.

But overall, said Dr. Pearson and Dr. Bach, using comparative effectiveness data to guide payment would benefit both Medicare and physicians, who would no longer have “perverse incentives to invest in and deliver services that add to the cost but not the quality of care.”

Dr. Pearson reported no conflicts. He is a member of the National Institutes of Health's Comparative Effectiveness Research Steering Committee. Dr. Bach made no disclosures. He serves on the Committee on Performance Management of the National Committee for Quality Assurance and the Institute of Medicine's National Cancer Policy Forum.

The four biggest primary care physician organizations issued a joint document last month that contained what they believe are important principles to guide the development of accountable care organizations.

The 21 principles were developed and issued by the American Academy of Pediatrics, American Academy of Family Physicians, the American College of Physicians, and the American Osteopathic Association. According to the groups, the principles were submitted to the Centers for Medicare and Medicaid Services for consideration as guiding principles for ACO demonstration projects.

The organizations also are hoping to see the guidelines adopted more widely. “The AAP urges adoption of these principles by governments, payers, providers and all others who are involved in the health, well-being and success of America's children and their families,” Dr. O. Marion Burton, president of the AAP, said in a statement.

ACOs are being considered as the underpinning of health reform, changing how health care is delivered and financed. The Affordable Care Act calls for Medicare beneficiaries to be assigned to ACOs, which has spurred some debate.

The CMS is charged with developing regulations on how ACOs will be structured and how Medicare and Medicaid will pay providers that participate. The agency, along with the Federal Trade Commission and the Office of Inspector General of the Department of Health and Human Services, held a public meeting on ACOs on Oct. 5 to gather input.

And in mid-November, the CMS issued a request for information on ACOs. All comments were due by Dec. 3. The agency is expected to issue regulations later, perhaps by early 2011.

The agency has been looking at a risk-sharing payment methodology that would reward providers for improved quality and lower costs.

The Joint Principles for Accountable Care Organizations issued by the primary care groups outlines a number of principles that should guide that payment system. For instance, incentives should “adequately reflect the relative contributions of participating physicians,” and practices that participate in ACOs and achieve recognition as medical homes “should receive additional financial incentives,” according to the Joint Principles.

The Medicare Payment Advisory Commission (MedPAC) has backed the ACO concept and the notion of shared savings as a means for eliminating inefficiencies.

In comments submitted to the CMS on Nov. 22, MedPAC Chairman Glenn Hackbarth wrote, “If structured carefully, a shared savings program for ACOs could present an opportunity to correct some of the undesirable incentives inherent in fee-for-service payment and reward providers who are doing their part to control costs and improve quality.”

Shared savings also could “help beneficiaries receive more coordinated care and become more engaged with their care management, particularly if beneficiaries are informed when they are assigned to ACOs,” he wrote.

The four biggest primary care physician organizations issued a joint document last month that contained what they believe are important principles to guide the development of accountable care organizations.

The 21 principles were developed and issued by the American Academy of Pediatrics, American Academy of Family Physicians, the American College of Physicians, and the American Osteopathic Association. According to the groups, the principles were submitted to the Centers for Medicare and Medicaid Services for consideration as guiding principles for ACO demonstration projects.

The organizations also are hoping to see the guidelines adopted more widely. “The AAP urges adoption of these principles by governments, payers, providers and all others who are involved in the health, well-being and success of America's children and their families,” Dr. O. Marion Burton, president of the AAP, said in a statement.

ACOs are being considered as the underpinning of health reform, changing how health care is delivered and financed. The Affordable Care Act calls for Medicare beneficiaries to be assigned to ACOs, which has spurred some debate.

The CMS is charged with developing regulations on how ACOs will be structured and how Medicare and Medicaid will pay providers that participate. The agency, along with the Federal Trade Commission and the Office of Inspector General of the Department of Health and Human Services, held a public meeting on ACOs on Oct. 5 to gather input.

And in mid-November, the CMS issued a request for information on ACOs. All comments were due by Dec. 3. The agency is expected to issue regulations later, perhaps by early 2011.

The agency has been looking at a risk-sharing payment methodology that would reward providers for improved quality and lower costs.

The Joint Principles for Accountable Care Organizations issued by the primary care groups outlines a number of principles that should guide that payment system. For instance, incentives should “adequately reflect the relative contributions of participating physicians,” and practices that participate in ACOs and achieve recognition as medical homes “should receive additional financial incentives,” according to the Joint Principles.

The Medicare Payment Advisory Commission (MedPAC) has backed the ACO concept and the notion of shared savings as a means for eliminating inefficiencies.

In comments submitted to the CMS on Nov. 22, MedPAC Chairman Glenn Hackbarth wrote, “If structured carefully, a shared savings program for ACOs could present an opportunity to correct some of the undesirable incentives inherent in fee-for-service payment and reward providers who are doing their part to control costs and improve quality.”

Shared savings also could “help beneficiaries receive more coordinated care and become more engaged with their care management, particularly if beneficiaries are informed when they are assigned to ACOs,” he wrote.

The four biggest primary care physician organizations issued a joint document last month that contained what they believe are important principles to guide the development of accountable care organizations.

The 21 principles were developed and issued by the American Academy of Pediatrics, American Academy of Family Physicians, the American College of Physicians, and the American Osteopathic Association. According to the groups, the principles were submitted to the Centers for Medicare and Medicaid Services for consideration as guiding principles for ACO demonstration projects.

The organizations also are hoping to see the guidelines adopted more widely. “The AAP urges adoption of these principles by governments, payers, providers and all others who are involved in the health, well-being and success of America's children and their families,” Dr. O. Marion Burton, president of the AAP, said in a statement.

ACOs are being considered as the underpinning of health reform, changing how health care is delivered and financed. The Affordable Care Act calls for Medicare beneficiaries to be assigned to ACOs, which has spurred some debate.

The CMS is charged with developing regulations on how ACOs will be structured and how Medicare and Medicaid will pay providers that participate. The agency, along with the Federal Trade Commission and the Office of Inspector General of the Department of Health and Human Services, held a public meeting on ACOs on Oct. 5 to gather input.

And in mid-November, the CMS issued a request for information on ACOs. All comments were due by Dec. 3. The agency is expected to issue regulations later, perhaps by early 2011.

The agency has been looking at a risk-sharing payment methodology that would reward providers for improved quality and lower costs.

The Joint Principles for Accountable Care Organizations issued by the primary care groups outlines a number of principles that should guide that payment system. For instance, incentives should “adequately reflect the relative contributions of participating physicians,” and practices that participate in ACOs and achieve recognition as medical homes “should receive additional financial incentives,” according to the Joint Principles.

The Medicare Payment Advisory Commission (MedPAC) has backed the ACO concept and the notion of shared savings as a means for eliminating inefficiencies.

In comments submitted to the CMS on Nov. 22, MedPAC Chairman Glenn Hackbarth wrote, “If structured carefully, a shared savings program for ACOs could present an opportunity to correct some of the undesirable incentives inherent in fee-for-service payment and reward providers who are doing their part to control costs and improve quality.”

Shared savings also could “help beneficiaries receive more coordinated care and become more engaged with their care management, particularly if beneficiaries are informed when they are assigned to ACOs,” he wrote.

The House of Representatives voted Nov. 29 to approve a 1-month extension of current Medicare physician fee schedule.

If signed by President Obama, which is expected, physicians will avoid a 23% reduction in fees mandated by Medicare's Sustainable Growth Rate (SGR) and slated to go into effect Dec. 1.

However, unless Congress takes additional action before the Christmas recess, physicians face a 25% cut in fees Jan. 1.

The House vote follows the Senate's Nov. 18 approval of a 1-month extension contained in the Physician Payment and Therapy Relief Act of 2010. That bill was introduced in the Senate by Finance Committee Chairman Max Baucus (D-Mont.) and ranking minority member Chuck Grassley (R-Iowa).

The estimated cost for the 1-month extension is $1 billion.

The Senate legislation pays for that by using savings from a new Centers for Medicare and Medicaid Services policy that reduces Medicare payments for multiple therapy services provided to patients in 1 day. Therapists would not be squeezed, however; the proposal would also shrink the called-for reduction from 25% to 20%, according to Sen. Baucus and Sen. Grassley.

In a statement, American Medical Association President Cecil B. Wilson said that the short-term delay “helps ensure that physicians can continue to care for seniors for the next month.” But he added “the AMA urges Congress to build on the bipartisan action that delayed this year's cut and act in December to stop the cut for 1 year so that Congress has time to work on a long-term solution.

The House of Representatives voted Nov. 29 to approve a 1-month extension of current Medicare physician fee schedule.

If signed by President Obama, which is expected, physicians will avoid a 23% reduction in fees mandated by Medicare's Sustainable Growth Rate (SGR) and slated to go into effect Dec. 1.

However, unless Congress takes additional action before the Christmas recess, physicians face a 25% cut in fees Jan. 1.

The House vote follows the Senate's Nov. 18 approval of a 1-month extension contained in the Physician Payment and Therapy Relief Act of 2010. That bill was introduced in the Senate by Finance Committee Chairman Max Baucus (D-Mont.) and ranking minority member Chuck Grassley (R-Iowa).

The estimated cost for the 1-month extension is $1 billion.

The Senate legislation pays for that by using savings from a new Centers for Medicare and Medicaid Services policy that reduces Medicare payments for multiple therapy services provided to patients in 1 day. Therapists would not be squeezed, however; the proposal would also shrink the called-for reduction from 25% to 20%, according to Sen. Baucus and Sen. Grassley.

In a statement, American Medical Association President Cecil B. Wilson said that the short-term delay “helps ensure that physicians can continue to care for seniors for the next month.” But he added “the AMA urges Congress to build on the bipartisan action that delayed this year's cut and act in December to stop the cut for 1 year so that Congress has time to work on a long-term solution.

The House of Representatives voted Nov. 29 to approve a 1-month extension of current Medicare physician fee schedule.

If signed by President Obama, which is expected, physicians will avoid a 23% reduction in fees mandated by Medicare's Sustainable Growth Rate (SGR) and slated to go into effect Dec. 1.

However, unless Congress takes additional action before the Christmas recess, physicians face a 25% cut in fees Jan. 1.

The House vote follows the Senate's Nov. 18 approval of a 1-month extension contained in the Physician Payment and Therapy Relief Act of 2010. That bill was introduced in the Senate by Finance Committee Chairman Max Baucus (D-Mont.) and ranking minority member Chuck Grassley (R-Iowa).

The estimated cost for the 1-month extension is $1 billion.

The Senate legislation pays for that by using savings from a new Centers for Medicare and Medicaid Services policy that reduces Medicare payments for multiple therapy services provided to patients in 1 day. Therapists would not be squeezed, however; the proposal would also shrink the called-for reduction from 25% to 20%, according to Sen. Baucus and Sen. Grassley.

In a statement, American Medical Association President Cecil B. Wilson said that the short-term delay “helps ensure that physicians can continue to care for seniors for the next month.” But he added “the AMA urges Congress to build on the bipartisan action that delayed this year's cut and act in December to stop the cut for 1 year so that Congress has time to work on a long-term solution.

The Department of Health and Human Services issued a sweeping new tobacco control strategy that would require cigarette makers to place photographs and graphic depictions of the harms of smoking prominently on the packages or in advertising.

The graphic warnings – which will be regulated by the Food and Drug Administration – were part of a proposed rule issued by the agency. They were required by the Family Smoking Prevention and Tobacco Control Act and are the centerpiece of the 66-page strategy released by HHS.

“Every day, almost 4,000 youth try a cigarette for the first time and 1,000 youth become regular, daily smokers,” HHS Secretary Kathleen Sebelius said in a statement. “Today marks an important milestone in protecting our children and the health of the American public.”

HHS estimates that 443,000 Americans die from tobacco-related diseases each year, with 50,000 of those deaths caused by secondhand smoke. Some 8.6 million Americans have smoking-related chronic diseases.

“When this rule takes effect, the health consequences of smoking will be obvious every time someone picks up a pack of cigarettes,” FDA Commissioner Margaret Hamburg said.

The agency is going to require a disturbing photograph or cartoon graphic that takes up half a package of cigarettes or is prominently placed in an ad.

The graphic would depict one of the following warnings: “Cigarettes are addictive,” “Tobacco smoke can harm your children,” “Cigarettes cause fatal lung disease,” “Cigarettes cause cancer,” “Cigarettes cause strokes and heart disease,” “Smoking during pregnancy can harm your baby,” “Smoking can kill you,” “Tobacco smoke causes fatal lung disease in nonsmokers,” and “Quitting smoking now greatly reduces serious risks to your health.”

The cancer warning might have a photograph of an obviously terminally ill person in a hospital bed, or a close-up of a mouth riddled with rotting teeth and sores. The heart disease warning might have a photograph of a man clutching his chest, in the throes of a myocardial infarction.

The FDA is seeking the public's input on which graphic depiction to use for each warning. It is accepting comments until Jan. 9, 2011. Then, the agency will select one graphic for each of the nine warnings and publish the choices in a final rule to be issued by June 22, 2011.

Manufacturers would have 15 months from that time – by October 2012 – to come into compliance. If they do not comply, their product will be banned from sale in the United States.

Public health advocacy groups applauded the HHS plan and the FDA proposal. “The new warnings represent the most significant change in U.S. cigarette warnings since they were first required in 1965,” Matthew L. Myers, president of the Campaign for Tobacco-Free Kids, said in a statement.

The HHS strategy paper recommended expanding tobacco cessation services and accelerating the adoption of smoke-free laws across the country. According to the HHS, if the agency receives funding and all of the initiatives were to go forward, the country could meet the Healthy People 2010 objective to reduce the smoking rate to 12% of American adults.

The Department of Health and Human Services issued a sweeping new tobacco control strategy that would require cigarette makers to place photographs and graphic depictions of the harms of smoking prominently on the packages or in advertising.

The graphic warnings – which will be regulated by the Food and Drug Administration – were part of a proposed rule issued by the agency. They were required by the Family Smoking Prevention and Tobacco Control Act and are the centerpiece of the 66-page strategy released by HHS.

“Every day, almost 4,000 youth try a cigarette for the first time and 1,000 youth become regular, daily smokers,” HHS Secretary Kathleen Sebelius said in a statement. “Today marks an important milestone in protecting our children and the health of the American public.”

HHS estimates that 443,000 Americans die from tobacco-related diseases each year, with 50,000 of those deaths caused by secondhand smoke. Some 8.6 million Americans have smoking-related chronic diseases.

“When this rule takes effect, the health consequences of smoking will be obvious every time someone picks up a pack of cigarettes,” FDA Commissioner Margaret Hamburg said.

The agency is going to require a disturbing photograph or cartoon graphic that takes up half a package of cigarettes or is prominently placed in an ad.

The graphic would depict one of the following warnings: “Cigarettes are addictive,” “Tobacco smoke can harm your children,” “Cigarettes cause fatal lung disease,” “Cigarettes cause cancer,” “Cigarettes cause strokes and heart disease,” “Smoking during pregnancy can harm your baby,” “Smoking can kill you,” “Tobacco smoke causes fatal lung disease in nonsmokers,” and “Quitting smoking now greatly reduces serious risks to your health.”

The cancer warning might have a photograph of an obviously terminally ill person in a hospital bed, or a close-up of a mouth riddled with rotting teeth and sores. The heart disease warning might have a photograph of a man clutching his chest, in the throes of a myocardial infarction.

The FDA is seeking the public's input on which graphic depiction to use for each warning. It is accepting comments until Jan. 9, 2011. Then, the agency will select one graphic for each of the nine warnings and publish the choices in a final rule to be issued by June 22, 2011.

Manufacturers would have 15 months from that time – by October 2012 – to come into compliance. If they do not comply, their product will be banned from sale in the United States.

Public health advocacy groups applauded the HHS plan and the FDA proposal. “The new warnings represent the most significant change in U.S. cigarette warnings since they were first required in 1965,” Matthew L. Myers, president of the Campaign for Tobacco-Free Kids, said in a statement.

The HHS strategy paper recommended expanding tobacco cessation services and accelerating the adoption of smoke-free laws across the country. According to the HHS, if the agency receives funding and all of the initiatives were to go forward, the country could meet the Healthy People 2010 objective to reduce the smoking rate to 12% of American adults.

The Department of Health and Human Services issued a sweeping new tobacco control strategy that would require cigarette makers to place photographs and graphic depictions of the harms of smoking prominently on the packages or in advertising.

The graphic warnings – which will be regulated by the Food and Drug Administration – were part of a proposed rule issued by the agency. They were required by the Family Smoking Prevention and Tobacco Control Act and are the centerpiece of the 66-page strategy released by HHS.

“Every day, almost 4,000 youth try a cigarette for the first time and 1,000 youth become regular, daily smokers,” HHS Secretary Kathleen Sebelius said in a statement. “Today marks an important milestone in protecting our children and the health of the American public.”

HHS estimates that 443,000 Americans die from tobacco-related diseases each year, with 50,000 of those deaths caused by secondhand smoke. Some 8.6 million Americans have smoking-related chronic diseases.

“When this rule takes effect, the health consequences of smoking will be obvious every time someone picks up a pack of cigarettes,” FDA Commissioner Margaret Hamburg said.

The agency is going to require a disturbing photograph or cartoon graphic that takes up half a package of cigarettes or is prominently placed in an ad.

The graphic would depict one of the following warnings: “Cigarettes are addictive,” “Tobacco smoke can harm your children,” “Cigarettes cause fatal lung disease,” “Cigarettes cause cancer,” “Cigarettes cause strokes and heart disease,” “Smoking during pregnancy can harm your baby,” “Smoking can kill you,” “Tobacco smoke causes fatal lung disease in nonsmokers,” and “Quitting smoking now greatly reduces serious risks to your health.”

The cancer warning might have a photograph of an obviously terminally ill person in a hospital bed, or a close-up of a mouth riddled with rotting teeth and sores. The heart disease warning might have a photograph of a man clutching his chest, in the throes of a myocardial infarction.

The FDA is seeking the public's input on which graphic depiction to use for each warning. It is accepting comments until Jan. 9, 2011. Then, the agency will select one graphic for each of the nine warnings and publish the choices in a final rule to be issued by June 22, 2011.

Manufacturers would have 15 months from that time – by October 2012 – to come into compliance. If they do not comply, their product will be banned from sale in the United States.

Public health advocacy groups applauded the HHS plan and the FDA proposal. “The new warnings represent the most significant change in U.S. cigarette warnings since they were first required in 1965,” Matthew L. Myers, president of the Campaign for Tobacco-Free Kids, said in a statement.

The HHS strategy paper recommended expanding tobacco cessation services and accelerating the adoption of smoke-free laws across the country. According to the HHS, if the agency receives funding and all of the initiatives were to go forward, the country could meet the Healthy People 2010 objective to reduce the smoking rate to 12% of American adults.

The four biggest primary care physician organizations issued a joint document last month that contained what they believe are important principles to guide the development of accountable care organizations.

The 21 principles were developed and issued by the American Academy of Family Physicians, American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association.

According to the groups, the principles were submitted to the Centers for Medicare and Medicaid Services for consideration as guiding principles for ACO demonstration projects.

ACOs will be crucial to shifting the delivery and payment system, noted Dr. Roland Goertz, president of the AAFP.

“If implemented correctly, ACOs may help improve quality and efficiency of care and reduce costs while strengthening the patient-physician relationship in the context of a patient-centered medical home,” Dr. Goertz said.

The organizations also are hoping to see the ACO guidelines adopted more widely.

“The AAP urges adoption of these principles by governments, payers, providers and all others who are involved in the health, well-being and success of America's children and their families,” Dr. O. Marion Burton, president of the AAP, said in a statement.

ACOs are being considered as the underpinning of health reform, changing how health care is delivered and financed. The Affordable Care Act calls for Medicare beneficiaries to be assigned to ACOs, which has spurred some debate.

CMS is charged with developing regulations on how ACOs will be structured and how Medicare and Medicaid will pay providers that participate. The agency, along with the Federal Trade Commission and the Office of Inspector General of the Department of Health and Human Services, held a public meeting on ACOs on Oct. 5 to gather input.

And in mid-November, CMS issued a request for information on ACOs. All comments were due by Dec. 3. The agency is expected to issue regulations later, perhaps by early 2011.

CMS has been looking at a risk-sharing payment methodology that would reward providers for improved quality and lower costs.

The Joint Principles for Accountable Care Organizations issued by the primary care groups outlines a number of principles that should guide that payment system. For instance, incentives should “adequately reflect the relative contributions of participating physicians,” and practices that participate in ACOs and achieve recognition as medical homes “should receive additional financial incentives,” according to the Joint Principles.

The Medicare Payment Advisory Commission (MedPAC) has backed the ACO concept and the notion of shared savings as a means to eliminate inefficiencies.

In comments submitted to CMS on Nov. 22, MedPAC Chairman Glenn Hackbarth wrote, “If structured carefully, a shared savings program for ACOs could present an opportunity to correct some of the undesirable incentives inherent in fee-for-service payment and reward providers who are doing their part to control costs and improve quality.”

Shared savings also could “help beneficiaries receive more coordinated care and become more engaged with their care management, particularly if beneficiaries are informed when they are assigned to ACOs,” Mr. Hackbarth wrote.

The American Medical Association (AMA) also has established guiding principles for ACOs. Members approved the 13 principles at its interim House of Delegates meeting in November.

The AMA is concerned that existing antitrust and fraud rules can make it difficult for physicians to participate in ACOs. The organization called for increased flexibility in those laws, and for the FTC to provide explicit exceptions to antitrust laws for ACO participants.

ACO savings should be retained for patient care services and distributed to ACO participants, and the organizations should also be allowed to use a variety of payment models, according to the AMA principles.

The four biggest primary care physician organizations issued a joint document last month that contained what they believe are important principles to guide the development of accountable care organizations.

The 21 principles were developed and issued by the American Academy of Family Physicians, American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association.

According to the groups, the principles were submitted to the Centers for Medicare and Medicaid Services for consideration as guiding principles for ACO demonstration projects.

ACOs will be crucial to shifting the delivery and payment system, noted Dr. Roland Goertz, president of the AAFP.

“If implemented correctly, ACOs may help improve quality and efficiency of care and reduce costs while strengthening the patient-physician relationship in the context of a patient-centered medical home,” Dr. Goertz said.

The organizations also are hoping to see the ACO guidelines adopted more widely.

“The AAP urges adoption of these principles by governments, payers, providers and all others who are involved in the health, well-being and success of America's children and their families,” Dr. O. Marion Burton, president of the AAP, said in a statement.

ACOs are being considered as the underpinning of health reform, changing how health care is delivered and financed. The Affordable Care Act calls for Medicare beneficiaries to be assigned to ACOs, which has spurred some debate.

CMS is charged with developing regulations on how ACOs will be structured and how Medicare and Medicaid will pay providers that participate. The agency, along with the Federal Trade Commission and the Office of Inspector General of the Department of Health and Human Services, held a public meeting on ACOs on Oct. 5 to gather input.

And in mid-November, CMS issued a request for information on ACOs. All comments were due by Dec. 3. The agency is expected to issue regulations later, perhaps by early 2011.

CMS has been looking at a risk-sharing payment methodology that would reward providers for improved quality and lower costs.

The Joint Principles for Accountable Care Organizations issued by the primary care groups outlines a number of principles that should guide that payment system. For instance, incentives should “adequately reflect the relative contributions of participating physicians,” and practices that participate in ACOs and achieve recognition as medical homes “should receive additional financial incentives,” according to the Joint Principles.

The Medicare Payment Advisory Commission (MedPAC) has backed the ACO concept and the notion of shared savings as a means to eliminate inefficiencies.

In comments submitted to CMS on Nov. 22, MedPAC Chairman Glenn Hackbarth wrote, “If structured carefully, a shared savings program for ACOs could present an opportunity to correct some of the undesirable incentives inherent in fee-for-service payment and reward providers who are doing their part to control costs and improve quality.”

Shared savings also could “help beneficiaries receive more coordinated care and become more engaged with their care management, particularly if beneficiaries are informed when they are assigned to ACOs,” Mr. Hackbarth wrote.

The American Medical Association (AMA) also has established guiding principles for ACOs. Members approved the 13 principles at its interim House of Delegates meeting in November.

The AMA is concerned that existing antitrust and fraud rules can make it difficult for physicians to participate in ACOs. The organization called for increased flexibility in those laws, and for the FTC to provide explicit exceptions to antitrust laws for ACO participants.

ACO savings should be retained for patient care services and distributed to ACO participants, and the organizations should also be allowed to use a variety of payment models, according to the AMA principles.

The four biggest primary care physician organizations issued a joint document last month that contained what they believe are important principles to guide the development of accountable care organizations.

The 21 principles were developed and issued by the American Academy of Family Physicians, American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association.

According to the groups, the principles were submitted to the Centers for Medicare and Medicaid Services for consideration as guiding principles for ACO demonstration projects.

ACOs will be crucial to shifting the delivery and payment system, noted Dr. Roland Goertz, president of the AAFP.

“If implemented correctly, ACOs may help improve quality and efficiency of care and reduce costs while strengthening the patient-physician relationship in the context of a patient-centered medical home,” Dr. Goertz said.

The organizations also are hoping to see the ACO guidelines adopted more widely.

“The AAP urges adoption of these principles by governments, payers, providers and all others who are involved in the health, well-being and success of America's children and their families,” Dr. O. Marion Burton, president of the AAP, said in a statement.

ACOs are being considered as the underpinning of health reform, changing how health care is delivered and financed. The Affordable Care Act calls for Medicare beneficiaries to be assigned to ACOs, which has spurred some debate.

CMS is charged with developing regulations on how ACOs will be structured and how Medicare and Medicaid will pay providers that participate. The agency, along with the Federal Trade Commission and the Office of Inspector General of the Department of Health and Human Services, held a public meeting on ACOs on Oct. 5 to gather input.

And in mid-November, CMS issued a request for information on ACOs. All comments were due by Dec. 3. The agency is expected to issue regulations later, perhaps by early 2011.

CMS has been looking at a risk-sharing payment methodology that would reward providers for improved quality and lower costs.

The Joint Principles for Accountable Care Organizations issued by the primary care groups outlines a number of principles that should guide that payment system. For instance, incentives should “adequately reflect the relative contributions of participating physicians,” and practices that participate in ACOs and achieve recognition as medical homes “should receive additional financial incentives,” according to the Joint Principles.

The Medicare Payment Advisory Commission (MedPAC) has backed the ACO concept and the notion of shared savings as a means to eliminate inefficiencies.

In comments submitted to CMS on Nov. 22, MedPAC Chairman Glenn Hackbarth wrote, “If structured carefully, a shared savings program for ACOs could present an opportunity to correct some of the undesirable incentives inherent in fee-for-service payment and reward providers who are doing their part to control costs and improve quality.”

Shared savings also could “help beneficiaries receive more coordinated care and become more engaged with their care management, particularly if beneficiaries are informed when they are assigned to ACOs,” Mr. Hackbarth wrote.

The American Medical Association (AMA) also has established guiding principles for ACOs. Members approved the 13 principles at its interim House of Delegates meeting in November.

The AMA is concerned that existing antitrust and fraud rules can make it difficult for physicians to participate in ACOs. The organization called for increased flexibility in those laws, and for the FTC to provide explicit exceptions to antitrust laws for ACO participants.

ACO savings should be retained for patient care services and distributed to ACO participants, and the organizations should also be allowed to use a variety of payment models, according to the AMA principles.

WASHINGTON — Dr. Donald Berwick, the new administrator of the Centers for Medicare and Medicaid Services, largely escaped criticism from the Republican senators during his first official appearance on Capitol Hill on Nov. 17, but several senators vowed that they would ensure that he answered all their questions in writing or at another hearing.

Dr. Berwick was appointed by President Obama in July while Congress was in recess. Thus, Dr. Berwick was never subject to confirmation hearings, leaving most Republicans and some Democrats saying that the legislative authority to confirm high-level executive branch appointments had been bypassed.

Speaking before the Finance committee, Dr. Berwick tried to soothe his potential critics by discussing the potential he sees in addressing the wrongs of the American health care system.

“I feel incredibly lucky to be able to join CMS at a historic time, a time of enormous promise for the future of our nation's health care,” he commented. He added that he felt that the federal government “should aim for three goals simultaneously: better care for individuals, better health for the American people, and lower costs through improvement.”

The Affordable Care Act (ACA) is “the best opportunity we've had in a generation or more to make progress,” said Dr. Berwick.

The hearing was led by Chairman Max Baucus (D-Mont.), who scheduled 1 hour for opening statements, testimony, and questioning – an unusually short duration for any congressional committee hearing.

Democratic members of the panel used their allotted 5 minutes of questioning to express enthusiasm for various parts of the ACA and to give Dr. Berwick the opportunity to do the same. Republicans mainly expressed concern that they did not have the ability to properly question Dr. Berwick, given the hearing's tight timeline.

During his turn to question the CMS administrator, the committee's ranking minority member, Sen. Chuck Grassley (R-Iowa), wanted to know whether Dr. Berwick supported the conclusions of an April report that was issued by Rick Foster, the Medicare Chief Actuary. According to Sen. Grassley, that report said that the reductions envisioned in the ACA would threaten beneficiaries' access to care.

Dr. Berwick countered that Mr. Foster's estimates were just that – estimates based on his best judgment.

“Our intention is to increase access to care,” he told Sen. Grassley. He added that beneficiaries will “find themselves in better shape after implementation of this act is fully engaged.”

Sen. Orrin Hatch (R-Utah) also queried Dr. Berwick about the actuary's report. But he used most of his time to complain that the CMS Administrator – in charge of a budget that is larger than the Pentagon's, as he noted – had not been available until that day.

“Obviously, asking us to cover all of our concerns in this hour-long hearing with only 5 minutes … per person, is like asking us to drain the Pacific Ocean with a thimble,” Sen. Hatch said.

He said that he hoped that Dr. Berwick would answer any and all questions put to him in writing and that the Administration would allow him to fully answer the queries.

Sen. Hatch and Sen. Grassley and other Republicans asked for additional hearings with Dr. Berwick after the Thanksgiving break, but Chairman Baucus was noncommittal about scheduling such an event.

That prompted a blunt assessment from Sen. Jim Bunning (R-Ky.), who is not returning for the next Congress.

“I can assure you that you will not get special treatment next year,” when Republicans hold the majority in the House. “I suspect that you will be spending a lot of time testifying before the House of Representatives, partly because we in the Senate have been shut out,” Sen. Bunning said.

WASHINGTON — Dr. Donald Berwick, the new administrator of the Centers for Medicare and Medicaid Services, largely escaped criticism from the Republican senators during his first official appearance on Capitol Hill on Nov. 17, but several senators vowed that they would ensure that he answered all their questions in writing or at another hearing.

Dr. Berwick was appointed by President Obama in July while Congress was in recess. Thus, Dr. Berwick was never subject to confirmation hearings, leaving most Republicans and some Democrats saying that the legislative authority to confirm high-level executive branch appointments had been bypassed.

Speaking before the Finance committee, Dr. Berwick tried to soothe his potential critics by discussing the potential he sees in addressing the wrongs of the American health care system.

“I feel incredibly lucky to be able to join CMS at a historic time, a time of enormous promise for the future of our nation's health care,” he commented. He added that he felt that the federal government “should aim for three goals simultaneously: better care for individuals, better health for the American people, and lower costs through improvement.”

The Affordable Care Act (ACA) is “the best opportunity we've had in a generation or more to make progress,” said Dr. Berwick.

The hearing was led by Chairman Max Baucus (D-Mont.), who scheduled 1 hour for opening statements, testimony, and questioning – an unusually short duration for any congressional committee hearing.

Democratic members of the panel used their allotted 5 minutes of questioning to express enthusiasm for various parts of the ACA and to give Dr. Berwick the opportunity to do the same. Republicans mainly expressed concern that they did not have the ability to properly question Dr. Berwick, given the hearing's tight timeline.

During his turn to question the CMS administrator, the committee's ranking minority member, Sen. Chuck Grassley (R-Iowa), wanted to know whether Dr. Berwick supported the conclusions of an April report that was issued by Rick Foster, the Medicare Chief Actuary. According to Sen. Grassley, that report said that the reductions envisioned in the ACA would threaten beneficiaries' access to care.

Dr. Berwick countered that Mr. Foster's estimates were just that – estimates based on his best judgment.

“Our intention is to increase access to care,” he told Sen. Grassley. He added that beneficiaries will “find themselves in better shape after implementation of this act is fully engaged.”

Sen. Orrin Hatch (R-Utah) also queried Dr. Berwick about the actuary's report. But he used most of his time to complain that the CMS Administrator – in charge of a budget that is larger than the Pentagon's, as he noted – had not been available until that day.

“Obviously, asking us to cover all of our concerns in this hour-long hearing with only 5 minutes … per person, is like asking us to drain the Pacific Ocean with a thimble,” Sen. Hatch said.

He said that he hoped that Dr. Berwick would answer any and all questions put to him in writing and that the Administration would allow him to fully answer the queries.

Sen. Hatch and Sen. Grassley and other Republicans asked for additional hearings with Dr. Berwick after the Thanksgiving break, but Chairman Baucus was noncommittal about scheduling such an event.

That prompted a blunt assessment from Sen. Jim Bunning (R-Ky.), who is not returning for the next Congress.

“I can assure you that you will not get special treatment next year,” when Republicans hold the majority in the House. “I suspect that you will be spending a lot of time testifying before the House of Representatives, partly because we in the Senate have been shut out,” Sen. Bunning said.

WASHINGTON — Dr. Donald Berwick, the new administrator of the Centers for Medicare and Medicaid Services, largely escaped criticism from the Republican senators during his first official appearance on Capitol Hill on Nov. 17, but several senators vowed that they would ensure that he answered all their questions in writing or at another hearing.

Dr. Berwick was appointed by President Obama in July while Congress was in recess. Thus, Dr. Berwick was never subject to confirmation hearings, leaving most Republicans and some Democrats saying that the legislative authority to confirm high-level executive branch appointments had been bypassed.

Speaking before the Finance committee, Dr. Berwick tried to soothe his potential critics by discussing the potential he sees in addressing the wrongs of the American health care system.

“I feel incredibly lucky to be able to join CMS at a historic time, a time of enormous promise for the future of our nation's health care,” he commented. He added that he felt that the federal government “should aim for three goals simultaneously: better care for individuals, better health for the American people, and lower costs through improvement.”

The Affordable Care Act (ACA) is “the best opportunity we've had in a generation or more to make progress,” said Dr. Berwick.

The hearing was led by Chairman Max Baucus (D-Mont.), who scheduled 1 hour for opening statements, testimony, and questioning – an unusually short duration for any congressional committee hearing.

Democratic members of the panel used their allotted 5 minutes of questioning to express enthusiasm for various parts of the ACA and to give Dr. Berwick the opportunity to do the same. Republicans mainly expressed concern that they did not have the ability to properly question Dr. Berwick, given the hearing's tight timeline.

During his turn to question the CMS administrator, the committee's ranking minority member, Sen. Chuck Grassley (R-Iowa), wanted to know whether Dr. Berwick supported the conclusions of an April report that was issued by Rick Foster, the Medicare Chief Actuary. According to Sen. Grassley, that report said that the reductions envisioned in the ACA would threaten beneficiaries' access to care.

Dr. Berwick countered that Mr. Foster's estimates were just that – estimates based on his best judgment.

“Our intention is to increase access to care,” he told Sen. Grassley. He added that beneficiaries will “find themselves in better shape after implementation of this act is fully engaged.”

Sen. Orrin Hatch (R-Utah) also queried Dr. Berwick about the actuary's report. But he used most of his time to complain that the CMS Administrator – in charge of a budget that is larger than the Pentagon's, as he noted – had not been available until that day.

“Obviously, asking us to cover all of our concerns in this hour-long hearing with only 5 minutes … per person, is like asking us to drain the Pacific Ocean with a thimble,” Sen. Hatch said.

He said that he hoped that Dr. Berwick would answer any and all questions put to him in writing and that the Administration would allow him to fully answer the queries.

Sen. Hatch and Sen. Grassley and other Republicans asked for additional hearings with Dr. Berwick after the Thanksgiving break, but Chairman Baucus was noncommittal about scheduling such an event.

That prompted a blunt assessment from Sen. Jim Bunning (R-Ky.), who is not returning for the next Congress.

“I can assure you that you will not get special treatment next year,” when Republicans hold the majority in the House. “I suspect that you will be spending a lot of time testifying before the House of Representatives, partly because we in the Senate have been shut out,” Sen. Bunning said.