Mary Ellen Schneider

Another Planned Parenthood Cut

North Carolina's new budget strips all funding for Planned Parenthood clinics in the state. Lawmakers there recently overrode a veto from Gov. Bev Perdue (D) to enact the cut that Planned Parenthood said would amount to $434,000 used for family planning services and teen pregnancy prevention initiatives.

Although Planned Parenthood facilitates abortions, none of the North Carolina funding went to such procedures. The organization is weighing its options, including a possible lawsuit, Planned Parenthood official Melissa Reed said in a statement. North Carolina follows Indiana and Kansas in defunding Planned Parenthood clinics.

Midwives Needed Globally

Up to 3.6 million maternal, fetal, and neonatal deaths could be avoided each year if more midwives were available in 58 developing countries surveyed for the United Nations Population Fund's “The State of the World's Midwifery 2011” report.

“The report points to an urgent need to train more health workers with midwifery skills and ensure equitable access to their life-saving services in communities to improve the health of women and children,” Babatunde Osotimehin, executive director of the United Nations Population Fund, said in a statement.

More than 110,000 midwives are needed in the 38 countries with severe shortages of health care workers, according to the survey. The full report is available at

www.unfpa.org/sowmy/resources/en/main.htm

FDA Warns on Thermography

Officials at the Food and Drug Administration are warning women and their physicians that thermography should not be used as a stand-alone test for the early detection of breast cancer.

Some facilities and websites are making misleading claims, including that thermography can detect precancerous abnormalities and that compressing the breast during mammography can cause or spread cancer throughout the body, according to the FDA.

“The FDA is not aware of any valid scientific data to show that thermographic devices, when used on their own, are an effective screening tool for any medical condition,” the announcement said.

Formula Ads Win FDA OK

The FDA granted permission for Gerber Products to make a “qualified health claim” that the company's Good Start infant formulas may reduce the risk of atopic dermatitis. The milk-based formulas contain 100% partially hydrolyzed whey protein. The products' labels can say that feeding infants the formula up to age 4 months “may reduce the risk of developing atopic dermatitis throughout the first year of life,” according to a company announcement.

However, the labels have to add that “FDA has concluded that the relationship between 100% whey protein partially hydrolyzed infant formulas and the reduced risk of atopic dermatitis is uncertain, because there is little scientific evidence for the relationship.”

In a blog post, Ricardo Carvajal of the law firm Hyman, Phelps & McNamara said that the label claim appears weak, but he noted that Gerber took out a full-page ad in the New York Times touting the FDA-approved claim.

Single-Specialty Groups Pay Best

Primary care physicians received a median first-year guaranteed salary of $172,400 in single-specialty group practices in 2010, according to a Medical Group Management Association survey. That's more than 4% higher than the median first-year guaranteed salary ($165,000) that primary care physicians received in multispecialty practices, the report said.

First-year compensation for primary care didn't vary much geographically, according to MGMA. More than half the physicians received signing bonuses and relocation packages as part of their employment offers, and 12% received loan-forgiveness packages.

Employers were more likely to offer loan-forgiveness packages to primary care physicians than to specialists, and most such packages totaled $50,000 or less, according to the survey.

Bill Seeks to Repeal Tan Tax

A Republican congressman and 24 cosponsors have introduced a bill to repeal the 10% “regressive tax” on tanning services that was part of the Affordable Care Act.

“The health care law unfairly imposes onerous taxes, like the tan tax, on our nation's business owners and consumers, slowing economic growth and costing jobs,” the bill's sponsor, Rep. Michael Grimm (R-N.Y.), said in a statement. The Indoor Tanning Association supports the bill, as does the National Federation of Independent Businesses and the National Taxpayers Union, Rep. Grimm said.

The tanning group's president, Dan Humiston, said in a statement, “In reality, this tax takes money out of the pockets of some of those least able to afford it: working women, who are not only customers but also make up a majority of our business owners; and college students, who are both customers and employees.”

Another Planned Parenthood Cut

North Carolina's new budget strips all funding for Planned Parenthood clinics in the state. Lawmakers there recently overrode a veto from Gov. Bev Perdue (D) to enact the cut that Planned Parenthood said would amount to $434,000 used for family planning services and teen pregnancy prevention initiatives.

Although Planned Parenthood facilitates abortions, none of the North Carolina funding went to such procedures. The organization is weighing its options, including a possible lawsuit, Planned Parenthood official Melissa Reed said in a statement. North Carolina follows Indiana and Kansas in defunding Planned Parenthood clinics.

Midwives Needed Globally

Up to 3.6 million maternal, fetal, and neonatal deaths could be avoided each year if more midwives were available in 58 developing countries surveyed for the United Nations Population Fund's “The State of the World's Midwifery 2011” report.

“The report points to an urgent need to train more health workers with midwifery skills and ensure equitable access to their life-saving services in communities to improve the health of women and children,” Babatunde Osotimehin, executive director of the United Nations Population Fund, said in a statement.

More than 110,000 midwives are needed in the 38 countries with severe shortages of health care workers, according to the survey. The full report is available at

www.unfpa.org/sowmy/resources/en/main.htm

FDA Warns on Thermography

Officials at the Food and Drug Administration are warning women and their physicians that thermography should not be used as a stand-alone test for the early detection of breast cancer.

Some facilities and websites are making misleading claims, including that thermography can detect precancerous abnormalities and that compressing the breast during mammography can cause or spread cancer throughout the body, according to the FDA.

“The FDA is not aware of any valid scientific data to show that thermographic devices, when used on their own, are an effective screening tool for any medical condition,” the announcement said.

Formula Ads Win FDA OK

The FDA granted permission for Gerber Products to make a “qualified health claim” that the company's Good Start infant formulas may reduce the risk of atopic dermatitis. The milk-based formulas contain 100% partially hydrolyzed whey protein. The products' labels can say that feeding infants the formula up to age 4 months “may reduce the risk of developing atopic dermatitis throughout the first year of life,” according to a company announcement.

However, the labels have to add that “FDA has concluded that the relationship between 100% whey protein partially hydrolyzed infant formulas and the reduced risk of atopic dermatitis is uncertain, because there is little scientific evidence for the relationship.”

In a blog post, Ricardo Carvajal of the law firm Hyman, Phelps & McNamara said that the label claim appears weak, but he noted that Gerber took out a full-page ad in the New York Times touting the FDA-approved claim.

Single-Specialty Groups Pay Best

Primary care physicians received a median first-year guaranteed salary of $172,400 in single-specialty group practices in 2010, according to a Medical Group Management Association survey. That's more than 4% higher than the median first-year guaranteed salary ($165,000) that primary care physicians received in multispecialty practices, the report said.

First-year compensation for primary care didn't vary much geographically, according to MGMA. More than half the physicians received signing bonuses and relocation packages as part of their employment offers, and 12% received loan-forgiveness packages.

Employers were more likely to offer loan-forgiveness packages to primary care physicians than to specialists, and most such packages totaled $50,000 or less, according to the survey.

Bill Seeks to Repeal Tan Tax

A Republican congressman and 24 cosponsors have introduced a bill to repeal the 10% “regressive tax” on tanning services that was part of the Affordable Care Act.

“The health care law unfairly imposes onerous taxes, like the tan tax, on our nation's business owners and consumers, slowing economic growth and costing jobs,” the bill's sponsor, Rep. Michael Grimm (R-N.Y.), said in a statement. The Indoor Tanning Association supports the bill, as does the National Federation of Independent Businesses and the National Taxpayers Union, Rep. Grimm said.

The tanning group's president, Dan Humiston, said in a statement, “In reality, this tax takes money out of the pockets of some of those least able to afford it: working women, who are not only customers but also make up a majority of our business owners; and college students, who are both customers and employees.”

Another Planned Parenthood Cut

North Carolina's new budget strips all funding for Planned Parenthood clinics in the state. Lawmakers there recently overrode a veto from Gov. Bev Perdue (D) to enact the cut that Planned Parenthood said would amount to $434,000 used for family planning services and teen pregnancy prevention initiatives.

Although Planned Parenthood facilitates abortions, none of the North Carolina funding went to such procedures. The organization is weighing its options, including a possible lawsuit, Planned Parenthood official Melissa Reed said in a statement. North Carolina follows Indiana and Kansas in defunding Planned Parenthood clinics.

Midwives Needed Globally

Up to 3.6 million maternal, fetal, and neonatal deaths could be avoided each year if more midwives were available in 58 developing countries surveyed for the United Nations Population Fund's “The State of the World's Midwifery 2011” report.

“The report points to an urgent need to train more health workers with midwifery skills and ensure equitable access to their life-saving services in communities to improve the health of women and children,” Babatunde Osotimehin, executive director of the United Nations Population Fund, said in a statement.

More than 110,000 midwives are needed in the 38 countries with severe shortages of health care workers, according to the survey. The full report is available at

www.unfpa.org/sowmy/resources/en/main.htm

FDA Warns on Thermography

Officials at the Food and Drug Administration are warning women and their physicians that thermography should not be used as a stand-alone test for the early detection of breast cancer.

Some facilities and websites are making misleading claims, including that thermography can detect precancerous abnormalities and that compressing the breast during mammography can cause or spread cancer throughout the body, according to the FDA.

“The FDA is not aware of any valid scientific data to show that thermographic devices, when used on their own, are an effective screening tool for any medical condition,” the announcement said.

Formula Ads Win FDA OK

The FDA granted permission for Gerber Products to make a “qualified health claim” that the company's Good Start infant formulas may reduce the risk of atopic dermatitis. The milk-based formulas contain 100% partially hydrolyzed whey protein. The products' labels can say that feeding infants the formula up to age 4 months “may reduce the risk of developing atopic dermatitis throughout the first year of life,” according to a company announcement.

However, the labels have to add that “FDA has concluded that the relationship between 100% whey protein partially hydrolyzed infant formulas and the reduced risk of atopic dermatitis is uncertain, because there is little scientific evidence for the relationship.”

In a blog post, Ricardo Carvajal of the law firm Hyman, Phelps & McNamara said that the label claim appears weak, but he noted that Gerber took out a full-page ad in the New York Times touting the FDA-approved claim.

Single-Specialty Groups Pay Best

Primary care physicians received a median first-year guaranteed salary of $172,400 in single-specialty group practices in 2010, according to a Medical Group Management Association survey. That's more than 4% higher than the median first-year guaranteed salary ($165,000) that primary care physicians received in multispecialty practices, the report said.

First-year compensation for primary care didn't vary much geographically, according to MGMA. More than half the physicians received signing bonuses and relocation packages as part of their employment offers, and 12% received loan-forgiveness packages.

Employers were more likely to offer loan-forgiveness packages to primary care physicians than to specialists, and most such packages totaled $50,000 or less, according to the survey.

Bill Seeks to Repeal Tan Tax

A Republican congressman and 24 cosponsors have introduced a bill to repeal the 10% “regressive tax” on tanning services that was part of the Affordable Care Act.

“The health care law unfairly imposes onerous taxes, like the tan tax, on our nation's business owners and consumers, slowing economic growth and costing jobs,” the bill's sponsor, Rep. Michael Grimm (R-N.Y.), said in a statement. The Indoor Tanning Association supports the bill, as does the National Federation of Independent Businesses and the National Taxpayers Union, Rep. Grimm said.

The tanning group's president, Dan Humiston, said in a statement, “In reality, this tax takes money out of the pockets of some of those least able to afford it: working women, who are not only customers but also make up a majority of our business owners; and college students, who are both customers and employees.”

Taxpayers spend more than $11 billion each year as a result of unintended pregnancies, according to new data from two separate studies.

The estimates are based on public insurance costs for pregnancies and infant care in the first year. Researchers from the Guttmacher Institute used state-level data from 2006 to come up with a national estimate of $11.1 billion in public spending on unintended pregnancies. In a separate study, researchers at the Brookings Institution came up with their figures by using 2001 national data on publicly financed unintended pregnancies, resulting in average spending of $11.3 billion annually. Both studies were published in the June issue of Perspectives on Sexual and Reproductive Health.

Researchers from the Guttmacher Institute found that public programs such as Medicaid and the Children's Health Insurance Program bear the brunt of the nation's costs for unintended pregnancies (Perspect. Sex. Reprod. Health 2011;43:94–102 [doi:10.1363/4309411]). While 38% of U.S. births result from unintended pregnancies, births from unintended pregnancies make up about half of publicly funded births. But reducing unintended pregnancies also will require major new public investments, the Guttmacher researchers wrote, including increasing access to family planning services and comprehensive sex education. The Affordable Care Act may help, too, they said, by expanding insurance coverage and giving new authority to states to expand Medicaid eligibility for family planning services.

While preventing unintended pregnancies would require an up-front investment, the researchers at the Brookings Institution said it would be more than offset by potential savings. They estimated that if unintended pregnancies could be prevented altogether, with some being delayed until the women were ready to be pregnant, it could save taxpayers about $5.6 billion annually (Perspect. Sex. Reprod. Health 2011;43:88–93 [doi: 10.1363/4308811]).

Taxpayers spend more than $11 billion each year as a result of unintended pregnancies, according to new data from two separate studies.

The estimates are based on public insurance costs for pregnancies and infant care in the first year. Researchers from the Guttmacher Institute used state-level data from 2006 to come up with a national estimate of $11.1 billion in public spending on unintended pregnancies. In a separate study, researchers at the Brookings Institution came up with their figures by using 2001 national data on publicly financed unintended pregnancies, resulting in average spending of $11.3 billion annually. Both studies were published in the June issue of Perspectives on Sexual and Reproductive Health.

Researchers from the Guttmacher Institute found that public programs such as Medicaid and the Children's Health Insurance Program bear the brunt of the nation's costs for unintended pregnancies (Perspect. Sex. Reprod. Health 2011;43:94–102 [doi:10.1363/4309411]). While 38% of U.S. births result from unintended pregnancies, births from unintended pregnancies make up about half of publicly funded births. But reducing unintended pregnancies also will require major new public investments, the Guttmacher researchers wrote, including increasing access to family planning services and comprehensive sex education. The Affordable Care Act may help, too, they said, by expanding insurance coverage and giving new authority to states to expand Medicaid eligibility for family planning services.

While preventing unintended pregnancies would require an up-front investment, the researchers at the Brookings Institution said it would be more than offset by potential savings. They estimated that if unintended pregnancies could be prevented altogether, with some being delayed until the women were ready to be pregnant, it could save taxpayers about $5.6 billion annually (Perspect. Sex. Reprod. Health 2011;43:88–93 [doi: 10.1363/4308811]).

Taxpayers spend more than $11 billion each year as a result of unintended pregnancies, according to new data from two separate studies.

The estimates are based on public insurance costs for pregnancies and infant care in the first year. Researchers from the Guttmacher Institute used state-level data from 2006 to come up with a national estimate of $11.1 billion in public spending on unintended pregnancies. In a separate study, researchers at the Brookings Institution came up with their figures by using 2001 national data on publicly financed unintended pregnancies, resulting in average spending of $11.3 billion annually. Both studies were published in the June issue of Perspectives on Sexual and Reproductive Health.

Researchers from the Guttmacher Institute found that public programs such as Medicaid and the Children's Health Insurance Program bear the brunt of the nation's costs for unintended pregnancies (Perspect. Sex. Reprod. Health 2011;43:94–102 [doi:10.1363/4309411]). While 38% of U.S. births result from unintended pregnancies, births from unintended pregnancies make up about half of publicly funded births. But reducing unintended pregnancies also will require major new public investments, the Guttmacher researchers wrote, including increasing access to family planning services and comprehensive sex education. The Affordable Care Act may help, too, they said, by expanding insurance coverage and giving new authority to states to expand Medicaid eligibility for family planning services.

While preventing unintended pregnancies would require an up-front investment, the researchers at the Brookings Institution said it would be more than offset by potential savings. They estimated that if unintended pregnancies could be prevented altogether, with some being delayed until the women were ready to be pregnant, it could save taxpayers about $5.6 billion annually (Perspect. Sex. Reprod. Health 2011;43:88–93 [doi: 10.1363/4308811]).

Enacting comprehensive state laws that ban smoking in workplaces and restaurants, and raising the cigarette tax by $1 per pack, could bring in billions ofirevenue for cash-strapped states, while also saving nearly 2 million lives, according to new estimates from the American Cancer Society Cancer Action Network.

The ACS CAN released two reports that examined the public health benefits and economic savings from strengthening state antitobacco policies. In one report, researchers from the University of Illinois at Chicago looked at what would happen if the 27 states without comprehensive smoke-free laws were to enact such laws. In the second report, the same researchers considered the impact if all 50 states and the District of Columbia were to adopt a $ 1-per-pack increase in the cigarette excise tax.

“The bottom line is that strong tobacco control policies are a win-win for state legislators, for the states themselves, and [for] their constituents,” said John R. Seffrin, Ph.D., chief executive officer of ACS CAN.

Currently, 23 states and the District of Columbia have enacted comprehensive laws that ban smoking in all bars, restaurants, and workplaces. The remaining 27 states have either less-comprehensive laws or no laws at all in this area. When the researchers considered the impact if these 27 states were to adopt comprehensive smoking bans, they found that more than 1 million adults would quit smoking, nearly 400,000 children would never start smoking, and smoking-related deaths would fall by 624,000.

Those 27 states would see a savings of about $316 million from lung cancer treatment, $875 million from heart attack and stroke treatment, and $128 million from smoking-related pregnancy treatment. The researchers estimated that Medicaid programs in those 27 states would save a collective $42 million.

The report on tobacco taxes found similar public health and financial gains if a $ 1-per-pack tax increase were enacted around the country. Such a tax would result in 1.4 million adults quitting smoking, 1.69 million children never starting to smoke, and 1.32 million fewer people dying from smoking-related causes. States could benefit from decreases in Medicaid spending and increased revenue. The report estimated that the tax would cut Medicaid spending by about $146 million across the states, and would bring in $8.62 billion in new state revenue.

Dr. Seffrin said that the results are attainable. An increasing number of states are adopting smoke-free laws and nearly all the states have increased cigarette excise taxes in recent years.

Enacting comprehensive state laws that ban smoking in workplaces and restaurants, and raising the cigarette tax by $1 per pack, could bring in billions ofirevenue for cash-strapped states, while also saving nearly 2 million lives, according to new estimates from the American Cancer Society Cancer Action Network.

The ACS CAN released two reports that examined the public health benefits and economic savings from strengthening state antitobacco policies. In one report, researchers from the University of Illinois at Chicago looked at what would happen if the 27 states without comprehensive smoke-free laws were to enact such laws. In the second report, the same researchers considered the impact if all 50 states and the District of Columbia were to adopt a $ 1-per-pack increase in the cigarette excise tax.

“The bottom line is that strong tobacco control policies are a win-win for state legislators, for the states themselves, and [for] their constituents,” said John R. Seffrin, Ph.D., chief executive officer of ACS CAN.

Currently, 23 states and the District of Columbia have enacted comprehensive laws that ban smoking in all bars, restaurants, and workplaces. The remaining 27 states have either less-comprehensive laws or no laws at all in this area. When the researchers considered the impact if these 27 states were to adopt comprehensive smoking bans, they found that more than 1 million adults would quit smoking, nearly 400,000 children would never start smoking, and smoking-related deaths would fall by 624,000.

Those 27 states would see a savings of about $316 million from lung cancer treatment, $875 million from heart attack and stroke treatment, and $128 million from smoking-related pregnancy treatment. The researchers estimated that Medicaid programs in those 27 states would save a collective $42 million.

The report on tobacco taxes found similar public health and financial gains if a $ 1-per-pack tax increase were enacted around the country. Such a tax would result in 1.4 million adults quitting smoking, 1.69 million children never starting to smoke, and 1.32 million fewer people dying from smoking-related causes. States could benefit from decreases in Medicaid spending and increased revenue. The report estimated that the tax would cut Medicaid spending by about $146 million across the states, and would bring in $8.62 billion in new state revenue.

Dr. Seffrin said that the results are attainable. An increasing number of states are adopting smoke-free laws and nearly all the states have increased cigarette excise taxes in recent years.

Enacting comprehensive state laws that ban smoking in workplaces and restaurants, and raising the cigarette tax by $1 per pack, could bring in billions ofirevenue for cash-strapped states, while also saving nearly 2 million lives, according to new estimates from the American Cancer Society Cancer Action Network.

The ACS CAN released two reports that examined the public health benefits and economic savings from strengthening state antitobacco policies. In one report, researchers from the University of Illinois at Chicago looked at what would happen if the 27 states without comprehensive smoke-free laws were to enact such laws. In the second report, the same researchers considered the impact if all 50 states and the District of Columbia were to adopt a $ 1-per-pack increase in the cigarette excise tax.

“The bottom line is that strong tobacco control policies are a win-win for state legislators, for the states themselves, and [for] their constituents,” said John R. Seffrin, Ph.D., chief executive officer of ACS CAN.

Currently, 23 states and the District of Columbia have enacted comprehensive laws that ban smoking in all bars, restaurants, and workplaces. The remaining 27 states have either less-comprehensive laws or no laws at all in this area. When the researchers considered the impact if these 27 states were to adopt comprehensive smoking bans, they found that more than 1 million adults would quit smoking, nearly 400,000 children would never start smoking, and smoking-related deaths would fall by 624,000.

Those 27 states would see a savings of about $316 million from lung cancer treatment, $875 million from heart attack and stroke treatment, and $128 million from smoking-related pregnancy treatment. The researchers estimated that Medicaid programs in those 27 states would save a collective $42 million.

The report on tobacco taxes found similar public health and financial gains if a $ 1-per-pack tax increase were enacted around the country. Such a tax would result in 1.4 million adults quitting smoking, 1.69 million children never starting to smoke, and 1.32 million fewer people dying from smoking-related causes. States could benefit from decreases in Medicaid spending and increased revenue. The report estimated that the tax would cut Medicaid spending by about $146 million across the states, and would bring in $8.62 billion in new state revenue.

Dr. Seffrin said that the results are attainable. An increasing number of states are adopting smoke-free laws and nearly all the states have increased cigarette excise taxes in recent years.

Medicare payments to physicians will be slashed by 29.4% on Jan. 1 unless Congress acts to avert the scheduled cut, according to an estimate from the Congressional Budget Office.

Last year, Congress passed a 1-year pay fix that kept Medicare fees to physicians at 2010 rates through the end of 2011. Come January, though, physicians will be faced with paying the bill on years of accumulated pay cuts.

The new report from the nonpartisan Congressional Budget Office (CBO) also outlines the costs of various proposals to replace or revamp Medicare's Sustainable Growth Rate (SGR), the formula that requires annual cuts to physician pay whenever actual spending on physician services exceeds spending targets. For example, if Congress were to throw out the SGR and simply freeze Medicare payments to physicians at current rates, the cost to the federal government would be almost $298 billion over 10 years. Offering physicians a 2% pay bump in each year through 2021 would raise the price of the fix to $389 billion over the decade.

A somewhat less expensive option would be to reset the SGR instead of replacing it. Under that option, Congress would forgive all spending above the cumulative targets as of the end of 2010. Going forward, 2011 would be the baseline period for the application of the SGR and in 2012 physicians would receive an increase equal to the Medicare Economic Index. That option would cost about $195 billion over 10 years.

Lawmakers on the House Energy and Commerce Committee are considering the options for replacing the SGR. They recently held a hearing in which they solicited ideas from several of the major professional medical societies on what could replace the SGR. Rep. Michael Burgess (R-Tex.), a member of the committee, said that the goal was to enact a permanent solution to the Medicare physician payment problem this year.

Medicare payments to physicians will be slashed by 29.4% on Jan. 1 unless Congress acts to avert the scheduled cut, according to an estimate from the Congressional Budget Office.

Last year, Congress passed a 1-year pay fix that kept Medicare fees to physicians at 2010 rates through the end of 2011. Come January, though, physicians will be faced with paying the bill on years of accumulated pay cuts.

The new report from the nonpartisan Congressional Budget Office (CBO) also outlines the costs of various proposals to replace or revamp Medicare's Sustainable Growth Rate (SGR), the formula that requires annual cuts to physician pay whenever actual spending on physician services exceeds spending targets. For example, if Congress were to throw out the SGR and simply freeze Medicare payments to physicians at current rates, the cost to the federal government would be almost $298 billion over 10 years. Offering physicians a 2% pay bump in each year through 2021 would raise the price of the fix to $389 billion over the decade.

A somewhat less expensive option would be to reset the SGR instead of replacing it. Under that option, Congress would forgive all spending above the cumulative targets as of the end of 2010. Going forward, 2011 would be the baseline period for the application of the SGR and in 2012 physicians would receive an increase equal to the Medicare Economic Index. That option would cost about $195 billion over 10 years.

Lawmakers on the House Energy and Commerce Committee are considering the options for replacing the SGR. They recently held a hearing in which they solicited ideas from several of the major professional medical societies on what could replace the SGR. Rep. Michael Burgess (R-Tex.), a member of the committee, said that the goal was to enact a permanent solution to the Medicare physician payment problem this year.

Medicare payments to physicians will be slashed by 29.4% on Jan. 1 unless Congress acts to avert the scheduled cut, according to an estimate from the Congressional Budget Office.

Last year, Congress passed a 1-year pay fix that kept Medicare fees to physicians at 2010 rates through the end of 2011. Come January, though, physicians will be faced with paying the bill on years of accumulated pay cuts.

The new report from the nonpartisan Congressional Budget Office (CBO) also outlines the costs of various proposals to replace or revamp Medicare's Sustainable Growth Rate (SGR), the formula that requires annual cuts to physician pay whenever actual spending on physician services exceeds spending targets. For example, if Congress were to throw out the SGR and simply freeze Medicare payments to physicians at current rates, the cost to the federal government would be almost $298 billion over 10 years. Offering physicians a 2% pay bump in each year through 2021 would raise the price of the fix to $389 billion over the decade.

A somewhat less expensive option would be to reset the SGR instead of replacing it. Under that option, Congress would forgive all spending above the cumulative targets as of the end of 2010. Going forward, 2011 would be the baseline period for the application of the SGR and in 2012 physicians would receive an increase equal to the Medicare Economic Index. That option would cost about $195 billion over 10 years.

Lawmakers on the House Energy and Commerce Committee are considering the options for replacing the SGR. They recently held a hearing in which they solicited ideas from several of the major professional medical societies on what could replace the SGR. Rep. Michael Burgess (R-Tex.), a member of the committee, said that the goal was to enact a permanent solution to the Medicare physician payment problem this year.

The federal government plans to help Americans live healthier lives not only by improving access to health care services, but also by reducing pollution, keeping children from abusing drugs, and serving nutritious school lunches, according to the first-ever National Prevention Strategy.

The new strategy was mandated under the Affordable Care Act (ACA), and with it federal officials have created a blueprint for themselves, as well as states, businesses, and community leaders to follow in building healthier communities. The 122-page document lays out seven priority areas based on evidence-based recommendations for improving health and prolonging life: tobacco-free living, preventing drug abuse and excessive alcohol use, healthy eating, active living, injury- and violence-free living, reproductive and sexual health, and mental and emotional well-being.

The document sets a number of goals and 10-year targets for measuring progress. For example, the strategy calls on physicians to inform patients about the benefits of preventive services, adopt and use certified electronic health records and personal health records, and adopt medical home or team-based care models. One 10-year target is to increase the proportion of medical practices that use electronic health records from 25% to 27.5%.

Health and Human Services Secretary Kathleen Sebelius said the strategy was part of a “new focus on prevention” started by President Obama. The National Prevention Strategy will build off earlier efforts, some of which were included in the ACA, to curb tobacco use and give Americans free or low-cost access to preventive services such as mammograms.

“We know that prevention helps people live long and productive lives and can help combat rising health care costs,” Ms. Sebelius said.

The ACA created the National Prevention, Health Promotion, and Public Health Council (National Prevention Council), which developed the National Prevention Strategy, along with input from outside advisers. The council is made up of the heads of 17 federal agencies and is chaired by the U.S. Surgeon General. The council and the ACA authorized the Prevention and Public Health Fund, which provides nearly $18 billion for public health programs.

The federal government plans to help Americans live healthier lives not only by improving access to health care services, but also by reducing pollution, keeping children from abusing drugs, and serving nutritious school lunches, according to the first-ever National Prevention Strategy.

The new strategy was mandated under the Affordable Care Act (ACA), and with it federal officials have created a blueprint for themselves, as well as states, businesses, and community leaders to follow in building healthier communities. The 122-page document lays out seven priority areas based on evidence-based recommendations for improving health and prolonging life: tobacco-free living, preventing drug abuse and excessive alcohol use, healthy eating, active living, injury- and violence-free living, reproductive and sexual health, and mental and emotional well-being.

The document sets a number of goals and 10-year targets for measuring progress. For example, the strategy calls on physicians to inform patients about the benefits of preventive services, adopt and use certified electronic health records and personal health records, and adopt medical home or team-based care models. One 10-year target is to increase the proportion of medical practices that use electronic health records from 25% to 27.5%.

Health and Human Services Secretary Kathleen Sebelius said the strategy was part of a “new focus on prevention” started by President Obama. The National Prevention Strategy will build off earlier efforts, some of which were included in the ACA, to curb tobacco use and give Americans free or low-cost access to preventive services such as mammograms.

“We know that prevention helps people live long and productive lives and can help combat rising health care costs,” Ms. Sebelius said.

The ACA created the National Prevention, Health Promotion, and Public Health Council (National Prevention Council), which developed the National Prevention Strategy, along with input from outside advisers. The council is made up of the heads of 17 federal agencies and is chaired by the U.S. Surgeon General. The council and the ACA authorized the Prevention and Public Health Fund, which provides nearly $18 billion for public health programs.

The federal government plans to help Americans live healthier lives not only by improving access to health care services, but also by reducing pollution, keeping children from abusing drugs, and serving nutritious school lunches, according to the first-ever National Prevention Strategy.

The new strategy was mandated under the Affordable Care Act (ACA), and with it federal officials have created a blueprint for themselves, as well as states, businesses, and community leaders to follow in building healthier communities. The 122-page document lays out seven priority areas based on evidence-based recommendations for improving health and prolonging life: tobacco-free living, preventing drug abuse and excessive alcohol use, healthy eating, active living, injury- and violence-free living, reproductive and sexual health, and mental and emotional well-being.

The document sets a number of goals and 10-year targets for measuring progress. For example, the strategy calls on physicians to inform patients about the benefits of preventive services, adopt and use certified electronic health records and personal health records, and adopt medical home or team-based care models. One 10-year target is to increase the proportion of medical practices that use electronic health records from 25% to 27.5%.

Health and Human Services Secretary Kathleen Sebelius said the strategy was part of a “new focus on prevention” started by President Obama. The National Prevention Strategy will build off earlier efforts, some of which were included in the ACA, to curb tobacco use and give Americans free or low-cost access to preventive services such as mammograms.

“We know that prevention helps people live long and productive lives and can help combat rising health care costs,” Ms. Sebelius said.

The ACA created the National Prevention, Health Promotion, and Public Health Council (National Prevention Council), which developed the National Prevention Strategy, along with input from outside advisers. The council is made up of the heads of 17 federal agencies and is chaired by the U.S. Surgeon General. The council and the ACA authorized the Prevention and Public Health Fund, which provides nearly $18 billion for public health programs.

More than 5.5 million Medicare beneficiaries have taken advantage of the free preventive services offered under the Affordable Care Act, but that number is far short of the 33 million who are eligible under the new law, Medicare officials reported.

Beneficiarieshare eligible for preventive services such as mammograms and smoking cessation counseling with no copayments or deductibles under Medicare Part B. They are also eligible for an annual wellness visit at no cost. Between Jan. 1 and June 10, more than 780,000 people on Medicare had an annual wellness visit, according to the report from the Centers for Medicare and Medicaid Services. Mammograms, as well as bone density and prostate cancer screenings, were among the most popular preventives services so far this year.

On June 20, federal officials launched a public outreach campaign, “Share the News, Share the Health,” to increase awareness of the new benefits. The campaign includes TV and radio advertisements, information on the Medicare.gov

“People trust their doctors,” CMS Administrator Donald Berwick said during the press briefing.

Dr. Berwick predicted that visits to physicians will increase substantially once more patients are aware that preventive services are available for free.

“These are very important benefits, and I expect we're going to see a lot of increasing interest, especially now that barriers have been lowered,” he said.

This is part of an overall shift toward prevention within health care, Dr. Berwick noted.

More than 5.5 million Medicare beneficiaries have taken advantage of the free preventive services offered under the Affordable Care Act, but that number is far short of the 33 million who are eligible under the new law, Medicare officials reported.

Beneficiarieshare eligible for preventive services such as mammograms and smoking cessation counseling with no copayments or deductibles under Medicare Part B. They are also eligible for an annual wellness visit at no cost. Between Jan. 1 and June 10, more than 780,000 people on Medicare had an annual wellness visit, according to the report from the Centers for Medicare and Medicaid Services. Mammograms, as well as bone density and prostate cancer screenings, were among the most popular preventives services so far this year.

On June 20, federal officials launched a public outreach campaign, “Share the News, Share the Health,” to increase awareness of the new benefits. The campaign includes TV and radio advertisements, information on the Medicare.gov

“People trust their doctors,” CMS Administrator Donald Berwick said during the press briefing.

Dr. Berwick predicted that visits to physicians will increase substantially once more patients are aware that preventive services are available for free.

“These are very important benefits, and I expect we're going to see a lot of increasing interest, especially now that barriers have been lowered,” he said.

This is part of an overall shift toward prevention within health care, Dr. Berwick noted.

More than 5.5 million Medicare beneficiaries have taken advantage of the free preventive services offered under the Affordable Care Act, but that number is far short of the 33 million who are eligible under the new law, Medicare officials reported.

Beneficiarieshare eligible for preventive services such as mammograms and smoking cessation counseling with no copayments or deductibles under Medicare Part B. They are also eligible for an annual wellness visit at no cost. Between Jan. 1 and June 10, more than 780,000 people on Medicare had an annual wellness visit, according to the report from the Centers for Medicare and Medicaid Services. Mammograms, as well as bone density and prostate cancer screenings, were among the most popular preventives services so far this year.

On June 20, federal officials launched a public outreach campaign, “Share the News, Share the Health,” to increase awareness of the new benefits. The campaign includes TV and radio advertisements, information on the Medicare.gov

“People trust their doctors,” CMS Administrator Donald Berwick said during the press briefing.

Dr. Berwick predicted that visits to physicians will increase substantially once more patients are aware that preventive services are available for free.

“These are very important benefits, and I expect we're going to see a lot of increasing interest, especially now that barriers have been lowered,” he said.

This is part of an overall shift toward prevention within health care, Dr. Berwick noted.

Major Finding: An ACGME-compliant staffing model with 13-hour trainee shifts and increased night coverage reduced length of stay by 18% and reduced hospitalization costs by 11% in a pediatric inpatient unit.

Data Source: UCSF administrative billing data.

Disclosures: The authors reported no disclosures.

GRAPEVINE, TEX. – July brings more restrictions on resident duty hours, but compliance with these requirements can result in reduced hospitalization costs and shorter lengths of stay, in a study by the University of California, San Francisco's Benioff Children's Hospital.

Researchers who analyzed an attempt to cut resident work hours by enlarging care teams and eliminating cross-coverage found that a new staffing model reduced hospitalization costs by 11% and length of stay by 18%.

Under new resident duty-hours requirements from the Accreditation Council for Graduate Medical Education now in effect, interns (PGY-1 residents) are limited to shifts of no more than 16 hours.

In September 2008, UCSF reorganized its pediatric inpatient hospitalist service, moving from a traditional call model to a shift-based staffing model. The hospital eliminated cross-coverage of different teams in favor of dedicated night teams that were subsets of their day teams. The goal was to increase “patient ownership” by reducing handoffs and to improve patient care by having a more consistent provider overnight, Dr. Glenn Rosenbluth, a pediatric hospitalist at the Benioff, said at the meeting.

“The idea was that a resident working a 30-hour shift at 2 in the morning might be more focused on just urgent issues, calls from the nurses, and potentially seeing the call room when they get some down time, whereas someone working a week of dedicated night shifts might be more awake and more interested in advancing care because they're a member of the primary team,” he said.

Prior to September 2008, general pediatrics patients were covered by house-staff teams of two interns and one senior resident working shifts of up to 30 hours. The interns took call every sixth night and senior residents took call every fifth night. They provided cross-coverage of patients on multiple teams at night. This meant that one team was working each night and covering for all other teams, Dr. Rosenbluth said.

After the reorganization, they expanded the house-staff teams to four interns per team, with each intern working 3 weeks of day shift and 6 consecutive night shifts. The shifts were about 13 hours. The changes allowed them to eliminate cross-coverage and to have a dedicated night team. The attending coverage by hospitalists was unchanged.

To study the impact of the new staffing model, the researchers performed a retrospective, interrupted time series cohort study using concurrent controls. The target group was children who were admitted to the hospital's general pediatric service. The concurrent control group comprised surgical patients admitted to the same inpatient unit.

The researchers used the medical center's administrative billing data to analyze hospitalization costs and length of stay for children admitted to the pediatric medical-surgical unit from Sept. 15, 2007, through Sept. 15, 2009. They analyzed data on 280 patients before intervention and 274 patients after intervention, excluding patients who had spent time in the pediatric ICU and those who were on specialty services not covered by a pediatric hospitalist or general surgeon. The researchers used multivariate models to adjust for age, sex, the season of year, the admitting diagnosis, and any clustering at the attending level.

They found that for general pediatric patients admitted to the medical-surgical unit there was an adjusted rate ratio of 0.82 for length of stay following the intervention. That was an 18% decrease in length of stay from before the intervention. Similarly, hospitalization costs had an adjusted rate ratio of 0.89, an 11% decrease from before the intervention. Among the surgery patients who acted as the control group, there was no statistically significant change in the length of stay and there was a small increase in the cost of hospitalization.

The study suggests that costs associated with staffing changes needed to comply with the new duty-hours requirements could be offset by improved care efficiency, Dr. Rosenbluth said.

view on the News

New Era Requires New Strategies

I think as we move into the new frontier of continued restriction on resident duty hours, new ways and strategies need to be explored to maintain continuity and ownership of the patients we provide care for. Both of these areas have been negatively impacted by the continued restrictions.

This study suggests a night float model is an effective strategy to combat the problem thus decreasing LOS and patient handoffs. I suspect the authors are correct in their assessment, but I would like to see a prospective analysis to control for some confounding variables, plus I wonder what the attending staff model looked like over the same time period.

Vitals

MICHELLE M. MARKS, D.O., is director of pediatric hospitalist medicine and director of medical operations at the Cleveland Clinic Children's Hospital.

Major Finding: An ACGME-compliant staffing model with 13-hour trainee shifts and increased night coverage reduced length of stay by 18% and reduced hospitalization costs by 11% in a pediatric inpatient unit.

Data Source: UCSF administrative billing data.

Disclosures: The authors reported no disclosures.

GRAPEVINE, TEX. – July brings more restrictions on resident duty hours, but compliance with these requirements can result in reduced hospitalization costs and shorter lengths of stay, in a study by the University of California, San Francisco's Benioff Children's Hospital.

Researchers who analyzed an attempt to cut resident work hours by enlarging care teams and eliminating cross-coverage found that a new staffing model reduced hospitalization costs by 11% and length of stay by 18%.

Under new resident duty-hours requirements from the Accreditation Council for Graduate Medical Education now in effect, interns (PGY-1 residents) are limited to shifts of no more than 16 hours.

In September 2008, UCSF reorganized its pediatric inpatient hospitalist service, moving from a traditional call model to a shift-based staffing model. The hospital eliminated cross-coverage of different teams in favor of dedicated night teams that were subsets of their day teams. The goal was to increase “patient ownership” by reducing handoffs and to improve patient care by having a more consistent provider overnight, Dr. Glenn Rosenbluth, a pediatric hospitalist at the Benioff, said at the meeting.

“The idea was that a resident working a 30-hour shift at 2 in the morning might be more focused on just urgent issues, calls from the nurses, and potentially seeing the call room when they get some down time, whereas someone working a week of dedicated night shifts might be more awake and more interested in advancing care because they're a member of the primary team,” he said.

Prior to September 2008, general pediatrics patients were covered by house-staff teams of two interns and one senior resident working shifts of up to 30 hours. The interns took call every sixth night and senior residents took call every fifth night. They provided cross-coverage of patients on multiple teams at night. This meant that one team was working each night and covering for all other teams, Dr. Rosenbluth said.

After the reorganization, they expanded the house-staff teams to four interns per team, with each intern working 3 weeks of day shift and 6 consecutive night shifts. The shifts were about 13 hours. The changes allowed them to eliminate cross-coverage and to have a dedicated night team. The attending coverage by hospitalists was unchanged.

To study the impact of the new staffing model, the researchers performed a retrospective, interrupted time series cohort study using concurrent controls. The target group was children who were admitted to the hospital's general pediatric service. The concurrent control group comprised surgical patients admitted to the same inpatient unit.

The researchers used the medical center's administrative billing data to analyze hospitalization costs and length of stay for children admitted to the pediatric medical-surgical unit from Sept. 15, 2007, through Sept. 15, 2009. They analyzed data on 280 patients before intervention and 274 patients after intervention, excluding patients who had spent time in the pediatric ICU and those who were on specialty services not covered by a pediatric hospitalist or general surgeon. The researchers used multivariate models to adjust for age, sex, the season of year, the admitting diagnosis, and any clustering at the attending level.

They found that for general pediatric patients admitted to the medical-surgical unit there was an adjusted rate ratio of 0.82 for length of stay following the intervention. That was an 18% decrease in length of stay from before the intervention. Similarly, hospitalization costs had an adjusted rate ratio of 0.89, an 11% decrease from before the intervention. Among the surgery patients who acted as the control group, there was no statistically significant change in the length of stay and there was a small increase in the cost of hospitalization.

The study suggests that costs associated with staffing changes needed to comply with the new duty-hours requirements could be offset by improved care efficiency, Dr. Rosenbluth said.

view on the News

New Era Requires New Strategies

I think as we move into the new frontier of continued restriction on resident duty hours, new ways and strategies need to be explored to maintain continuity and ownership of the patients we provide care for. Both of these areas have been negatively impacted by the continued restrictions.

This study suggests a night float model is an effective strategy to combat the problem thus decreasing LOS and patient handoffs. I suspect the authors are correct in their assessment, but I would like to see a prospective analysis to control for some confounding variables, plus I wonder what the attending staff model looked like over the same time period.

Vitals

MICHELLE M. MARKS, D.O., is director of pediatric hospitalist medicine and director of medical operations at the Cleveland Clinic Children's Hospital.

Major Finding: An ACGME-compliant staffing model with 13-hour trainee shifts and increased night coverage reduced length of stay by 18% and reduced hospitalization costs by 11% in a pediatric inpatient unit.

Data Source: UCSF administrative billing data.

Disclosures: The authors reported no disclosures.

GRAPEVINE, TEX. – July brings more restrictions on resident duty hours, but compliance with these requirements can result in reduced hospitalization costs and shorter lengths of stay, in a study by the University of California, San Francisco's Benioff Children's Hospital.

Researchers who analyzed an attempt to cut resident work hours by enlarging care teams and eliminating cross-coverage found that a new staffing model reduced hospitalization costs by 11% and length of stay by 18%.

Under new resident duty-hours requirements from the Accreditation Council for Graduate Medical Education now in effect, interns (PGY-1 residents) are limited to shifts of no more than 16 hours.

In September 2008, UCSF reorganized its pediatric inpatient hospitalist service, moving from a traditional call model to a shift-based staffing model. The hospital eliminated cross-coverage of different teams in favor of dedicated night teams that were subsets of their day teams. The goal was to increase “patient ownership” by reducing handoffs and to improve patient care by having a more consistent provider overnight, Dr. Glenn Rosenbluth, a pediatric hospitalist at the Benioff, said at the meeting.

“The idea was that a resident working a 30-hour shift at 2 in the morning might be more focused on just urgent issues, calls from the nurses, and potentially seeing the call room when they get some down time, whereas someone working a week of dedicated night shifts might be more awake and more interested in advancing care because they're a member of the primary team,” he said.

Prior to September 2008, general pediatrics patients were covered by house-staff teams of two interns and one senior resident working shifts of up to 30 hours. The interns took call every sixth night and senior residents took call every fifth night. They provided cross-coverage of patients on multiple teams at night. This meant that one team was working each night and covering for all other teams, Dr. Rosenbluth said.

After the reorganization, they expanded the house-staff teams to four interns per team, with each intern working 3 weeks of day shift and 6 consecutive night shifts. The shifts were about 13 hours. The changes allowed them to eliminate cross-coverage and to have a dedicated night team. The attending coverage by hospitalists was unchanged.

To study the impact of the new staffing model, the researchers performed a retrospective, interrupted time series cohort study using concurrent controls. The target group was children who were admitted to the hospital's general pediatric service. The concurrent control group comprised surgical patients admitted to the same inpatient unit.

The researchers used the medical center's administrative billing data to analyze hospitalization costs and length of stay for children admitted to the pediatric medical-surgical unit from Sept. 15, 2007, through Sept. 15, 2009. They analyzed data on 280 patients before intervention and 274 patients after intervention, excluding patients who had spent time in the pediatric ICU and those who were on specialty services not covered by a pediatric hospitalist or general surgeon. The researchers used multivariate models to adjust for age, sex, the season of year, the admitting diagnosis, and any clustering at the attending level.

They found that for general pediatric patients admitted to the medical-surgical unit there was an adjusted rate ratio of 0.82 for length of stay following the intervention. That was an 18% decrease in length of stay from before the intervention. Similarly, hospitalization costs had an adjusted rate ratio of 0.89, an 11% decrease from before the intervention. Among the surgery patients who acted as the control group, there was no statistically significant change in the length of stay and there was a small increase in the cost of hospitalization.

The study suggests that costs associated with staffing changes needed to comply with the new duty-hours requirements could be offset by improved care efficiency, Dr. Rosenbluth said.

view on the News

New Era Requires New Strategies

I think as we move into the new frontier of continued restriction on resident duty hours, new ways and strategies need to be explored to maintain continuity and ownership of the patients we provide care for. Both of these areas have been negatively impacted by the continued restrictions.

This study suggests a night float model is an effective strategy to combat the problem thus decreasing LOS and patient handoffs. I suspect the authors are correct in their assessment, but I would like to see a prospective analysis to control for some confounding variables, plus I wonder what the attending staff model looked like over the same time period.

Vitals

MICHELLE M. MARKS, D.O., is director of pediatric hospitalist medicine and director of medical operations at the Cleveland Clinic Children's Hospital.

GRAPEVINE, TEX. – Hospitalists will have new opportunities to show just how indispensable they are as the provisions of the Affordable Care Act go into effect, according to Dr. Robert Kocher, who helped formulate the health reform law that was enacted last year.

Dr. Kocher, an internist who previously served as a member of President Obama's National Economic Council, said that hospital administrators will be looking to hospitalists to help them cope with elements of the health reform law such as requirements to reduce readmissions and possible participation in accountable care organizations.

The new law also makes “productivity adjustments” that cut Medicare payments to hospitals, he said.

Thus, hospitals will be under pressure to be as efficient as possible and hospitalists will be in a position to help reduce costs in various ways, from reducing redundancies on care teams to improving handoffs, said Dr. Kocher, a principal at the Center for U.S. Health System Reform at McKinsey & Company.

Hospitalists have an opportunity to show their worth as hospitals try to better use technology to drive down costs. “Technology lowers prices in every other part of the economy, but it doesn't in health care,” Dr. Kocher said. “There's no reason why that shouldn't be possible in health care.”

And physicians shouldn't drag their feet in preparing for the implementation of the new law, because despite efforts to repeal it, it's here to stay, Dr. Kocher predicted. “I doubt this Congress is going to meaningfully change the law,” he said.

The one place where the law could be threatened is in the courts, he said. Several challenges are winding their way through the federal court system, and legal experts expect that the issue of the law's constitutionality will end up before the Supreme Court.

A ruling from the high court is likely to be very close, but it's unclear what direction it will go in, Dr. Kocher said. Even if the court were to strike down the law's mandate that individuals purchase health insurance, there are other ways in which the government could incentivize people to buy coverage, he added.

GRAPEVINE, TEX. – Hospitalists will have new opportunities to show just how indispensable they are as the provisions of the Affordable Care Act go into effect, according to Dr. Robert Kocher, who helped formulate the health reform law that was enacted last year.

Dr. Kocher, an internist who previously served as a member of President Obama's National Economic Council, said that hospital administrators will be looking to hospitalists to help them cope with elements of the health reform law such as requirements to reduce readmissions and possible participation in accountable care organizations.

The new law also makes “productivity adjustments” that cut Medicare payments to hospitals, he said.

Thus, hospitals will be under pressure to be as efficient as possible and hospitalists will be in a position to help reduce costs in various ways, from reducing redundancies on care teams to improving handoffs, said Dr. Kocher, a principal at the Center for U.S. Health System Reform at McKinsey & Company.

Hospitalists have an opportunity to show their worth as hospitals try to better use technology to drive down costs. “Technology lowers prices in every other part of the economy, but it doesn't in health care,” Dr. Kocher said. “There's no reason why that shouldn't be possible in health care.”

And physicians shouldn't drag their feet in preparing for the implementation of the new law, because despite efforts to repeal it, it's here to stay, Dr. Kocher predicted. “I doubt this Congress is going to meaningfully change the law,” he said.

The one place where the law could be threatened is in the courts, he said. Several challenges are winding their way through the federal court system, and legal experts expect that the issue of the law's constitutionality will end up before the Supreme Court.

A ruling from the high court is likely to be very close, but it's unclear what direction it will go in, Dr. Kocher said. Even if the court were to strike down the law's mandate that individuals purchase health insurance, there are other ways in which the government could incentivize people to buy coverage, he added.

GRAPEVINE, TEX. – Hospitalists will have new opportunities to show just how indispensable they are as the provisions of the Affordable Care Act go into effect, according to Dr. Robert Kocher, who helped formulate the health reform law that was enacted last year.

Dr. Kocher, an internist who previously served as a member of President Obama's National Economic Council, said that hospital administrators will be looking to hospitalists to help them cope with elements of the health reform law such as requirements to reduce readmissions and possible participation in accountable care organizations.

The new law also makes “productivity adjustments” that cut Medicare payments to hospitals, he said.

Thus, hospitals will be under pressure to be as efficient as possible and hospitalists will be in a position to help reduce costs in various ways, from reducing redundancies on care teams to improving handoffs, said Dr. Kocher, a principal at the Center for U.S. Health System Reform at McKinsey & Company.

Hospitalists have an opportunity to show their worth as hospitals try to better use technology to drive down costs. “Technology lowers prices in every other part of the economy, but it doesn't in health care,” Dr. Kocher said. “There's no reason why that shouldn't be possible in health care.”

And physicians shouldn't drag their feet in preparing for the implementation of the new law, because despite efforts to repeal it, it's here to stay, Dr. Kocher predicted. “I doubt this Congress is going to meaningfully change the law,” he said.

The one place where the law could be threatened is in the courts, he said. Several challenges are winding their way through the federal court system, and legal experts expect that the issue of the law's constitutionality will end up before the Supreme Court.

A ruling from the high court is likely to be very close, but it's unclear what direction it will go in, Dr. Kocher said. Even if the court were to strike down the law's mandate that individuals purchase health insurance, there are other ways in which the government could incentivize people to buy coverage, he added.

Starting in October 2012, about 1% of the payments that hospitals receive from Medicare will be calculated based on performance on clinical quality measures and patient satisfaction scores.

Details of the new initiative, known as the Hospital Inpatient Value-Based Purchasing program, were unveiled in a final rule released by the Centers for Medicare and Medicaid Services on April 29. The initiative was mandated by Congress under the Affordable Care Act.

Under the program, the CMS will take 1% of the payments that would otherwise go to hospitals under Medicare's Inpatient Prospective Payment System and put them in a fund to pay for care based on quality. In the first year, the CMS estimates that about $850 million will be available through the fund. Medicare officials will score hospitals based on their performance on each of the measures compared to other hospitals and to how their performance has improved over time.

The program is the first step in shifting payments toward quality and away from volume, Dr. Donald Berwick, CMS administrator, said during a press conference.

“This is one of those areas where improvement of quality and reduction in cost go hand-in-hand,” Dr. Berwick said. “My feeling continues to be that the best way for us to arrive at sustainable costs for the health care system is precisely through the improvement of quality of care.”

Under the program, payments will be based on performance on 12 clinical process-of-care measures and a survey of patient satisfaction. Process-of-care indicators include measures such as the percentage of patients with myo-cardial infarction who are given fibrinolytic medication within 30 minutes of arrival at the hospital.

To evaluate patient satisfaction, a survey of a random sample of discharged patients will be taken about their perceptions, including physician and nurse communication, hospital staff responsiveness, pain management, discharge instructions, and hospital cleanliness.

A complete list of the measures is available at www.healthcare.gov/news/factsheets/valuebasedpurchasing04292011b.html

The measures have been endorsed by such national panels as the National Quality Forum, and hospitals have already been reporting their performance on them through Medicare's Hospital Compare website. The measures are weighted so that 70% of the payment is based on the quality measures and 30% is based on patient evaluations.

Over time, CMS officials plan to add measures focused on patient outcomes, including prevention of hospital-acquired conditions. And measures will be phased out over time if hospitals achieve consistently high compliance scores, Dr. Berwick said.

The new value-based purchasing initiative is only one way that hospital payments will be tied to quality of care. Starting in 2013, Medicare will reduce payments to hospitals if they have excess 30-day readmissions for patients who suffer heart attacks, heart failure, and pneumonia. And in 2015, hospitals could see their payments cut if they have high rates of certain hospital-acquired conditions.

The final rule on hospital value-based purchasing will be published in the Federal Register in May and becomes final on July 1.

Starting in October 2012, about 1% of the payments that hospitals receive from Medicare will be calculated based on performance on clinical quality measures and patient satisfaction scores.

Details of the new initiative, known as the Hospital Inpatient Value-Based Purchasing program, were unveiled in a final rule released by the Centers for Medicare and Medicaid Services on April 29. The initiative was mandated by Congress under the Affordable Care Act.

Under the program, the CMS will take 1% of the payments that would otherwise go to hospitals under Medicare's Inpatient Prospective Payment System and put them in a fund to pay for care based on quality. In the first year, the CMS estimates that about $850 million will be available through the fund. Medicare officials will score hospitals based on their performance on each of the measures compared to other hospitals and to how their performance has improved over time.

The program is the first step in shifting payments toward quality and away from volume, Dr. Donald Berwick, CMS administrator, said during a press conference.

“This is one of those areas where improvement of quality and reduction in cost go hand-in-hand,” Dr. Berwick said. “My feeling continues to be that the best way for us to arrive at sustainable costs for the health care system is precisely through the improvement of quality of care.”

Under the program, payments will be based on performance on 12 clinical process-of-care measures and a survey of patient satisfaction. Process-of-care indicators include measures such as the percentage of patients with myo-cardial infarction who are given fibrinolytic medication within 30 minutes of arrival at the hospital.

To evaluate patient satisfaction, a survey of a random sample of discharged patients will be taken about their perceptions, including physician and nurse communication, hospital staff responsiveness, pain management, discharge instructions, and hospital cleanliness.

A complete list of the measures is available at www.healthcare.gov/news/factsheets/valuebasedpurchasing04292011b.html

The measures have been endorsed by such national panels as the National Quality Forum, and hospitals have already been reporting their performance on them through Medicare's Hospital Compare website. The measures are weighted so that 70% of the payment is based on the quality measures and 30% is based on patient evaluations.

Over time, CMS officials plan to add measures focused on patient outcomes, including prevention of hospital-acquired conditions. And measures will be phased out over time if hospitals achieve consistently high compliance scores, Dr. Berwick said.

The new value-based purchasing initiative is only one way that hospital payments will be tied to quality of care. Starting in 2013, Medicare will reduce payments to hospitals if they have excess 30-day readmissions for patients who suffer heart attacks, heart failure, and pneumonia. And in 2015, hospitals could see their payments cut if they have high rates of certain hospital-acquired conditions.

The final rule on hospital value-based purchasing will be published in the Federal Register in May and becomes final on July 1.

Starting in October 2012, about 1% of the payments that hospitals receive from Medicare will be calculated based on performance on clinical quality measures and patient satisfaction scores.

Details of the new initiative, known as the Hospital Inpatient Value-Based Purchasing program, were unveiled in a final rule released by the Centers for Medicare and Medicaid Services on April 29. The initiative was mandated by Congress under the Affordable Care Act.

Under the program, the CMS will take 1% of the payments that would otherwise go to hospitals under Medicare's Inpatient Prospective Payment System and put them in a fund to pay for care based on quality. In the first year, the CMS estimates that about $850 million will be available through the fund. Medicare officials will score hospitals based on their performance on each of the measures compared to other hospitals and to how their performance has improved over time.

The program is the first step in shifting payments toward quality and away from volume, Dr. Donald Berwick, CMS administrator, said during a press conference.

“This is one of those areas where improvement of quality and reduction in cost go hand-in-hand,” Dr. Berwick said. “My feeling continues to be that the best way for us to arrive at sustainable costs for the health care system is precisely through the improvement of quality of care.”

Under the program, payments will be based on performance on 12 clinical process-of-care measures and a survey of patient satisfaction. Process-of-care indicators include measures such as the percentage of patients with myo-cardial infarction who are given fibrinolytic medication within 30 minutes of arrival at the hospital.

To evaluate patient satisfaction, a survey of a random sample of discharged patients will be taken about their perceptions, including physician and nurse communication, hospital staff responsiveness, pain management, discharge instructions, and hospital cleanliness.

A complete list of the measures is available at www.healthcare.gov/news/factsheets/valuebasedpurchasing04292011b.html

The measures have been endorsed by such national panels as the National Quality Forum, and hospitals have already been reporting their performance on them through Medicare's Hospital Compare website. The measures are weighted so that 70% of the payment is based on the quality measures and 30% is based on patient evaluations.

Over time, CMS officials plan to add measures focused on patient outcomes, including prevention of hospital-acquired conditions. And measures will be phased out over time if hospitals achieve consistently high compliance scores, Dr. Berwick said.

The new value-based purchasing initiative is only one way that hospital payments will be tied to quality of care. Starting in 2013, Medicare will reduce payments to hospitals if they have excess 30-day readmissions for patients who suffer heart attacks, heart failure, and pneumonia. And in 2015, hospitals could see their payments cut if they have high rates of certain hospital-acquired conditions.

The final rule on hospital value-based purchasing will be published in the Federal Register in May and becomes final on July 1.

Checking Musculoskeletal Injuries

The consumer group Public Citizen is urging the federal government to require businesses to report employees' musculoskeletal injuries more specifically. The Occupational Safety and Health Administration last year proposed an extra box on an OSHA form where employers would indicate any such injuries. This year, OSHA pulled back the proposal while asking for more comments. In a letter, public Citizen urged the requirement for the checkbox, saying it would not overly burden even small businesses and would provide much-needed data on repetitive-stress injuries.

A Vote for Arthritis Data

Sen. Robert Menendez (D-N.J.) and Rep. Jim Gerlach (R-Pa.) introduced the Psoriasis and Psoriatic Arthritis Research, Cure, and Care Act of 2011. Their bill (H.R. 2033 in the House and S. 1107 in the Senate) would build on the $1.5 million already given to the Centers for Disease Control and Prevention in 2009 for collecting psoriasis-related data. An additional $1.5 million each year would continue the project from 2012 to 2017. The bills would also urge the National Institutes of Health to create a virtual “center of excellence” to share information on psoriasis and psoriatic arthritis.

Group Suggests Payment Fixes

An official of the American College of Rheumatology told lawmakers they could fix the ailing Medicare physician payment system by first dumping the Sustainable Growth Rate (SGR) formula and setting a series of incremental pay increases for the next 5 years. In written comments to the House Ways and Means Committee, Dr. Tim Laing, chairman of the college's government affairs committee, said that repealing the SGR and setting the increases would allow enough time to test, adjust, and implement new payment models. Dr. Laing asked Congress to extend 10% payment bonuses for primary care physicians to rheumatologists and to correct the pay disparity between physicians who perform procedures and those who do cognitive work. “With the additional training rheumatologists and other cognitive specialists receive, they have been lumped together with surgical and procedural specialties even though their patient care aligns more with primary care,” Dr. Laing wrote. “Recognizing the differences in these specialties is important when reforming the physician payment system.”

1 Billion Deal With Disabilities

More than 1 billion people have some form of disability, according to the first-ever World Report on Disability by the World Health Organization and the World Bank. People with mental and physical disabilities are twice as likely as are others to say they lack health care because available providers' skills are inadequate, and three times as likely to report being denied needed health care, according to the report. In a forward, theoretical physicist Stephen Hawking, who lives with motor neuron disease, said, “We have a moral duty to remove the barriers to participation for people with disabilities, and to invest sufficient funding and expertise to unlock their vast potential.” The report encouraged governments to step up their efforts to make services accessible to people with disabilities.

No, It's Never Healthy

The Food and Drug Administration has warned online retailers to stop marketing tobacco products with unsubstantiated claims that the products can reduce the risk of tobacco-related diseases. In 11 warning letters, the agency cited the online retailers for various illegal claims, including use of terms such as “light,” “mild,” “low,” “less toxic,” and “safer.” Companies cannot make these claims without FDA approval, and the FDA has not okayed any such claim for tobacco products. The agency also cited some Internet retailers for selling flavored cigarettes. “There is no known safe tobacco product,” Dr. Lawrence Deyton, director of the FDA's Center for Tobacco Products, said in a statement. “It is illegal for tobacco companies or retailers, including Internet sellers, to make unsubstantiated claims or statements that imply tobacco products reduce health risks.”

Bill Seeks to Repeal Tan Tax

A Republican congressman and 24 cosponsors have introduced a bill to repeal the 10% “regressive tax” on tanning services that was part of the Affordable Care Act. “The health care law unfairly imposes onerous taxes, like the tan tax, on our nation's business owners and consumers, slowing economic growth and costing jobs,” the bill's sponsor, Rep. Michael Grimm (R-N.Y.), said in a statement. The Indoor Tanning Association supports the bill, as does the National Federation of Independent Businesses and the National Taxpayers Union, Rep. Grimm said. The tanning group's president, Dan Humiston, said in a statement, “In reality, this tax takes money out of the pockets of some of those least able to afford it: working women, who are not only customers but also make up a majority of our business owners; and college students, who are both customers and employees.”

Checking Musculoskeletal Injuries

The consumer group Public Citizen is urging the federal government to require businesses to report employees' musculoskeletal injuries more specifically. The Occupational Safety and Health Administration last year proposed an extra box on an OSHA form where employers would indicate any such injuries. This year, OSHA pulled back the proposal while asking for more comments. In a letter, public Citizen urged the requirement for the checkbox, saying it would not overly burden even small businesses and would provide much-needed data on repetitive-stress injuries.

A Vote for Arthritis Data

Sen. Robert Menendez (D-N.J.) and Rep. Jim Gerlach (R-Pa.) introduced the Psoriasis and Psoriatic Arthritis Research, Cure, and Care Act of 2011. Their bill (H.R. 2033 in the House and S. 1107 in the Senate) would build on the $1.5 million already given to the Centers for Disease Control and Prevention in 2009 for collecting psoriasis-related data. An additional $1.5 million each year would continue the project from 2012 to 2017. The bills would also urge the National Institutes of Health to create a virtual “center of excellence” to share information on psoriasis and psoriatic arthritis.

Group Suggests Payment Fixes

An official of the American College of Rheumatology told lawmakers they could fix the ailing Medicare physician payment system by first dumping the Sustainable Growth Rate (SGR) formula and setting a series of incremental pay increases for the next 5 years. In written comments to the House Ways and Means Committee, Dr. Tim Laing, chairman of the college's government affairs committee, said that repealing the SGR and setting the increases would allow enough time to test, adjust, and implement new payment models. Dr. Laing asked Congress to extend 10% payment bonuses for primary care physicians to rheumatologists and to correct the pay disparity between physicians who perform procedures and those who do cognitive work. “With the additional training rheumatologists and other cognitive specialists receive, they have been lumped together with surgical and procedural specialties even though their patient care aligns more with primary care,” Dr. Laing wrote. “Recognizing the differences in these specialties is important when reforming the physician payment system.”

1 Billion Deal With Disabilities

More than 1 billion people have some form of disability, according to the first-ever World Report on Disability by the World Health Organization and the World Bank. People with mental and physical disabilities are twice as likely as are others to say they lack health care because available providers' skills are inadequate, and three times as likely to report being denied needed health care, according to the report. In a forward, theoretical physicist Stephen Hawking, who lives with motor neuron disease, said, “We have a moral duty to remove the barriers to participation for people with disabilities, and to invest sufficient funding and expertise to unlock their vast potential.” The report encouraged governments to step up their efforts to make services accessible to people with disabilities.

No, It's Never Healthy

The Food and Drug Administration has warned online retailers to stop marketing tobacco products with unsubstantiated claims that the products can reduce the risk of tobacco-related diseases. In 11 warning letters, the agency cited the online retailers for various illegal claims, including use of terms such as “light,” “mild,” “low,” “less toxic,” and “safer.” Companies cannot make these claims without FDA approval, and the FDA has not okayed any such claim for tobacco products. The agency also cited some Internet retailers for selling flavored cigarettes. “There is no known safe tobacco product,” Dr. Lawrence Deyton, director of the FDA's Center for Tobacco Products, said in a statement. “It is illegal for tobacco companies or retailers, including Internet sellers, to make unsubstantiated claims or statements that imply tobacco products reduce health risks.”

Bill Seeks to Repeal Tan Tax

A Republican congressman and 24 cosponsors have introduced a bill to repeal the 10% “regressive tax” on tanning services that was part of the Affordable Care Act. “The health care law unfairly imposes onerous taxes, like the tan tax, on our nation's business owners and consumers, slowing economic growth and costing jobs,” the bill's sponsor, Rep. Michael Grimm (R-N.Y.), said in a statement. The Indoor Tanning Association supports the bill, as does the National Federation of Independent Businesses and the National Taxpayers Union, Rep. Grimm said. The tanning group's president, Dan Humiston, said in a statement, “In reality, this tax takes money out of the pockets of some of those least able to afford it: working women, who are not only customers but also make up a majority of our business owners; and college students, who are both customers and employees.”

Checking Musculoskeletal Injuries

The consumer group Public Citizen is urging the federal government to require businesses to report employees' musculoskeletal injuries more specifically. The Occupational Safety and Health Administration last year proposed an extra box on an OSHA form where employers would indicate any such injuries. This year, OSHA pulled back the proposal while asking for more comments. In a letter, public Citizen urged the requirement for the checkbox, saying it would not overly burden even small businesses and would provide much-needed data on repetitive-stress injuries.

A Vote for Arthritis Data

Sen. Robert Menendez (D-N.J.) and Rep. Jim Gerlach (R-Pa.) introduced the Psoriasis and Psoriatic Arthritis Research, Cure, and Care Act of 2011. Their bill (H.R. 2033 in the House and S. 1107 in the Senate) would build on the $1.5 million already given to the Centers for Disease Control and Prevention in 2009 for collecting psoriasis-related data. An additional $1.5 million each year would continue the project from 2012 to 2017. The bills would also urge the National Institutes of Health to create a virtual “center of excellence” to share information on psoriasis and psoriatic arthritis.

Group Suggests Payment Fixes

An official of the American College of Rheumatology told lawmakers they could fix the ailing Medicare physician payment system by first dumping the Sustainable Growth Rate (SGR) formula and setting a series of incremental pay increases for the next 5 years. In written comments to the House Ways and Means Committee, Dr. Tim Laing, chairman of the college's government affairs committee, said that repealing the SGR and setting the increases would allow enough time to test, adjust, and implement new payment models. Dr. Laing asked Congress to extend 10% payment bonuses for primary care physicians to rheumatologists and to correct the pay disparity between physicians who perform procedures and those who do cognitive work. “With the additional training rheumatologists and other cognitive specialists receive, they have been lumped together with surgical and procedural specialties even though their patient care aligns more with primary care,” Dr. Laing wrote. “Recognizing the differences in these specialties is important when reforming the physician payment system.”

1 Billion Deal With Disabilities

More than 1 billion people have some form of disability, according to the first-ever World Report on Disability by the World Health Organization and the World Bank. People with mental and physical disabilities are twice as likely as are others to say they lack health care because available providers' skills are inadequate, and three times as likely to report being denied needed health care, according to the report. In a forward, theoretical physicist Stephen Hawking, who lives with motor neuron disease, said, “We have a moral duty to remove the barriers to participation for people with disabilities, and to invest sufficient funding and expertise to unlock their vast potential.” The report encouraged governments to step up their efforts to make services accessible to people with disabilities.

No, It's Never Healthy

The Food and Drug Administration has warned online retailers to stop marketing tobacco products with unsubstantiated claims that the products can reduce the risk of tobacco-related diseases. In 11 warning letters, the agency cited the online retailers for various illegal claims, including use of terms such as “light,” “mild,” “low,” “less toxic,” and “safer.” Companies cannot make these claims without FDA approval, and the FDA has not okayed any such claim for tobacco products. The agency also cited some Internet retailers for selling flavored cigarettes. “There is no known safe tobacco product,” Dr. Lawrence Deyton, director of the FDA's Center for Tobacco Products, said in a statement. “It is illegal for tobacco companies or retailers, including Internet sellers, to make unsubstantiated claims or statements that imply tobacco products reduce health risks.”

Bill Seeks to Repeal Tan Tax

A Republican congressman and 24 cosponsors have introduced a bill to repeal the 10% “regressive tax” on tanning services that was part of the Affordable Care Act. “The health care law unfairly imposes onerous taxes, like the tan tax, on our nation's business owners and consumers, slowing economic growth and costing jobs,” the bill's sponsor, Rep. Michael Grimm (R-N.Y.), said in a statement. The Indoor Tanning Association supports the bill, as does the National Federation of Independent Businesses and the National Taxpayers Union, Rep. Grimm said. The tanning group's president, Dan Humiston, said in a statement, “In reality, this tax takes money out of the pockets of some of those least able to afford it: working women, who are not only customers but also make up a majority of our business owners; and college students, who are both customers and employees.”