Mary Ellen Schneider

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 (CMS) on April 29. The initiative was mandated by Congress under the Affordable Care Act.

Under the program, 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, 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 in 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 myocardial infarction who are given fibrinolytic medication within 30 minutes of arrival at the hospital.

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

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 plans 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. Starting in 2013, Medicare will reduce payments if hospitals have excess 30-day readmissions for patients who suffer heart attacks, heart failure, and pneumonia. In 2015, hospitals could see payments cut if they have high rates of certain hospital-acquired conditions.

The final rule on hospital value-based purchasing 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 (CMS) on April 29. The initiative was mandated by Congress under the Affordable Care Act.

Under the program, 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, 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 in 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 myocardial infarction who are given fibrinolytic medication within 30 minutes of arrival at the hospital.

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

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 plans 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. Starting in 2013, Medicare will reduce payments if hospitals have excess 30-day readmissions for patients who suffer heart attacks, heart failure, and pneumonia. In 2015, hospitals could see payments cut if they have high rates of certain hospital-acquired conditions.

The final rule on hospital value-based purchasing 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 (CMS) on April 29. The initiative was mandated by Congress under the Affordable Care Act.

Under the program, 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, 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 in 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 myocardial infarction who are given fibrinolytic medication within 30 minutes of arrival at the hospital.

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

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 plans 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. Starting in 2013, Medicare will reduce payments if hospitals have excess 30-day readmissions for patients who suffer heart attacks, heart failure, and pneumonia. In 2015, hospitals could see payments cut if they have high rates of certain hospital-acquired conditions.

The final rule on hospital value-based purchasing becomes final on July 1.

Without Congressional action, Medicare payments for dual-energy x-ray absorptiometry will be cut in about half at the beginning of 2012.

But a small, bipartisan group of lawmakers in the House and Senate is pushing to extend DXA payment rates, which were passed as part of the Affordable Care Act and are set to expire at the end of this year, through 2013. Under the ACA, Congress instructed officials at the Centers for Medicare and Medicaid Services to increase DXA payments to 70% of the rate paid by Medicare in 2006.

The Preservation of Access to Osteoporosis Testing for Medicare Beneficiaries Act of 2011 (H.R. 2020/S. 1096) was introduced at the end of May; it would keep the current DXA payment rate in place for 2 years.

Rep. Michael Burgess (R-Tex.), one of the bill's sponsors, said that cutting DXA payments is shortsighted. “As a physician, I diagnosed and treated many patients during my 25 years of practicing medicine in Texas, and I saw firsthand the way osteoporosis affects patients and their families. The more we can do to promote and encourage education, awareness, and prevention, the better. Why Medicare will pay for a fracture, but not reimburse a reasonable amount for a scan that can prevent that fracture, is beyond me,” he said in a statement.

Medicare began cutting DXA payments in 2007, after Congress included bone densitometry among a group of high-cost imaging services that were slashed as part of the Deficit Reduction Act of 2005. Since then, physicians have been struggling to cover their costs as reimbursement steadily declined from around $148 per scan in 2006 to about $54 in 2010. Exacerbating the problem is that private insurers have largely followed Medicare's lead, ratcheting down their reimbursements as well. The ACA brought DXA payments up to about $98.

Physicians' organizations, including the American College of Rheumatology (ACR) and the American Association of Clinical Endocrinologists, are urging lawmakers to pass an extension of the current DXA payment rate.

Dr. Timothy J. Laing, government affairs committee chair for the ACR and a rheumatologist at the University of Michigan, Ann Arbor, said that if the reimbursement for the test falls below current levels, it will become economically unsustainable for physicians to provide the test in their offices.

Patients still will be able to get a DXA scan in the hospital, but there are downsides to that limited access, Dr. Laing said.

Patients are far more likely to get the test if it can be done at the time it is recommended, he said, adding that providing DXA scans in the office also provides an opportunity for on-the-spot, in-depth counseling from a physician who is knowledgeable about both interpreting the test and treating osteoporosis.

Getting the legislation passed this year will be an uphill battle. “Right now, Congress is deadlocked over the budget, so any bill that is introduced that adds costs to anything is going to be difficult,” Dr. Laing said.

Without Congressional action, Medicare payments for dual-energy x-ray absorptiometry will be cut in about half at the beginning of 2012.

But a small, bipartisan group of lawmakers in the House and Senate is pushing to extend DXA payment rates, which were passed as part of the Affordable Care Act and are set to expire at the end of this year, through 2013. Under the ACA, Congress instructed officials at the Centers for Medicare and Medicaid Services to increase DXA payments to 70% of the rate paid by Medicare in 2006.

The Preservation of Access to Osteoporosis Testing for Medicare Beneficiaries Act of 2011 (H.R. 2020/S. 1096) was introduced at the end of May; it would keep the current DXA payment rate in place for 2 years.

Rep. Michael Burgess (R-Tex.), one of the bill's sponsors, said that cutting DXA payments is shortsighted. “As a physician, I diagnosed and treated many patients during my 25 years of practicing medicine in Texas, and I saw firsthand the way osteoporosis affects patients and their families. The more we can do to promote and encourage education, awareness, and prevention, the better. Why Medicare will pay for a fracture, but not reimburse a reasonable amount for a scan that can prevent that fracture, is beyond me,” he said in a statement.

Medicare began cutting DXA payments in 2007, after Congress included bone densitometry among a group of high-cost imaging services that were slashed as part of the Deficit Reduction Act of 2005. Since then, physicians have been struggling to cover their costs as reimbursement steadily declined from around $148 per scan in 2006 to about $54 in 2010. Exacerbating the problem is that private insurers have largely followed Medicare's lead, ratcheting down their reimbursements as well. The ACA brought DXA payments up to about $98.

Physicians' organizations, including the American College of Rheumatology (ACR) and the American Association of Clinical Endocrinologists, are urging lawmakers to pass an extension of the current DXA payment rate.

Dr. Timothy J. Laing, government affairs committee chair for the ACR and a rheumatologist at the University of Michigan, Ann Arbor, said that if the reimbursement for the test falls below current levels, it will become economically unsustainable for physicians to provide the test in their offices.

Patients still will be able to get a DXA scan in the hospital, but there are downsides to that limited access, Dr. Laing said.

Patients are far more likely to get the test if it can be done at the time it is recommended, he said, adding that providing DXA scans in the office also provides an opportunity for on-the-spot, in-depth counseling from a physician who is knowledgeable about both interpreting the test and treating osteoporosis.

Getting the legislation passed this year will be an uphill battle. “Right now, Congress is deadlocked over the budget, so any bill that is introduced that adds costs to anything is going to be difficult,” Dr. Laing said.

Without Congressional action, Medicare payments for dual-energy x-ray absorptiometry will be cut in about half at the beginning of 2012.

But a small, bipartisan group of lawmakers in the House and Senate is pushing to extend DXA payment rates, which were passed as part of the Affordable Care Act and are set to expire at the end of this year, through 2013. Under the ACA, Congress instructed officials at the Centers for Medicare and Medicaid Services to increase DXA payments to 70% of the rate paid by Medicare in 2006.

The Preservation of Access to Osteoporosis Testing for Medicare Beneficiaries Act of 2011 (H.R. 2020/S. 1096) was introduced at the end of May; it would keep the current DXA payment rate in place for 2 years.

Rep. Michael Burgess (R-Tex.), one of the bill's sponsors, said that cutting DXA payments is shortsighted. “As a physician, I diagnosed and treated many patients during my 25 years of practicing medicine in Texas, and I saw firsthand the way osteoporosis affects patients and their families. The more we can do to promote and encourage education, awareness, and prevention, the better. Why Medicare will pay for a fracture, but not reimburse a reasonable amount for a scan that can prevent that fracture, is beyond me,” he said in a statement.

Medicare began cutting DXA payments in 2007, after Congress included bone densitometry among a group of high-cost imaging services that were slashed as part of the Deficit Reduction Act of 2005. Since then, physicians have been struggling to cover their costs as reimbursement steadily declined from around $148 per scan in 2006 to about $54 in 2010. Exacerbating the problem is that private insurers have largely followed Medicare's lead, ratcheting down their reimbursements as well. The ACA brought DXA payments up to about $98.

Physicians' organizations, including the American College of Rheumatology (ACR) and the American Association of Clinical Endocrinologists, are urging lawmakers to pass an extension of the current DXA payment rate.

Dr. Timothy J. Laing, government affairs committee chair for the ACR and a rheumatologist at the University of Michigan, Ann Arbor, said that if the reimbursement for the test falls below current levels, it will become economically unsustainable for physicians to provide the test in their offices.

Patients still will be able to get a DXA scan in the hospital, but there are downsides to that limited access, Dr. Laing said.

Patients are far more likely to get the test if it can be done at the time it is recommended, he said, adding that providing DXA scans in the office also provides an opportunity for on-the-spot, in-depth counseling from a physician who is knowledgeable about both interpreting the test and treating osteoporosis.

Getting the legislation passed this year will be an uphill battle. “Right now, Congress is deadlocked over the budget, so any bill that is introduced that adds costs to anything is going to be difficult,” Dr. Laing said.

GRAPEVINE, TEX. – The combination of the aging baby boomers, growing minority populations, and the millions of Americans who will gain coverage under the Affordable Care Act, will stress the health care system and create a “crisis of access to care” in the near future, warned Dr. Cecil B. Wilson, president of the American Medical Association.

Dr. Wilson, who recently spoke at the annual meeting of the Society of Hospital Medicine, said there is already a physician shortage in many areas and specialties, but it is likely to get worse if steps aren't taken to recruit more young people into medicine.

“The situation is serious for the patients who do not have or cannot get a physician's care,” he said. “It also presents considerable challenges for those of us in medical practice as well.”

Right now, the AMA estimates that there will be a shortage of at least 125,000 physicians by 2025. The problem is not just the number of the physicians but who they are and where they practice.

Some of the greatest physician shortages are in rural areas and in minority communities. Recruiting minority physicians has been a challenge, he said, in part because of the high cost of medical school, but also because there are few minority role models in the medical community. And the result is that health care disparities are increasing, Dr. Wilson said.

There has been some good news, Dr. Wilson said. The Affordable Care Act includes some provisions to address these issues, including bonuses to primary care physicians to help deal with the pay differential with specialists, loan repayment programs, and a provision to shift unused residency slots to primary care. And medical schools are expanding. In the past 3 years, nearly two dozen new medical schools have either been opened, announced, or sought accreditation, Dr. Wilson said.

But there not has been a parallel growth in residency training slots. With the cap on federally funded residency positions, it's difficult to expand training programs, he said.

One possible solution is to move to an “all-payer system” that would be financed not just by Medicare, but also by insurance companies and others with a stake in the health care system, Dr. Wilson said.

GRAPEVINE, TEX. – The combination of the aging baby boomers, growing minority populations, and the millions of Americans who will gain coverage under the Affordable Care Act, will stress the health care system and create a “crisis of access to care” in the near future, warned Dr. Cecil B. Wilson, president of the American Medical Association.

Dr. Wilson, who recently spoke at the annual meeting of the Society of Hospital Medicine, said there is already a physician shortage in many areas and specialties, but it is likely to get worse if steps aren't taken to recruit more young people into medicine.

“The situation is serious for the patients who do not have or cannot get a physician's care,” he said. “It also presents considerable challenges for those of us in medical practice as well.”

Right now, the AMA estimates that there will be a shortage of at least 125,000 physicians by 2025. The problem is not just the number of the physicians but who they are and where they practice.

Some of the greatest physician shortages are in rural areas and in minority communities. Recruiting minority physicians has been a challenge, he said, in part because of the high cost of medical school, but also because there are few minority role models in the medical community. And the result is that health care disparities are increasing, Dr. Wilson said.

There has been some good news, Dr. Wilson said. The Affordable Care Act includes some provisions to address these issues, including bonuses to primary care physicians to help deal with the pay differential with specialists, loan repayment programs, and a provision to shift unused residency slots to primary care. And medical schools are expanding. In the past 3 years, nearly two dozen new medical schools have either been opened, announced, or sought accreditation, Dr. Wilson said.

But there not has been a parallel growth in residency training slots. With the cap on federally funded residency positions, it's difficult to expand training programs, he said.

One possible solution is to move to an “all-payer system” that would be financed not just by Medicare, but also by insurance companies and others with a stake in the health care system, Dr. Wilson said.

GRAPEVINE, TEX. – The combination of the aging baby boomers, growing minority populations, and the millions of Americans who will gain coverage under the Affordable Care Act, will stress the health care system and create a “crisis of access to care” in the near future, warned Dr. Cecil B. Wilson, president of the American Medical Association.

Dr. Wilson, who recently spoke at the annual meeting of the Society of Hospital Medicine, said there is already a physician shortage in many areas and specialties, but it is likely to get worse if steps aren't taken to recruit more young people into medicine.

“The situation is serious for the patients who do not have or cannot get a physician's care,” he said. “It also presents considerable challenges for those of us in medical practice as well.”

Right now, the AMA estimates that there will be a shortage of at least 125,000 physicians by 2025. The problem is not just the number of the physicians but who they are and where they practice.

Some of the greatest physician shortages are in rural areas and in minority communities. Recruiting minority physicians has been a challenge, he said, in part because of the high cost of medical school, but also because there are few minority role models in the medical community. And the result is that health care disparities are increasing, Dr. Wilson said.

There has been some good news, Dr. Wilson said. The Affordable Care Act includes some provisions to address these issues, including bonuses to primary care physicians to help deal with the pay differential with specialists, loan repayment programs, and a provision to shift unused residency slots to primary care. And medical schools are expanding. In the past 3 years, nearly two dozen new medical schools have either been opened, announced, or sought accreditation, Dr. Wilson said.

But there not has been a parallel growth in residency training slots. With the cap on federally funded residency positions, it's difficult to expand training programs, he said.

One possible solution is to move to an “all-payer system” that would be financed not just by Medicare, but also by insurance companies and others with a stake in the health care system, Dr. Wilson said.

Starting Sept. 1, health plans in the small group and individual markets that propose rate hikes of 10% or more must have their proposals vetted by either state or federal officials.

The mandatory review is a new requirement related to insurance premium review that has been released by the Health and Human Services Department and was required under the Affordable Care Act. The final regulation has been published in the Federal Register. The regulation does not apply to the large group insurance market or to small and individual plans that have “grandfather” status under the Affordable Care Act.

Under the regulation, states will take the lead when it comes to reviewing rate increase proposals. Federal officials will step in only when states don't have the resources or the statutory authority to review rates. Currently, insurance commissioners have differing authority based on state law, with some having the power to reject rate increases before they go into effect and others possessing more limited review powers.

Officials at HHS have encouraged states to beef up their oversight authority, and the agency has awarded about $44 million in grants to help with that process.

The final rule also includes a requirement that states give the public a chance to comment on proposed rate increases. And health plans are required to provide justification for their rate increases. HHS will post the outcome of all reviews on a rate increase of 10% or more at www.HealthCare.gov

The new regulation does not give states or the federal government new authority to deny rate increases. But Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at HHS, said that the ability to thoroughly review proposed increases and question the underlying assumptions is enough.

“Review, in and of itself, is in fact very effective in helping to ferret out reasonable and unreasonable rate increases,” Mr. Larsen said at a press conference to announce the new regulation.

Elizabeth P. (Beth) Sammis, Ph.D., acting Maryland Insurance Commissioner, agreed. Maryland has prior approval authority, allowing it to reject a premium increase if state officials conclude it is too high. However, she said in practice, that authority is rarely used. Typically, health plans voluntarily withdraw the higher rate increase after discussions with state officials.

“We're confident that insurers everywhere are already thinking twice and checking their math before submitting large rate hikes,” said HHS Secretary Kathleen Sebelius.

“This means millions of Americans will see savings to their own bottom lines,” she noted.

But America's Health Insurance Plans (AHIP), the trade group for health insurers, said HHS is missing the point with this regulation. “Focusing on health insurance premiums while ignoring underlying medical cost drivers will not make health care coverage more affordable for families and employers,” AHIP President and CEO Karen Ignagni said in a statement.

“The public policy discussion needs to be enlarged to focus on the soaring cost of medical care that threatens our economic competitiveness, our public safety net, and the affordability of health care coverage.”

Ms. Ignani also criticized the 10% threshold for review, saying that creating a “de facto presumption of unreasonableness” can influence the evaluation of the proposed rate increase.

The final regulation calls for the use of state-specific thresholds in September 2012.

Starting Sept. 1, health plans in the small group and individual markets that propose rate hikes of 10% or more must have their proposals vetted by either state or federal officials.

The mandatory review is a new requirement related to insurance premium review that has been released by the Health and Human Services Department and was required under the Affordable Care Act. The final regulation has been published in the Federal Register. The regulation does not apply to the large group insurance market or to small and individual plans that have “grandfather” status under the Affordable Care Act.

Under the regulation, states will take the lead when it comes to reviewing rate increase proposals. Federal officials will step in only when states don't have the resources or the statutory authority to review rates. Currently, insurance commissioners have differing authority based on state law, with some having the power to reject rate increases before they go into effect and others possessing more limited review powers.

Officials at HHS have encouraged states to beef up their oversight authority, and the agency has awarded about $44 million in grants to help with that process.

The final rule also includes a requirement that states give the public a chance to comment on proposed rate increases. And health plans are required to provide justification for their rate increases. HHS will post the outcome of all reviews on a rate increase of 10% or more at www.HealthCare.gov

The new regulation does not give states or the federal government new authority to deny rate increases. But Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at HHS, said that the ability to thoroughly review proposed increases and question the underlying assumptions is enough.

“Review, in and of itself, is in fact very effective in helping to ferret out reasonable and unreasonable rate increases,” Mr. Larsen said at a press conference to announce the new regulation.

Elizabeth P. (Beth) Sammis, Ph.D., acting Maryland Insurance Commissioner, agreed. Maryland has prior approval authority, allowing it to reject a premium increase if state officials conclude it is too high. However, she said in practice, that authority is rarely used. Typically, health plans voluntarily withdraw the higher rate increase after discussions with state officials.

“We're confident that insurers everywhere are already thinking twice and checking their math before submitting large rate hikes,” said HHS Secretary Kathleen Sebelius.

“This means millions of Americans will see savings to their own bottom lines,” she noted.

But America's Health Insurance Plans (AHIP), the trade group for health insurers, said HHS is missing the point with this regulation. “Focusing on health insurance premiums while ignoring underlying medical cost drivers will not make health care coverage more affordable for families and employers,” AHIP President and CEO Karen Ignagni said in a statement.

“The public policy discussion needs to be enlarged to focus on the soaring cost of medical care that threatens our economic competitiveness, our public safety net, and the affordability of health care coverage.”

Ms. Ignani also criticized the 10% threshold for review, saying that creating a “de facto presumption of unreasonableness” can influence the evaluation of the proposed rate increase.

The final regulation calls for the use of state-specific thresholds in September 2012.

Starting Sept. 1, health plans in the small group and individual markets that propose rate hikes of 10% or more must have their proposals vetted by either state or federal officials.

The mandatory review is a new requirement related to insurance premium review that has been released by the Health and Human Services Department and was required under the Affordable Care Act. The final regulation has been published in the Federal Register. The regulation does not apply to the large group insurance market or to small and individual plans that have “grandfather” status under the Affordable Care Act.

Under the regulation, states will take the lead when it comes to reviewing rate increase proposals. Federal officials will step in only when states don't have the resources or the statutory authority to review rates. Currently, insurance commissioners have differing authority based on state law, with some having the power to reject rate increases before they go into effect and others possessing more limited review powers.

Officials at HHS have encouraged states to beef up their oversight authority, and the agency has awarded about $44 million in grants to help with that process.

The final rule also includes a requirement that states give the public a chance to comment on proposed rate increases. And health plans are required to provide justification for their rate increases. HHS will post the outcome of all reviews on a rate increase of 10% or more at www.HealthCare.gov

The new regulation does not give states or the federal government new authority to deny rate increases. But Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at HHS, said that the ability to thoroughly review proposed increases and question the underlying assumptions is enough.

“Review, in and of itself, is in fact very effective in helping to ferret out reasonable and unreasonable rate increases,” Mr. Larsen said at a press conference to announce the new regulation.

Elizabeth P. (Beth) Sammis, Ph.D., acting Maryland Insurance Commissioner, agreed. Maryland has prior approval authority, allowing it to reject a premium increase if state officials conclude it is too high. However, she said in practice, that authority is rarely used. Typically, health plans voluntarily withdraw the higher rate increase after discussions with state officials.

“We're confident that insurers everywhere are already thinking twice and checking their math before submitting large rate hikes,” said HHS Secretary Kathleen Sebelius.

“This means millions of Americans will see savings to their own bottom lines,” she noted.

But America's Health Insurance Plans (AHIP), the trade group for health insurers, said HHS is missing the point with this regulation. “Focusing on health insurance premiums while ignoring underlying medical cost drivers will not make health care coverage more affordable for families and employers,” AHIP President and CEO Karen Ignagni said in a statement.

“The public policy discussion needs to be enlarged to focus on the soaring cost of medical care that threatens our economic competitiveness, our public safety net, and the affordability of health care coverage.”

Ms. Ignani also criticized the 10% threshold for review, saying that creating a “de facto presumption of unreasonableness” can influence the evaluation of the proposed rate increase.

The final regulation calls for the use of state-specific thresholds in September 2012.

Lawmakers Challenge Pricing

Four members of Congress have asked URL Pharma to justify its price for Colcrys (colchicine), a treatment for gout flares that was approved in 2009. The Philadelphia-based drug maker charges nearly $5 per pill, whereas the colchicine products that Colcrys replaced – never approved by the Food and Drug Administration – used to cost about 10 cents. In a letter, Sen. Herb Kohl (D-Wis.), Rep. Henry Waxman (D-Calif.), Rep. Frank Pallone, Jr. (D-N.J.), and Rep. Diana DeGette (D-Colo.) asked the company's president for the cost of the clinical trials that led to the approval of Colcrys, how the initial list price was established, how much the company spends to market and manufacture the drug, and the expected profits. A spokesman said the company welcomes the inquiry and intends to cooperate fully. In a statement, the company said it had invested tens of millions of dollars in research on safe dosing of the drug, and that it is striving to make Colcrys more affordable through patient-assistance programs. For example, a patient with a family of four and a household income of $88,000 a year can get a 30-day supply of Colcrys for $5, the company said.

Multispecialty Groups Pay Better

Specialists working in multispecialty practices had higher starting salaries last year than did those in single-specialty groups, according to new data from the Medical Group Management Association. Multispecialty groups paid a median $258,677 in guaranteed compensation, whereas single-specialty practices paid $240,598 to specialists. But the opposite was true in primary care: The median first-year guaranteed salary of $172,400 in single-specialty group practices, while multispecialty groups paid $165,000. The median annual compensation for rheumatologists during their first year after residency, including physicians in fellowships, was $190.000. “First-year” compensation for rheumatologists, excluding those just out of residency or in fellowships, was $205,000. The figures come from the association's Physician Placement Starting Salary Survey.

Arthritis Patients Lack Support

Many arthritis patients, especially women, feel that they don't get much sympathy, according to a survey sponsored by supplement maker Flexcin International. In the April online survey of 1,350 arthritis sufferers, 78% of women said they receive little or no support from their families. In contrast, 65% of men said they were satisfied with the level of support they received. “There can be a great divide in the way men and women communicate, which includes listening,” Flexcin CEO Tamer Elsafy said in a statement. The 12-question survey was open to patients with various types of arthritis, gout, lupus, and other joint-related pain, illness, or disability. About 65% of the respondents reported that they had arthritis, osteoarthritis, psoriatic arthritis, or septic arthritis.

Older Americans Doing Just Fine

Older Americans beat out all other age groups on various measures of well-being, with higher scores on healthy behaviors, work satisfaction, and access to necessities, according to a Gallup poll. Americans older than age 65 years scored 69 out of 100 on a well-being index, which measures physical, mental, social, and emotional health. Adults aged 18-29 years scored 68, those aged 30-44 scored 67, and people aged 45-64 trailed with a score of 65. The survey report indicated that seniors tend to be less sad and depressed than any other age group, although they fall slightly behind others in physical health.

Agency Seeks Biosimilars Advice

The FDA asked the public for its input on imposing user fees on makers of generic biologic products, or biosimilars. The agency is fulfilling a requirement under the Biologics Price Competition and Innovation Act of 2009, which became part of the Affordable Care Act. Under the law, the FDA is due to submit its recommendations to Congress in January 2012. User fees would be collected beginning in fiscal 2013.

State is Tipping Toward Tech

More than half of California primary care physicians now use electronic health records, with groups of more than 50 physicians significantly more likely than smaller practices to use EHRs, according to a report from the California Healthcare Foundation. Only 20% of solo practices reported using EHRs, compared with 80% of practices with more than 50 physicians. In all, 40% of the state's primary care physicians said they routinely order lab tests and track results electronically. Similarly, electronic prescribing technology was available in 42% of practices, the report said. Fewer than half of primary care physicians communicate with patients by e-mails. Although 40% of practices had implemented e-mail systems, only 30% of physicians said they routinely use e-mail to communicate with patients and 44% said they never do. The foundation pulled data from several national and state surveys that were taken in 2008–2011.

Lawmakers Challenge Pricing

Four members of Congress have asked URL Pharma to justify its price for Colcrys (colchicine), a treatment for gout flares that was approved in 2009. The Philadelphia-based drug maker charges nearly $5 per pill, whereas the colchicine products that Colcrys replaced – never approved by the Food and Drug Administration – used to cost about 10 cents. In a letter, Sen. Herb Kohl (D-Wis.), Rep. Henry Waxman (D-Calif.), Rep. Frank Pallone, Jr. (D-N.J.), and Rep. Diana DeGette (D-Colo.) asked the company's president for the cost of the clinical trials that led to the approval of Colcrys, how the initial list price was established, how much the company spends to market and manufacture the drug, and the expected profits. A spokesman said the company welcomes the inquiry and intends to cooperate fully. In a statement, the company said it had invested tens of millions of dollars in research on safe dosing of the drug, and that it is striving to make Colcrys more affordable through patient-assistance programs. For example, a patient with a family of four and a household income of $88,000 a year can get a 30-day supply of Colcrys for $5, the company said.

Multispecialty Groups Pay Better

Specialists working in multispecialty practices had higher starting salaries last year than did those in single-specialty groups, according to new data from the Medical Group Management Association. Multispecialty groups paid a median $258,677 in guaranteed compensation, whereas single-specialty practices paid $240,598 to specialists. But the opposite was true in primary care: The median first-year guaranteed salary of $172,400 in single-specialty group practices, while multispecialty groups paid $165,000. The median annual compensation for rheumatologists during their first year after residency, including physicians in fellowships, was $190.000. “First-year” compensation for rheumatologists, excluding those just out of residency or in fellowships, was $205,000. The figures come from the association's Physician Placement Starting Salary Survey.

Arthritis Patients Lack Support

Many arthritis patients, especially women, feel that they don't get much sympathy, according to a survey sponsored by supplement maker Flexcin International. In the April online survey of 1,350 arthritis sufferers, 78% of women said they receive little or no support from their families. In contrast, 65% of men said they were satisfied with the level of support they received. “There can be a great divide in the way men and women communicate, which includes listening,” Flexcin CEO Tamer Elsafy said in a statement. The 12-question survey was open to patients with various types of arthritis, gout, lupus, and other joint-related pain, illness, or disability. About 65% of the respondents reported that they had arthritis, osteoarthritis, psoriatic arthritis, or septic arthritis.

Older Americans Doing Just Fine

Older Americans beat out all other age groups on various measures of well-being, with higher scores on healthy behaviors, work satisfaction, and access to necessities, according to a Gallup poll. Americans older than age 65 years scored 69 out of 100 on a well-being index, which measures physical, mental, social, and emotional health. Adults aged 18-29 years scored 68, those aged 30-44 scored 67, and people aged 45-64 trailed with a score of 65. The survey report indicated that seniors tend to be less sad and depressed than any other age group, although they fall slightly behind others in physical health.

Agency Seeks Biosimilars Advice

The FDA asked the public for its input on imposing user fees on makers of generic biologic products, or biosimilars. The agency is fulfilling a requirement under the Biologics Price Competition and Innovation Act of 2009, which became part of the Affordable Care Act. Under the law, the FDA is due to submit its recommendations to Congress in January 2012. User fees would be collected beginning in fiscal 2013.

State is Tipping Toward Tech

More than half of California primary care physicians now use electronic health records, with groups of more than 50 physicians significantly more likely than smaller practices to use EHRs, according to a report from the California Healthcare Foundation. Only 20% of solo practices reported using EHRs, compared with 80% of practices with more than 50 physicians. In all, 40% of the state's primary care physicians said they routinely order lab tests and track results electronically. Similarly, electronic prescribing technology was available in 42% of practices, the report said. Fewer than half of primary care physicians communicate with patients by e-mails. Although 40% of practices had implemented e-mail systems, only 30% of physicians said they routinely use e-mail to communicate with patients and 44% said they never do. The foundation pulled data from several national and state surveys that were taken in 2008–2011.

Lawmakers Challenge Pricing

Four members of Congress have asked URL Pharma to justify its price for Colcrys (colchicine), a treatment for gout flares that was approved in 2009. The Philadelphia-based drug maker charges nearly $5 per pill, whereas the colchicine products that Colcrys replaced – never approved by the Food and Drug Administration – used to cost about 10 cents. In a letter, Sen. Herb Kohl (D-Wis.), Rep. Henry Waxman (D-Calif.), Rep. Frank Pallone, Jr. (D-N.J.), and Rep. Diana DeGette (D-Colo.) asked the company's president for the cost of the clinical trials that led to the approval of Colcrys, how the initial list price was established, how much the company spends to market and manufacture the drug, and the expected profits. A spokesman said the company welcomes the inquiry and intends to cooperate fully. In a statement, the company said it had invested tens of millions of dollars in research on safe dosing of the drug, and that it is striving to make Colcrys more affordable through patient-assistance programs. For example, a patient with a family of four and a household income of $88,000 a year can get a 30-day supply of Colcrys for $5, the company said.

Multispecialty Groups Pay Better

Specialists working in multispecialty practices had higher starting salaries last year than did those in single-specialty groups, according to new data from the Medical Group Management Association. Multispecialty groups paid a median $258,677 in guaranteed compensation, whereas single-specialty practices paid $240,598 to specialists. But the opposite was true in primary care: The median first-year guaranteed salary of $172,400 in single-specialty group practices, while multispecialty groups paid $165,000. The median annual compensation for rheumatologists during their first year after residency, including physicians in fellowships, was $190.000. “First-year” compensation for rheumatologists, excluding those just out of residency or in fellowships, was $205,000. The figures come from the association's Physician Placement Starting Salary Survey.

Arthritis Patients Lack Support

Many arthritis patients, especially women, feel that they don't get much sympathy, according to a survey sponsored by supplement maker Flexcin International. In the April online survey of 1,350 arthritis sufferers, 78% of women said they receive little or no support from their families. In contrast, 65% of men said they were satisfied with the level of support they received. “There can be a great divide in the way men and women communicate, which includes listening,” Flexcin CEO Tamer Elsafy said in a statement. The 12-question survey was open to patients with various types of arthritis, gout, lupus, and other joint-related pain, illness, or disability. About 65% of the respondents reported that they had arthritis, osteoarthritis, psoriatic arthritis, or septic arthritis.

Older Americans Doing Just Fine

Older Americans beat out all other age groups on various measures of well-being, with higher scores on healthy behaviors, work satisfaction, and access to necessities, according to a Gallup poll. Americans older than age 65 years scored 69 out of 100 on a well-being index, which measures physical, mental, social, and emotional health. Adults aged 18-29 years scored 68, those aged 30-44 scored 67, and people aged 45-64 trailed with a score of 65. The survey report indicated that seniors tend to be less sad and depressed than any other age group, although they fall slightly behind others in physical health.

Agency Seeks Biosimilars Advice

The FDA asked the public for its input on imposing user fees on makers of generic biologic products, or biosimilars. The agency is fulfilling a requirement under the Biologics Price Competition and Innovation Act of 2009, which became part of the Affordable Care Act. Under the law, the FDA is due to submit its recommendations to Congress in January 2012. User fees would be collected beginning in fiscal 2013.

State is Tipping Toward Tech

More than half of California primary care physicians now use electronic health records, with groups of more than 50 physicians significantly more likely than smaller practices to use EHRs, according to a report from the California Healthcare Foundation. Only 20% of solo practices reported using EHRs, compared with 80% of practices with more than 50 physicians. In all, 40% of the state's primary care physicians said they routinely order lab tests and track results electronically. Similarly, electronic prescribing technology was available in 42% of practices, the report said. Fewer than half of primary care physicians communicate with patients by e-mails. Although 40% of practices had implemented e-mail systems, only 30% of physicians said they routinely use e-mail to communicate with patients and 44% said they never do. The foundation pulled data from several national and state surveys that were taken in 2008–2011.

Major Finding: Displaying laboratory cost data for 6 months resulted in a savings of $15,692 per test, a 10% reduction from baseline. Control tests increased by about $1,718 per test.

Data Source: Laboratory cost data from Johns Hopkins Hospital in Baltimore, Md.

Disclosures: The authors reported no relevant financial disclosures.

GRAPEVINE, TEX. – Policy makers are scrambling for ways to bring down health care spending, but what if it were as simple as telling physicians how much things cost?

A new study by hospitalists at Johns Hopkins Hospital in Baltimore, which looks at the impact of displaying cost data on laboratory tests, shows that physicians' behavior is affected by seeing the price of the tests they order.

To see how having cost data at the time of order entry would affect behavior, researchers at Johns Hopkins compiled a list of both the most frequently ordered and the most expensive laboratory tests in their hospital, based on 2007 data. Costly tests were only included in the study if they were ordered at least 50 times during the year. The researchers then randomized the tests to be either active tests or concurrent controls. For active tests, the researchers displayed the price, based on 2008 Medicare allowable cost figures, on the hospital's computerized provider order entry (CPOE) system. For example, a blood gas was listed at $28.25 and a heme-8 lab was $9.37 each.

During the 6-month intervention period from November 2009 to May 2010, there was a mean decrease of about $15,692 per test for the lab tests in which cost data was displayed in the CPOE as compared with a baseline period exactly 1 year earlier.

For all 31 of the active tests, there was a combined decrease of about $486,000, resulting in a 10% reduction among tests in which the costs were displayed. The active test costs dropped from $4,877,439 to $4,390,979. Among the group of 31 control tests, in which cost information was not listed on the CPOE, there was a mean increase of $1,718 per test. Overall, costs for the control group went up about $53,000 for all 31 tests.

The total number of tests that were ordered in the active group fell from 458,518 during the baseline period to 417,078 during the intervention. In the control group, however, the number of tests rose from 142,196 to 149,455 during the study period.

Dr. Leonard Feldman, who was one of the study investigators and is in the department of medicine at Johns Hopkins, said the results did not come as a surprise.

“I think many of us do recognize that a lot of these tests and imaging studies that are done are unnecessary,” Dr. Feldman said during the annual meeting of the Society of Hospital Medicine.

Physicians order unnecessary tests for a number of reasons, he said, ranging from defensive medicine to patient expectations. But another reason is a lack of awareness of how much the tests cost, he said. “We, as doctors, have a limited understanding of diagnostic and nondrug therapeutic costs,” Dr. Feldman said. “We just have no idea, mostly, how much things cost when we go to order them.”

While the study appears to show a relatively simple and inexpensive way to reduce the ordering of tests, Dr. Feldman acknowledged that the study had some limitations. For example, the study looked at only costs and does not include data on how the change in orders might have affected patient outcomes. And the intervention period was only 6 months. Dr. Feldman said more time would be needed to show whether physicians would begin to ignore the costs over time. Similarly, costs were only displayed for 31 tests during the study. It's unclear if displaying all laboratory test costs would have the same effect on behavior, Dr. Feldman said.

'We just have no idea, mostly, how much things cost when we go to order them.'

Source DR. FELDMAN

Source Elsevier Global Medical News

Major Finding: Displaying laboratory cost data for 6 months resulted in a savings of $15,692 per test, a 10% reduction from baseline. Control tests increased by about $1,718 per test.

Data Source: Laboratory cost data from Johns Hopkins Hospital in Baltimore, Md.

Disclosures: The authors reported no relevant financial disclosures.

GRAPEVINE, TEX. – Policy makers are scrambling for ways to bring down health care spending, but what if it were as simple as telling physicians how much things cost?

A new study by hospitalists at Johns Hopkins Hospital in Baltimore, which looks at the impact of displaying cost data on laboratory tests, shows that physicians' behavior is affected by seeing the price of the tests they order.

To see how having cost data at the time of order entry would affect behavior, researchers at Johns Hopkins compiled a list of both the most frequently ordered and the most expensive laboratory tests in their hospital, based on 2007 data. Costly tests were only included in the study if they were ordered at least 50 times during the year. The researchers then randomized the tests to be either active tests or concurrent controls. For active tests, the researchers displayed the price, based on 2008 Medicare allowable cost figures, on the hospital's computerized provider order entry (CPOE) system. For example, a blood gas was listed at $28.25 and a heme-8 lab was $9.37 each.

During the 6-month intervention period from November 2009 to May 2010, there was a mean decrease of about $15,692 per test for the lab tests in which cost data was displayed in the CPOE as compared with a baseline period exactly 1 year earlier.

For all 31 of the active tests, there was a combined decrease of about $486,000, resulting in a 10% reduction among tests in which the costs were displayed. The active test costs dropped from $4,877,439 to $4,390,979. Among the group of 31 control tests, in which cost information was not listed on the CPOE, there was a mean increase of $1,718 per test. Overall, costs for the control group went up about $53,000 for all 31 tests.

The total number of tests that were ordered in the active group fell from 458,518 during the baseline period to 417,078 during the intervention. In the control group, however, the number of tests rose from 142,196 to 149,455 during the study period.

Dr. Leonard Feldman, who was one of the study investigators and is in the department of medicine at Johns Hopkins, said the results did not come as a surprise.

“I think many of us do recognize that a lot of these tests and imaging studies that are done are unnecessary,” Dr. Feldman said during the annual meeting of the Society of Hospital Medicine.

Physicians order unnecessary tests for a number of reasons, he said, ranging from defensive medicine to patient expectations. But another reason is a lack of awareness of how much the tests cost, he said. “We, as doctors, have a limited understanding of diagnostic and nondrug therapeutic costs,” Dr. Feldman said. “We just have no idea, mostly, how much things cost when we go to order them.”

While the study appears to show a relatively simple and inexpensive way to reduce the ordering of tests, Dr. Feldman acknowledged that the study had some limitations. For example, the study looked at only costs and does not include data on how the change in orders might have affected patient outcomes. And the intervention period was only 6 months. Dr. Feldman said more time would be needed to show whether physicians would begin to ignore the costs over time. Similarly, costs were only displayed for 31 tests during the study. It's unclear if displaying all laboratory test costs would have the same effect on behavior, Dr. Feldman said.

'We just have no idea, mostly, how much things cost when we go to order them.'

Source DR. FELDMAN

Source Elsevier Global Medical News

Major Finding: Displaying laboratory cost data for 6 months resulted in a savings of $15,692 per test, a 10% reduction from baseline. Control tests increased by about $1,718 per test.

Data Source: Laboratory cost data from Johns Hopkins Hospital in Baltimore, Md.

Disclosures: The authors reported no relevant financial disclosures.

GRAPEVINE, TEX. – Policy makers are scrambling for ways to bring down health care spending, but what if it were as simple as telling physicians how much things cost?

A new study by hospitalists at Johns Hopkins Hospital in Baltimore, which looks at the impact of displaying cost data on laboratory tests, shows that physicians' behavior is affected by seeing the price of the tests they order.

To see how having cost data at the time of order entry would affect behavior, researchers at Johns Hopkins compiled a list of both the most frequently ordered and the most expensive laboratory tests in their hospital, based on 2007 data. Costly tests were only included in the study if they were ordered at least 50 times during the year. The researchers then randomized the tests to be either active tests or concurrent controls. For active tests, the researchers displayed the price, based on 2008 Medicare allowable cost figures, on the hospital's computerized provider order entry (CPOE) system. For example, a blood gas was listed at $28.25 and a heme-8 lab was $9.37 each.

During the 6-month intervention period from November 2009 to May 2010, there was a mean decrease of about $15,692 per test for the lab tests in which cost data was displayed in the CPOE as compared with a baseline period exactly 1 year earlier.

For all 31 of the active tests, there was a combined decrease of about $486,000, resulting in a 10% reduction among tests in which the costs were displayed. The active test costs dropped from $4,877,439 to $4,390,979. Among the group of 31 control tests, in which cost information was not listed on the CPOE, there was a mean increase of $1,718 per test. Overall, costs for the control group went up about $53,000 for all 31 tests.

The total number of tests that were ordered in the active group fell from 458,518 during the baseline period to 417,078 during the intervention. In the control group, however, the number of tests rose from 142,196 to 149,455 during the study period.

Dr. Leonard Feldman, who was one of the study investigators and is in the department of medicine at Johns Hopkins, said the results did not come as a surprise.

“I think many of us do recognize that a lot of these tests and imaging studies that are done are unnecessary,” Dr. Feldman said during the annual meeting of the Society of Hospital Medicine.

Physicians order unnecessary tests for a number of reasons, he said, ranging from defensive medicine to patient expectations. But another reason is a lack of awareness of how much the tests cost, he said. “We, as doctors, have a limited understanding of diagnostic and nondrug therapeutic costs,” Dr. Feldman said. “We just have no idea, mostly, how much things cost when we go to order them.”

While the study appears to show a relatively simple and inexpensive way to reduce the ordering of tests, Dr. Feldman acknowledged that the study had some limitations. For example, the study looked at only costs and does not include data on how the change in orders might have affected patient outcomes. And the intervention period was only 6 months. Dr. Feldman said more time would be needed to show whether physicians would begin to ignore the costs over time. Similarly, costs were only displayed for 31 tests during the study. It's unclear if displaying all laboratory test costs would have the same effect on behavior, Dr. Feldman said.

'We just have no idea, mostly, how much things cost when we go to order them.'

Source DR. FELDMAN

Source Elsevier Global Medical News

The Food and Drug Administration expanded the indication for the RX Acculink carotid stent, allowing it to be marketed for use in patients with carotid artery disease who do not face an increased risk of complications from surgery.

The RX Acculink stent, which is marketed by Abbott Vascular, a subsidiary of Abbott Laboratories, was originally approved by the FDA in 2004. At that time, the stent was approved for patients at high risk of complications from carotid endarterectomy.

The company sought an expanded approval based on the results of the Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST), a randomized, multicenter, noninferiority study sponsored by the National Institutes of Health and funded in part by the manufacturer.

The study of more than 2,500 patients in the United States and Canada showed that at 1 year, patients who were treated with RX Acculink had a combined 30-day rate of death, stroke, and myocardial infarction, and a 31 to 365-day rate of ipsilateral stroke, of 7.1%, compared with 6.6% among those who underwent endarterectomy, a difference that met the prespecified criteria for noninferiority.

As a condition of the expanded approval, the FDA is requiring Abbott Vascular to conduct a postapproval study. The study would follow new patients treated with RX Acculink for at least 3 years to confirm the results from the CREST study.

The FDA has also asked the manufacturer to look at how patients aged 80 years and older respond to treatment and whether patients who show symptoms prior to treatment experience different outcomes than those who don't exhibit symptoms.

The FDA's action follows a recommendation from the Circulatory System Devices Panel. In January, a majority of those experts voted that the benefits of using the RX Acculink stent outweighed the risks when used in patients at standard risk for surgery.

The Food and Drug Administration expanded the indication for the RX Acculink carotid stent, allowing it to be marketed for use in patients with carotid artery disease who do not face an increased risk of complications from surgery.

The RX Acculink stent, which is marketed by Abbott Vascular, a subsidiary of Abbott Laboratories, was originally approved by the FDA in 2004. At that time, the stent was approved for patients at high risk of complications from carotid endarterectomy.

The company sought an expanded approval based on the results of the Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST), a randomized, multicenter, noninferiority study sponsored by the National Institutes of Health and funded in part by the manufacturer.

The study of more than 2,500 patients in the United States and Canada showed that at 1 year, patients who were treated with RX Acculink had a combined 30-day rate of death, stroke, and myocardial infarction, and a 31 to 365-day rate of ipsilateral stroke, of 7.1%, compared with 6.6% among those who underwent endarterectomy, a difference that met the prespecified criteria for noninferiority.

As a condition of the expanded approval, the FDA is requiring Abbott Vascular to conduct a postapproval study. The study would follow new patients treated with RX Acculink for at least 3 years to confirm the results from the CREST study.

The FDA has also asked the manufacturer to look at how patients aged 80 years and older respond to treatment and whether patients who show symptoms prior to treatment experience different outcomes than those who don't exhibit symptoms.

The FDA's action follows a recommendation from the Circulatory System Devices Panel. In January, a majority of those experts voted that the benefits of using the RX Acculink stent outweighed the risks when used in patients at standard risk for surgery.

The Food and Drug Administration expanded the indication for the RX Acculink carotid stent, allowing it to be marketed for use in patients with carotid artery disease who do not face an increased risk of complications from surgery.

The RX Acculink stent, which is marketed by Abbott Vascular, a subsidiary of Abbott Laboratories, was originally approved by the FDA in 2004. At that time, the stent was approved for patients at high risk of complications from carotid endarterectomy.

The company sought an expanded approval based on the results of the Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST), a randomized, multicenter, noninferiority study sponsored by the National Institutes of Health and funded in part by the manufacturer.

The study of more than 2,500 patients in the United States and Canada showed that at 1 year, patients who were treated with RX Acculink had a combined 30-day rate of death, stroke, and myocardial infarction, and a 31 to 365-day rate of ipsilateral stroke, of 7.1%, compared with 6.6% among those who underwent endarterectomy, a difference that met the prespecified criteria for noninferiority.

As a condition of the expanded approval, the FDA is requiring Abbott Vascular to conduct a postapproval study. The study would follow new patients treated with RX Acculink for at least 3 years to confirm the results from the CREST study.

The FDA has also asked the manufacturer to look at how patients aged 80 years and older respond to treatment and whether patients who show symptoms prior to treatment experience different outcomes than those who don't exhibit symptoms.

The FDA's action follows a recommendation from the Circulatory System Devices Panel. In January, a majority of those experts voted that the benefits of using the RX Acculink stent outweighed the risks when used in patients at standard risk for surgery.

This November, voters in San Francisco will decide whether to ban circumcision in boys younger than age 18 years, and to make the practice a crime.

Opponents of circumcision gathered more than 7,000 signatures from city residents in order to place the referendum on the Nov. 8 ballot.

If approved, circumcision of boys younger than age 18 would be prohibited unless it was medically necessary. The referendum does not allow for exceptions based on religious beliefs. Anyone who violates the policy would face misdemeanor charges, with a possible fine of up to $1,000, up to a year in the county jail, or both.

The effort to pass the referendum is being led by Lloyd Schofield, an activist against circumcision.

In the “notice of intent” to circulate the petition, which was filed with the city's Department of Elections, Mr. Schofield wrote that “genital mutilation constitutes a major health risk, violates human rights, and has lifelong physical and psychological effects.” Complications from the procedure can include hemorrhage, infection, nerve damage, sexual dysfunction, and decreased sexual sensitivity, he wrote.

In its official policy on male circumcision, the American Academy of Pediatrics states that existing scientific evidence shows potential medical benefits for newborn male circumcision. But that evidence is not enough to recommend routine neonatal circumcision, according to the AAP's policy statement, which was published in 1999 and reaffirmed in 2005.

The AAP leaves the decision to parents, saying they should determine what is in the “best interest of the child” based on “accurate and unbiased information.”

San Francisco's ballot measure on circumcision is sure to face opposition and possible legal challenges if it is approved.

The Anti-Defamation League is heading up a coalition of groups to defeat the proposal, saying it threatens religious freedom, privacy, and parental rights.

This November, voters in San Francisco will decide whether to ban circumcision in boys younger than age 18 years, and to make the practice a crime.

Opponents of circumcision gathered more than 7,000 signatures from city residents in order to place the referendum on the Nov. 8 ballot.

If approved, circumcision of boys younger than age 18 would be prohibited unless it was medically necessary. The referendum does not allow for exceptions based on religious beliefs. Anyone who violates the policy would face misdemeanor charges, with a possible fine of up to $1,000, up to a year in the county jail, or both.

The effort to pass the referendum is being led by Lloyd Schofield, an activist against circumcision.

In the “notice of intent” to circulate the petition, which was filed with the city's Department of Elections, Mr. Schofield wrote that “genital mutilation constitutes a major health risk, violates human rights, and has lifelong physical and psychological effects.” Complications from the procedure can include hemorrhage, infection, nerve damage, sexual dysfunction, and decreased sexual sensitivity, he wrote.

In its official policy on male circumcision, the American Academy of Pediatrics states that existing scientific evidence shows potential medical benefits for newborn male circumcision. But that evidence is not enough to recommend routine neonatal circumcision, according to the AAP's policy statement, which was published in 1999 and reaffirmed in 2005.

The AAP leaves the decision to parents, saying they should determine what is in the “best interest of the child” based on “accurate and unbiased information.”

San Francisco's ballot measure on circumcision is sure to face opposition and possible legal challenges if it is approved.

The Anti-Defamation League is heading up a coalition of groups to defeat the proposal, saying it threatens religious freedom, privacy, and parental rights.

This November, voters in San Francisco will decide whether to ban circumcision in boys younger than age 18 years, and to make the practice a crime.

Opponents of circumcision gathered more than 7,000 signatures from city residents in order to place the referendum on the Nov. 8 ballot.

If approved, circumcision of boys younger than age 18 would be prohibited unless it was medically necessary. The referendum does not allow for exceptions based on religious beliefs. Anyone who violates the policy would face misdemeanor charges, with a possible fine of up to $1,000, up to a year in the county jail, or both.

The effort to pass the referendum is being led by Lloyd Schofield, an activist against circumcision.

In the “notice of intent” to circulate the petition, which was filed with the city's Department of Elections, Mr. Schofield wrote that “genital mutilation constitutes a major health risk, violates human rights, and has lifelong physical and psychological effects.” Complications from the procedure can include hemorrhage, infection, nerve damage, sexual dysfunction, and decreased sexual sensitivity, he wrote.

In its official policy on male circumcision, the American Academy of Pediatrics states that existing scientific evidence shows potential medical benefits for newborn male circumcision. But that evidence is not enough to recommend routine neonatal circumcision, according to the AAP's policy statement, which was published in 1999 and reaffirmed in 2005.

The AAP leaves the decision to parents, saying they should determine what is in the “best interest of the child” based on “accurate and unbiased information.”

San Francisco's ballot measure on circumcision is sure to face opposition and possible legal challenges if it is approved.

The Anti-Defamation League is heading up a coalition of groups to defeat the proposal, saying it threatens religious freedom, privacy, and parental rights.

GRAPEVINE, TEX. – It’s not easy to put a smile on your face for every patient, but experts say it’s worth the effort to help boost patient satisfaction ratings.

It is critical to ensure that patients are satisfied with their hospital stay, said Dr. Steven B. Deitelzweig, system chairman of hospital medicine at Ochsner Health System in New Orleans. Patient satisfaction can translate to increased volume from referrals, improved quality measures because of better patient compliance, and increased satisfaction for physicians because of the better connection between them and their patients.

(c) Yuri Arcurs/Fotolia.com

And it helps hospitalists earn more money because patient satisfaction scores often are tied to compensation, he said.

But it’s not as simple as providing the best care. High-quality care alone does not translate to high patient satisfaction. And when it comes to the skills needed to help patients feel more comfortable in the hospital, most physicians just don’t know what to do. It’s not something taught in medical school, but physicians can learn these skills, Dr. Deitelzweig said at the annual meeting of the Society of Hospital Medicine.

Start by making the best first impression possible, Dr. Deitelzweig advised. That means smiling whenever you enter a patient’s room. Be sure to shake hands and introduce yourself and your team members. And take a seat. Patients will perceive that the visit has been longer if you sit down with them, he said.

Another important part of the introduction with patients and their families is to explain what a hospitalist does, said Dr. Winthrop F. Whitcomb, a cofounder of the Society of Hospital Medicine and the medical director for health care quality at Baystate Medical Center in Springfield, Mass. Dr. Whitcomb recommends putting together a short, simple script to explain the role of the hospitalist. "I cannot tell you how important this is," he said. He also suggests that hospitalists hand out a business card with a photo on it so that patients can remember them later. It’s difficult for patients to keep track of the many different physicians and nurses coming in and out of their room, he said.

Before leaving the patient’s room, summarize what you’ve said and write it down, Dr. Deitelzweig said. Then ask the patient to repeat the information back to you to make sure they understand. Ask them, "Does this seem reasonable to you?" Dr. Deitelzweig said. He also suggested letting patients have the last word by asking them, "Is there anything else I can do for you." Once the patient has had a chance to ask questions, the hospitalist should shake hands and thank them, he said.

If you’re going home for the day, be sure to let patients know who will see them next, Dr. Whitcomb said. And don’t just tell them that a new hospitalist will be in to see them. Tell them the name of that physician, he said.

Patients like to know what to expect so hospitalists can go a long way in improving patient satisfaction by telling patients what they are doing and why, Dr. Deitelzweig said. "It’s a very good way to connect with patients," he said. One way to do this is to use a white board located in the patient’s room to write the names of the care team, the expected length of stay, and the care plan, Dr. Whitcomb said.

After establishing a good rapport with a patient, don’t destroy it by making unprofessional comments in the hallway, Dr. Deitelzweig advised. Avoid talking about patients in elevators, hallways, the cafeteria, or others places where family members and patients can hear. And no griping about personal problems in front of patients, Dr. Deitelzweig said. He recommended an experiment to get a sense of what patients experience in the hospital. Go into an empty room for 15 minutes and see what you hear from the hallway. You may be shocked by what you hear, he said.

Hospitalists can also help improve patient satisfaction by keeping in mind that illness has an emotional side, too, Dr. Deitelzweig said. "empathetic listening" can be useful. Let patients know that you understand their concerns with comments like, "This must be difficult for you" or questions such as, "What worries you the most about being ill?" he said. And whenever possible, give patients some control by including them in decisions about their own care, he said.

GRAPEVINE, TEX. – It’s not easy to put a smile on your face for every patient, but experts say it’s worth the effort to help boost patient satisfaction ratings.

It is critical to ensure that patients are satisfied with their hospital stay, said Dr. Steven B. Deitelzweig, system chairman of hospital medicine at Ochsner Health System in New Orleans. Patient satisfaction can translate to increased volume from referrals, improved quality measures because of better patient compliance, and increased satisfaction for physicians because of the better connection between them and their patients.

(c) Yuri Arcurs/Fotolia.com

And it helps hospitalists earn more money because patient satisfaction scores often are tied to compensation, he said.

But it’s not as simple as providing the best care. High-quality care alone does not translate to high patient satisfaction. And when it comes to the skills needed to help patients feel more comfortable in the hospital, most physicians just don’t know what to do. It’s not something taught in medical school, but physicians can learn these skills, Dr. Deitelzweig said at the annual meeting of the Society of Hospital Medicine.

Start by making the best first impression possible, Dr. Deitelzweig advised. That means smiling whenever you enter a patient’s room. Be sure to shake hands and introduce yourself and your team members. And take a seat. Patients will perceive that the visit has been longer if you sit down with them, he said.

Another important part of the introduction with patients and their families is to explain what a hospitalist does, said Dr. Winthrop F. Whitcomb, a cofounder of the Society of Hospital Medicine and the medical director for health care quality at Baystate Medical Center in Springfield, Mass. Dr. Whitcomb recommends putting together a short, simple script to explain the role of the hospitalist. "I cannot tell you how important this is," he said. He also suggests that hospitalists hand out a business card with a photo on it so that patients can remember them later. It’s difficult for patients to keep track of the many different physicians and nurses coming in and out of their room, he said.

Before leaving the patient’s room, summarize what you’ve said and write it down, Dr. Deitelzweig said. Then ask the patient to repeat the information back to you to make sure they understand. Ask them, "Does this seem reasonable to you?" Dr. Deitelzweig said. He also suggested letting patients have the last word by asking them, "Is there anything else I can do for you." Once the patient has had a chance to ask questions, the hospitalist should shake hands and thank them, he said.

If you’re going home for the day, be sure to let patients know who will see them next, Dr. Whitcomb said. And don’t just tell them that a new hospitalist will be in to see them. Tell them the name of that physician, he said.

Patients like to know what to expect so hospitalists can go a long way in improving patient satisfaction by telling patients what they are doing and why, Dr. Deitelzweig said. "It’s a very good way to connect with patients," he said. One way to do this is to use a white board located in the patient’s room to write the names of the care team, the expected length of stay, and the care plan, Dr. Whitcomb said.

After establishing a good rapport with a patient, don’t destroy it by making unprofessional comments in the hallway, Dr. Deitelzweig advised. Avoid talking about patients in elevators, hallways, the cafeteria, or others places where family members and patients can hear. And no griping about personal problems in front of patients, Dr. Deitelzweig said. He recommended an experiment to get a sense of what patients experience in the hospital. Go into an empty room for 15 minutes and see what you hear from the hallway. You may be shocked by what you hear, he said.

Hospitalists can also help improve patient satisfaction by keeping in mind that illness has an emotional side, too, Dr. Deitelzweig said. "empathetic listening" can be useful. Let patients know that you understand their concerns with comments like, "This must be difficult for you" or questions such as, "What worries you the most about being ill?" he said. And whenever possible, give patients some control by including them in decisions about their own care, he said.

GRAPEVINE, TEX. – It’s not easy to put a smile on your face for every patient, but experts say it’s worth the effort to help boost patient satisfaction ratings.

It is critical to ensure that patients are satisfied with their hospital stay, said Dr. Steven B. Deitelzweig, system chairman of hospital medicine at Ochsner Health System in New Orleans. Patient satisfaction can translate to increased volume from referrals, improved quality measures because of better patient compliance, and increased satisfaction for physicians because of the better connection between them and their patients.

(c) Yuri Arcurs/Fotolia.com

And it helps hospitalists earn more money because patient satisfaction scores often are tied to compensation, he said.

But it’s not as simple as providing the best care. High-quality care alone does not translate to high patient satisfaction. And when it comes to the skills needed to help patients feel more comfortable in the hospital, most physicians just don’t know what to do. It’s not something taught in medical school, but physicians can learn these skills, Dr. Deitelzweig said at the annual meeting of the Society of Hospital Medicine.

Start by making the best first impression possible, Dr. Deitelzweig advised. That means smiling whenever you enter a patient’s room. Be sure to shake hands and introduce yourself and your team members. And take a seat. Patients will perceive that the visit has been longer if you sit down with them, he said.

Another important part of the introduction with patients and their families is to explain what a hospitalist does, said Dr. Winthrop F. Whitcomb, a cofounder of the Society of Hospital Medicine and the medical director for health care quality at Baystate Medical Center in Springfield, Mass. Dr. Whitcomb recommends putting together a short, simple script to explain the role of the hospitalist. "I cannot tell you how important this is," he said. He also suggests that hospitalists hand out a business card with a photo on it so that patients can remember them later. It’s difficult for patients to keep track of the many different physicians and nurses coming in and out of their room, he said.

Before leaving the patient’s room, summarize what you’ve said and write it down, Dr. Deitelzweig said. Then ask the patient to repeat the information back to you to make sure they understand. Ask them, "Does this seem reasonable to you?" Dr. Deitelzweig said. He also suggested letting patients have the last word by asking them, "Is there anything else I can do for you." Once the patient has had a chance to ask questions, the hospitalist should shake hands and thank them, he said.

If you’re going home for the day, be sure to let patients know who will see them next, Dr. Whitcomb said. And don’t just tell them that a new hospitalist will be in to see them. Tell them the name of that physician, he said.

Patients like to know what to expect so hospitalists can go a long way in improving patient satisfaction by telling patients what they are doing and why, Dr. Deitelzweig said. "It’s a very good way to connect with patients," he said. One way to do this is to use a white board located in the patient’s room to write the names of the care team, the expected length of stay, and the care plan, Dr. Whitcomb said.

After establishing a good rapport with a patient, don’t destroy it by making unprofessional comments in the hallway, Dr. Deitelzweig advised. Avoid talking about patients in elevators, hallways, the cafeteria, or others places where family members and patients can hear. And no griping about personal problems in front of patients, Dr. Deitelzweig said. He recommended an experiment to get a sense of what patients experience in the hospital. Go into an empty room for 15 minutes and see what you hear from the hallway. You may be shocked by what you hear, he said.

Hospitalists can also help improve patient satisfaction by keeping in mind that illness has an emotional side, too, Dr. Deitelzweig said. "empathetic listening" can be useful. Let patients know that you understand their concerns with comments like, "This must be difficult for you" or questions such as, "What worries you the most about being ill?" he said. And whenever possible, give patients some control by including them in decisions about their own care, he said.

GRAPEVINE, TEX. – The combination of the aging baby boomers, growing minority populations, and the millions of Americans who will gain coverage under the Affordable Care Act, will stress the U.S. health care system and create a "crisis of access to care" in the near future, warned Dr. Cecil B. Wilson, president of the American Medical Association.

Dr. Wilson, who recently spoke at the annual meeting of the Society of Hospital Medicine, said there is already a physician shortage in many areas and specialties, but it is likely to get worse if steps aren’t taken to recruit more young people into medicine.

"The situation is serious for the patients who do not have or cannot get a physician’s care," he said. "It also presents considerable challenges for those of us in medical practice as well."

Right now, the AMA estimates that there will be a shortage of at least 125,000 physicians by 2025. The problem is not just the number of the physicians but who they are and where they practice. Some of the greatest physician shortages are in rural areas and in minority communities. Recruiting minority physicians has been a challenge, he said, in part because of the high cost of medical school, but also because there are few minority role models in the medical community. And the result is that health care disparities are increasing, Dr. Wilson said.

There has been some good news, Dr. Wilson said. The Affordable Care Act includes some provisions to address these issues, including bonuses to primary care physicians to help deal with the pay differential with specialists, loan repayment programs, and a provision to shift unused residency slots to primary care. And medical schools are expanding. In the past 3 years, nearly two dozen new medical schools have either been opened, announced, or sought accreditation, Dr. Wilson said.

But there not has been a parallel growth in residency training slots. With the cap on federally funded residency positions, it’s difficult to expand training programs, he said. One possible solution is to move to an "all-payer system" that would be financed not just by Medicare, but also by insurance companies and others with a stake in the health care system, Dr. Wilson said.

GRAPEVINE, TEX. – The combination of the aging baby boomers, growing minority populations, and the millions of Americans who will gain coverage under the Affordable Care Act, will stress the U.S. health care system and create a "crisis of access to care" in the near future, warned Dr. Cecil B. Wilson, president of the American Medical Association.

Dr. Wilson, who recently spoke at the annual meeting of the Society of Hospital Medicine, said there is already a physician shortage in many areas and specialties, but it is likely to get worse if steps aren’t taken to recruit more young people into medicine.

"The situation is serious for the patients who do not have or cannot get a physician’s care," he said. "It also presents considerable challenges for those of us in medical practice as well."

Right now, the AMA estimates that there will be a shortage of at least 125,000 physicians by 2025. The problem is not just the number of the physicians but who they are and where they practice. Some of the greatest physician shortages are in rural areas and in minority communities. Recruiting minority physicians has been a challenge, he said, in part because of the high cost of medical school, but also because there are few minority role models in the medical community. And the result is that health care disparities are increasing, Dr. Wilson said.

There has been some good news, Dr. Wilson said. The Affordable Care Act includes some provisions to address these issues, including bonuses to primary care physicians to help deal with the pay differential with specialists, loan repayment programs, and a provision to shift unused residency slots to primary care. And medical schools are expanding. In the past 3 years, nearly two dozen new medical schools have either been opened, announced, or sought accreditation, Dr. Wilson said.

But there not has been a parallel growth in residency training slots. With the cap on federally funded residency positions, it’s difficult to expand training programs, he said. One possible solution is to move to an "all-payer system" that would be financed not just by Medicare, but also by insurance companies and others with a stake in the health care system, Dr. Wilson said.

GRAPEVINE, TEX. – The combination of the aging baby boomers, growing minority populations, and the millions of Americans who will gain coverage under the Affordable Care Act, will stress the U.S. health care system and create a "crisis of access to care" in the near future, warned Dr. Cecil B. Wilson, president of the American Medical Association.

Dr. Wilson, who recently spoke at the annual meeting of the Society of Hospital Medicine, said there is already a physician shortage in many areas and specialties, but it is likely to get worse if steps aren’t taken to recruit more young people into medicine.

"The situation is serious for the patients who do not have or cannot get a physician’s care," he said. "It also presents considerable challenges for those of us in medical practice as well."

Right now, the AMA estimates that there will be a shortage of at least 125,000 physicians by 2025. The problem is not just the number of the physicians but who they are and where they practice. Some of the greatest physician shortages are in rural areas and in minority communities. Recruiting minority physicians has been a challenge, he said, in part because of the high cost of medical school, but also because there are few minority role models in the medical community. And the result is that health care disparities are increasing, Dr. Wilson said.

There has been some good news, Dr. Wilson said. The Affordable Care Act includes some provisions to address these issues, including bonuses to primary care physicians to help deal with the pay differential with specialists, loan repayment programs, and a provision to shift unused residency slots to primary care. And medical schools are expanding. In the past 3 years, nearly two dozen new medical schools have either been opened, announced, or sought accreditation, Dr. Wilson said.

But there not has been a parallel growth in residency training slots. With the cap on federally funded residency positions, it’s difficult to expand training programs, he said. One possible solution is to move to an "all-payer system" that would be financed not just by Medicare, but also by insurance companies and others with a stake in the health care system, Dr. Wilson said.