Mary Ellen Schneider

Children living in states in New England and the Upper Midwest are more likely to have health insurance and to receive recommended medical care than are children in other parts of the United States, according to a new scorecard from the Commonwealth Fund.

The report, "Securing a Healthy Future: The Commonwealth Fund State Scorecard of Child Health System Performance, 2011," was released on Feb. 2. In it, researchers report on 20 indicators for how the health system is performing for children, based on the most recent data. The report ranks states on access and affordability, prevention, and treatment, the potential to lead healthy lives, and equity.

"Where children lives matters, and it shouldn’t," Cathy Schoen, Commonwealth Fund senior vice president and coauthor of the report, said in a press briefing.

Massachusetts and Iowa ranked first overall among the states; Massachusetts had the lowest rate (3.3%) of uninsured children under age 19 years. Vermont, Maine, and New Hampshire rounded out the five top-performing states overall.

States in the South and Southwest were the worst performers, with Nevada, Mississippi, Arizona, Texas, and Florida achieving the lowest scores, according to the report.

But exceptions to these geographic trends were found. For example, while Southern states were generally ranked lower, Alabama had a high insurance rate for children with 94% of children insured. And North Carolina had the highest rate of developmental screening.

The report also found that many states have been taking advantage of federal funding to expand insurance opportunities for children.

These actions helped to stabilize insurance rates for children even as many of their parents lost insurance coverage during the recent recession. Insurance coverage rates for parents declined in 41 states over the last decade, while coverage rates for children increased in 35 states during the same time period.

But going forward, expansion of coverage to the rest of the family will be important, according to the Commonwealth Fund. When parents also have insurance, they are more likely to bring their children in for needed care, Ms. Schoen said.

The report offers examples of innovative children’s health programs that can be models for other states. "States, we hope, will learn from each other," said Commonwealth Fund president Karen Davis.

For example, in Colorado, which ranked 20th overall on the scorecard, the nonprofit Colorado Children’s Healthcare Access Program works with primary care practices to negotiate with Medicaid for enhanced payments for certain preventive services for children. The additional reimbursement makes it feasible for those practices to accept more children enrolled in Medicaid and the Children’s Health Insurance Program, giving more low-income children access to a medical home.

Children living in states in New England and the Upper Midwest are more likely to have health insurance and to receive recommended medical care than are children in other parts of the United States, according to a new scorecard from the Commonwealth Fund.

The report, "Securing a Healthy Future: The Commonwealth Fund State Scorecard of Child Health System Performance, 2011," was released on Feb. 2. In it, researchers report on 20 indicators for how the health system is performing for children, based on the most recent data. The report ranks states on access and affordability, prevention, and treatment, the potential to lead healthy lives, and equity.

"Where children lives matters, and it shouldn’t," Cathy Schoen, Commonwealth Fund senior vice president and coauthor of the report, said in a press briefing.

Massachusetts and Iowa ranked first overall among the states; Massachusetts had the lowest rate (3.3%) of uninsured children under age 19 years. Vermont, Maine, and New Hampshire rounded out the five top-performing states overall.

States in the South and Southwest were the worst performers, with Nevada, Mississippi, Arizona, Texas, and Florida achieving the lowest scores, according to the report.

But exceptions to these geographic trends were found. For example, while Southern states were generally ranked lower, Alabama had a high insurance rate for children with 94% of children insured. And North Carolina had the highest rate of developmental screening.

The report also found that many states have been taking advantage of federal funding to expand insurance opportunities for children.

These actions helped to stabilize insurance rates for children even as many of their parents lost insurance coverage during the recent recession. Insurance coverage rates for parents declined in 41 states over the last decade, while coverage rates for children increased in 35 states during the same time period.

But going forward, expansion of coverage to the rest of the family will be important, according to the Commonwealth Fund. When parents also have insurance, they are more likely to bring their children in for needed care, Ms. Schoen said.

The report offers examples of innovative children’s health programs that can be models for other states. "States, we hope, will learn from each other," said Commonwealth Fund president Karen Davis.

For example, in Colorado, which ranked 20th overall on the scorecard, the nonprofit Colorado Children’s Healthcare Access Program works with primary care practices to negotiate with Medicaid for enhanced payments for certain preventive services for children. The additional reimbursement makes it feasible for those practices to accept more children enrolled in Medicaid and the Children’s Health Insurance Program, giving more low-income children access to a medical home.

Children living in states in New England and the Upper Midwest are more likely to have health insurance and to receive recommended medical care than are children in other parts of the United States, according to a new scorecard from the Commonwealth Fund.

The report, "Securing a Healthy Future: The Commonwealth Fund State Scorecard of Child Health System Performance, 2011," was released on Feb. 2. In it, researchers report on 20 indicators for how the health system is performing for children, based on the most recent data. The report ranks states on access and affordability, prevention, and treatment, the potential to lead healthy lives, and equity.

"Where children lives matters, and it shouldn’t," Cathy Schoen, Commonwealth Fund senior vice president and coauthor of the report, said in a press briefing.

Massachusetts and Iowa ranked first overall among the states; Massachusetts had the lowest rate (3.3%) of uninsured children under age 19 years. Vermont, Maine, and New Hampshire rounded out the five top-performing states overall.

States in the South and Southwest were the worst performers, with Nevada, Mississippi, Arizona, Texas, and Florida achieving the lowest scores, according to the report.

But exceptions to these geographic trends were found. For example, while Southern states were generally ranked lower, Alabama had a high insurance rate for children with 94% of children insured. And North Carolina had the highest rate of developmental screening.

The report also found that many states have been taking advantage of federal funding to expand insurance opportunities for children.

These actions helped to stabilize insurance rates for children even as many of their parents lost insurance coverage during the recent recession. Insurance coverage rates for parents declined in 41 states over the last decade, while coverage rates for children increased in 35 states during the same time period.

But going forward, expansion of coverage to the rest of the family will be important, according to the Commonwealth Fund. When parents also have insurance, they are more likely to bring their children in for needed care, Ms. Schoen said.

The report offers examples of innovative children’s health programs that can be models for other states. "States, we hope, will learn from each other," said Commonwealth Fund president Karen Davis.

For example, in Colorado, which ranked 20th overall on the scorecard, the nonprofit Colorado Children’s Healthcare Access Program works with primary care practices to negotiate with Medicaid for enhanced payments for certain preventive services for children. The additional reimbursement makes it feasible for those practices to accept more children enrolled in Medicaid and the Children’s Health Insurance Program, giving more low-income children access to a medical home.

Children living in states in New England and the Upper Midwest are more likely to have health insurance and to receive recommended medical care than are children in other parts of the United States, according to a new scorecard from the Commonwealth Fund.

The report, "Securing a Healthy Future: The Commonwealth Fund State Scorecard of Child Health System Performance, 2011," was released on Feb. 2. In it, researchers report on 20 indicators for how the health system is performing for children, based on the most recent data. The report ranks states on access and affordability, prevention, and treatment, the potential to lead healthy lives, and equity.

"Where children lives matters, and it shouldn’t," Cathy Schoen, Commonwealth Fund senior vice president and coauthor of the report, said in a press briefing.

Massachusetts and Iowa ranked first overall among the states; Massachusetts had the lowest rate (3.3%) of uninsured children under age 19 years. Vermont, Maine, and New Hampshire rounded out the five top-performing states overall.

States in the South and Southwest were the worst performers, with Nevada, Mississippi, Arizona, Texas, and Florida achieving the lowest scores, according to the report.

But exceptions to these geographic trends were found. For example, while Southern states were generally ranked lower, Alabama had a high insurance rate for children with 94% of children insured. And North Carolina had the highest rate of developmental screening.

The report also found that many states have been taking advantage of federal funding to expand insurance opportunities for children.

These actions helped to stabilize insurance rates for children even as many of their parents lost insurance coverage during the recent recession. Insurance coverage rates for parents declined in 41 states over the last decade, while coverage rates for children increased in 35 states during the same time period.

But going forward, expansion of coverage to the rest of the family will be important, according to the Commonwealth Fund. When parents also have insurance, they are more likely to bring their children in for needed care, Ms. Schoen said.

The report offers examples of innovative children’s health programs that can be models for other states. "States, we hope, will learn from each other," said Commonwealth Fund president Karen Davis.

For example, in Colorado, which ranked 20th overall on the scorecard, the nonprofit Colorado Children’s Healthcare Access Program works with primary care practices to negotiate with Medicaid for enhanced payments for certain preventive services for children. The additional reimbursement makes it feasible for those practices to accept more children enrolled in Medicaid and the Children’s Health Insurance Program, giving more low-income children access to a medical home.

Children living in states in New England and the Upper Midwest are more likely to have health insurance and to receive recommended medical care than are children in other parts of the United States, according to a new scorecard from the Commonwealth Fund.

The report, "Securing a Healthy Future: The Commonwealth Fund State Scorecard of Child Health System Performance, 2011," was released on Feb. 2. In it, researchers report on 20 indicators for how the health system is performing for children, based on the most recent data. The report ranks states on access and affordability, prevention, and treatment, the potential to lead healthy lives, and equity.

"Where children lives matters, and it shouldn’t," Cathy Schoen, Commonwealth Fund senior vice president and coauthor of the report, said in a press briefing.

Massachusetts and Iowa ranked first overall among the states; Massachusetts had the lowest rate (3.3%) of uninsured children under age 19 years. Vermont, Maine, and New Hampshire rounded out the five top-performing states overall.

States in the South and Southwest were the worst performers, with Nevada, Mississippi, Arizona, Texas, and Florida achieving the lowest scores, according to the report.

But exceptions to these geographic trends were found. For example, while Southern states were generally ranked lower, Alabama had a high insurance rate for children with 94% of children insured. And North Carolina had the highest rate of developmental screening.

The report also found that many states have been taking advantage of federal funding to expand insurance opportunities for children.

These actions helped to stabilize insurance rates for children even as many of their parents lost insurance coverage during the recent recession. Insurance coverage rates for parents declined in 41 states over the last decade, while coverage rates for children increased in 35 states during the same time period.

But going forward, expansion of coverage to the rest of the family will be important, according to the Commonwealth Fund. When parents also have insurance, they are more likely to bring their children in for needed care, Ms. Schoen said.

The report offers examples of innovative children’s health programs that can be models for other states. "States, we hope, will learn from each other," said Commonwealth Fund president Karen Davis.

For example, in Colorado, which ranked 20th overall on the scorecard, the nonprofit Colorado Children’s Healthcare Access Program works with primary care practices to negotiate with Medicaid for enhanced payments for certain preventive services for children. The additional reimbursement makes it feasible for those practices to accept more children enrolled in Medicaid and the Children’s Health Insurance Program, giving more low-income children access to a medical home.

Children living in states in New England and the Upper Midwest are more likely to have health insurance and to receive recommended medical care than are children in other parts of the United States, according to a new scorecard from the Commonwealth Fund.

The report, "Securing a Healthy Future: The Commonwealth Fund State Scorecard of Child Health System Performance, 2011," was released on Feb. 2. In it, researchers report on 20 indicators for how the health system is performing for children, based on the most recent data. The report ranks states on access and affordability, prevention, and treatment, the potential to lead healthy lives, and equity.

"Where children lives matters, and it shouldn’t," Cathy Schoen, Commonwealth Fund senior vice president and coauthor of the report, said in a press briefing.

Massachusetts and Iowa ranked first overall among the states; Massachusetts had the lowest rate (3.3%) of uninsured children under age 19 years. Vermont, Maine, and New Hampshire rounded out the five top-performing states overall.

States in the South and Southwest were the worst performers, with Nevada, Mississippi, Arizona, Texas, and Florida achieving the lowest scores, according to the report.

But exceptions to these geographic trends were found. For example, while Southern states were generally ranked lower, Alabama had a high insurance rate for children with 94% of children insured. And North Carolina had the highest rate of developmental screening.

The report also found that many states have been taking advantage of federal funding to expand insurance opportunities for children.

These actions helped to stabilize insurance rates for children even as many of their parents lost insurance coverage during the recent recession. Insurance coverage rates for parents declined in 41 states over the last decade, while coverage rates for children increased in 35 states during the same time period.

But going forward, expansion of coverage to the rest of the family will be important, according to the Commonwealth Fund. When parents also have insurance, they are more likely to bring their children in for needed care, Ms. Schoen said.

The report offers examples of innovative children’s health programs that can be models for other states. "States, we hope, will learn from each other," said Commonwealth Fund president Karen Davis.

For example, in Colorado, which ranked 20th overall on the scorecard, the nonprofit Colorado Children’s Healthcare Access Program works with primary care practices to negotiate with Medicaid for enhanced payments for certain preventive services for children. The additional reimbursement makes it feasible for those practices to accept more children enrolled in Medicaid and the Children’s Health Insurance Program, giving more low-income children access to a medical home.

A public health project aimed at reducing rates of health care–associated infections in Michigan intensive care units is associated with reduced mortality among patients aged 65 years and older, according to a retrospective study comparing Michigan ICU patients to ICU patients in other Midwest hospitals.

The study examined the impact of a quality improvement initiative, known as the Michigan Keystone ICU project, which used a series of evidence-based practices to reduce rates of catheter-related bloodstream infections and ventilator-associated pneumonia. While previous studies have shown that the Keystone project substantially reduced infection rates for up to 36 months after implementation, this is the first study to show a significant reduction in hospital mortality following implementation of the project. The study was published on Jan. 31 in the British Medical Journal (doi: 10.1136/bmj.d219).

Using Medicare claims data for patients aged 65 years and older who were admitted to ICUs, the researchers compared mortality and length of stay among patients in 95 Michigan ICUs and patients in 364 ICUs in surrounding Midwest states. The researchers compared mortality and length of stay before implementation of the Keystone project, during the project’s initiation and implementation, and post implementation.

They found that reductions in mortality were significantly greater during the postimplementation months for the study group. The adjust odds ratios for mortality at postimplementation months 1-12 were 0.83 vs. 0.88 for the study vs. the comparison group, respectively. During months 13-22, those odds ratios were 0.76 vs. 0.84.

There was no significant difference in length of stay between the two hospital groups. Although the length of stay was shorter among the Michigan ICUs after implementation of the Keystone project, there was not a statistically significant difference compared to baseline.

Although study involved data from more than 1 million ICU admissions, the researchers acknowledged that it was underpowered to detect the 0.1 day length of stay reduction they had originally projected.

"We knew that when we applied safety science principles to the delivery of health care, we would dramatically reduce infections in intensive care units, and now we know we are also saving lives," Dr. Peter J. Pronovost, one of the study authors and a professor of anesthesiology and critical care medicine at the Johns Hopkins University, Baltimore, said in a statement.

The Keystone Project, which was launched in 2003, has been touted as a national model by the Obama administration. The initiative promotes a culture of patient safety, encourages better communication among ICU staff, and uses checklists to remind providers to perform certain tasks. To prevent catheter-related bloodstream infections, the project promotes hand washing, full barrier precautions, skin antisepsis with chlorhexidine, avoiding the femoral site during catheter insertion, and removing unnecessary catheters. The interventions promoted for preventing ventilator-associated pneumonia included semirecumbent positioning, daily interruption of sedation infusions, and prophylaxis for peptic ulcer disease and deep venous thrombosis.

The researchers received no financial support for the study. However, they received funding from the Agency for Healthcare Research and Quality, the National Patient Safety Agency, and private philanthropic groups to expand the Keystone project to all 50 states.

A public health project aimed at reducing rates of health care–associated infections in Michigan intensive care units is associated with reduced mortality among patients aged 65 years and older, according to a retrospective study comparing Michigan ICU patients to ICU patients in other Midwest hospitals.

The study examined the impact of a quality improvement initiative, known as the Michigan Keystone ICU project, which used a series of evidence-based practices to reduce rates of catheter-related bloodstream infections and ventilator-associated pneumonia. While previous studies have shown that the Keystone project substantially reduced infection rates for up to 36 months after implementation, this is the first study to show a significant reduction in hospital mortality following implementation of the project. The study was published on Jan. 31 in the British Medical Journal (doi: 10.1136/bmj.d219).

Using Medicare claims data for patients aged 65 years and older who were admitted to ICUs, the researchers compared mortality and length of stay among patients in 95 Michigan ICUs and patients in 364 ICUs in surrounding Midwest states. The researchers compared mortality and length of stay before implementation of the Keystone project, during the project’s initiation and implementation, and post implementation.

They found that reductions in mortality were significantly greater during the postimplementation months for the study group. The adjust odds ratios for mortality at postimplementation months 1-12 were 0.83 vs. 0.88 for the study vs. the comparison group, respectively. During months 13-22, those odds ratios were 0.76 vs. 0.84.

There was no significant difference in length of stay between the two hospital groups. Although the length of stay was shorter among the Michigan ICUs after implementation of the Keystone project, there was not a statistically significant difference compared to baseline.

Although study involved data from more than 1 million ICU admissions, the researchers acknowledged that it was underpowered to detect the 0.1 day length of stay reduction they had originally projected.

"We knew that when we applied safety science principles to the delivery of health care, we would dramatically reduce infections in intensive care units, and now we know we are also saving lives," Dr. Peter J. Pronovost, one of the study authors and a professor of anesthesiology and critical care medicine at the Johns Hopkins University, Baltimore, said in a statement.

The Keystone Project, which was launched in 2003, has been touted as a national model by the Obama administration. The initiative promotes a culture of patient safety, encourages better communication among ICU staff, and uses checklists to remind providers to perform certain tasks. To prevent catheter-related bloodstream infections, the project promotes hand washing, full barrier precautions, skin antisepsis with chlorhexidine, avoiding the femoral site during catheter insertion, and removing unnecessary catheters. The interventions promoted for preventing ventilator-associated pneumonia included semirecumbent positioning, daily interruption of sedation infusions, and prophylaxis for peptic ulcer disease and deep venous thrombosis.

The researchers received no financial support for the study. However, they received funding from the Agency for Healthcare Research and Quality, the National Patient Safety Agency, and private philanthropic groups to expand the Keystone project to all 50 states.

A public health project aimed at reducing rates of health care–associated infections in Michigan intensive care units is associated with reduced mortality among patients aged 65 years and older, according to a retrospective study comparing Michigan ICU patients to ICU patients in other Midwest hospitals.

The study examined the impact of a quality improvement initiative, known as the Michigan Keystone ICU project, which used a series of evidence-based practices to reduce rates of catheter-related bloodstream infections and ventilator-associated pneumonia. While previous studies have shown that the Keystone project substantially reduced infection rates for up to 36 months after implementation, this is the first study to show a significant reduction in hospital mortality following implementation of the project. The study was published on Jan. 31 in the British Medical Journal (doi: 10.1136/bmj.d219).

Using Medicare claims data for patients aged 65 years and older who were admitted to ICUs, the researchers compared mortality and length of stay among patients in 95 Michigan ICUs and patients in 364 ICUs in surrounding Midwest states. The researchers compared mortality and length of stay before implementation of the Keystone project, during the project’s initiation and implementation, and post implementation.

They found that reductions in mortality were significantly greater during the postimplementation months for the study group. The adjust odds ratios for mortality at postimplementation months 1-12 were 0.83 vs. 0.88 for the study vs. the comparison group, respectively. During months 13-22, those odds ratios were 0.76 vs. 0.84.

There was no significant difference in length of stay between the two hospital groups. Although the length of stay was shorter among the Michigan ICUs after implementation of the Keystone project, there was not a statistically significant difference compared to baseline.

Although study involved data from more than 1 million ICU admissions, the researchers acknowledged that it was underpowered to detect the 0.1 day length of stay reduction they had originally projected.

"We knew that when we applied safety science principles to the delivery of health care, we would dramatically reduce infections in intensive care units, and now we know we are also saving lives," Dr. Peter J. Pronovost, one of the study authors and a professor of anesthesiology and critical care medicine at the Johns Hopkins University, Baltimore, said in a statement.

The Keystone Project, which was launched in 2003, has been touted as a national model by the Obama administration. The initiative promotes a culture of patient safety, encourages better communication among ICU staff, and uses checklists to remind providers to perform certain tasks. To prevent catheter-related bloodstream infections, the project promotes hand washing, full barrier precautions, skin antisepsis with chlorhexidine, avoiding the femoral site during catheter insertion, and removing unnecessary catheters. The interventions promoted for preventing ventilator-associated pneumonia included semirecumbent positioning, daily interruption of sedation infusions, and prophylaxis for peptic ulcer disease and deep venous thrombosis.

The researchers received no financial support for the study. However, they received funding from the Agency for Healthcare Research and Quality, the National Patient Safety Agency, and private philanthropic groups to expand the Keystone project to all 50 states.

A public health project aimed at reducing rates of health care–associated infections in Michigan intensive care units is associated with reduced mortality among patients aged 65 years and older, according to a retrospective study comparing Michigan ICU patients to ICU patients in other Midwest hospitals.

The study examined the impact of a quality improvement initiative, known as the Michigan Keystone ICU project, which used a series of evidence-based practices to reduce rates of catheter-related bloodstream infections and ventilator-associated pneumonia. While previous studies have shown that the Keystone project substantially reduced infection rates for up to 36 months after implementation, this is the first study to show a significant reduction in hospital mortality following implementation of the project. The study was published on Jan. 31 in the British Medical Journal (doi: 10.1136/bmj.d219).

Using Medicare claims data for patients aged 65 years and older who were admitted to ICUs, the researchers compared mortality and length of stay among patients in 95 Michigan ICUs and patients in 364 ICUs in surrounding Midwest states. The researchers compared mortality and length of stay before implementation of the Keystone project, during the project’s initiation and implementation, and post implementation.

They found that reductions in mortality were significantly greater during the postimplementation months for the study group. The adjust odds ratios for mortality at postimplementation months 1-12 were 0.83 vs. 0.88 for the study vs. the comparison group, respectively. During months 13-22, those odds ratios were 0.76 vs. 0.84.

There was no significant difference in length of stay between the two hospital groups. Although the length of stay was shorter among the Michigan ICUs after implementation of the Keystone project, there was not a statistically significant difference compared to baseline.

Although study involved data from more than 1 million ICU admissions, the researchers acknowledged that it was underpowered to detect the 0.1 day length of stay reduction they had originally projected.

"We knew that when we applied safety science principles to the delivery of health care, we would dramatically reduce infections in intensive care units, and now we know we are also saving lives," Dr. Peter J. Pronovost, one of the study authors and a professor of anesthesiology and critical care medicine at the Johns Hopkins University, Baltimore, said in a statement.

The Keystone Project, which was launched in 2003, has been touted as a national model by the Obama administration. The initiative promotes a culture of patient safety, encourages better communication among ICU staff, and uses checklists to remind providers to perform certain tasks. To prevent catheter-related bloodstream infections, the project promotes hand washing, full barrier precautions, skin antisepsis with chlorhexidine, avoiding the femoral site during catheter insertion, and removing unnecessary catheters. The interventions promoted for preventing ventilator-associated pneumonia included semirecumbent positioning, daily interruption of sedation infusions, and prophylaxis for peptic ulcer disease and deep venous thrombosis.

The researchers received no financial support for the study. However, they received funding from the Agency for Healthcare Research and Quality, the National Patient Safety Agency, and private philanthropic groups to expand the Keystone project to all 50 states.

A public health project aimed at reducing rates of health care–associated infections in Michigan intensive care units is associated with reduced mortality among patients aged 65 years and older, according to a retrospective study comparing Michigan ICU patients to ICU patients in other Midwest hospitals.

The study examined the impact of a quality improvement initiative, known as the Michigan Keystone ICU project, which used a series of evidence-based practices to reduce rates of catheter-related bloodstream infections and ventilator-associated pneumonia. While previous studies have shown that the Keystone project substantially reduced infection rates for up to 36 months after implementation, this is the first study to show a significant reduction in hospital mortality following implementation of the project. The study was published on Jan. 31 in the British Medical Journal (doi: 10.1136/bmj.d219).

Using Medicare claims data for patients aged 65 years and older who were admitted to ICUs, the researchers compared mortality and length of stay among patients in 95 Michigan ICUs and patients in 364 ICUs in surrounding Midwest states. The researchers compared mortality and length of stay before implementation of the Keystone project, during the project’s initiation and implementation, and post implementation.

They found that reductions in mortality were significantly greater during the postimplementation months for the study group. The adjust odds ratios for mortality at postimplementation months 1-12 were 0.83 vs. 0.88 for the study vs. the comparison group, respectively. During months 13-22, those odds ratios were 0.76 vs. 0.84.

There was no significant difference in length of stay between the two hospital groups. Although the length of stay was shorter among the Michigan ICUs after implementation of the Keystone project, there was not a statistically significant difference compared to baseline.

Although study involved data from more than 1 million ICU admissions, the researchers acknowledged that it was underpowered to detect the 0.1 day length of stay reduction they had originally projected.

"We knew that when we applied safety science principles to the delivery of health care, we would dramatically reduce infections in intensive care units, and now we know we are also saving lives," Dr. Peter J. Pronovost, one of the study authors and a professor of anesthesiology and critical care medicine at the Johns Hopkins University, Baltimore, said in a statement.

The Keystone Project, which was launched in 2003, has been touted as a national model by the Obama administration. The initiative promotes a culture of patient safety, encourages better communication among ICU staff, and uses checklists to remind providers to perform certain tasks. To prevent catheter-related bloodstream infections, the project promotes hand washing, full barrier precautions, skin antisepsis with chlorhexidine, avoiding the femoral site during catheter insertion, and removing unnecessary catheters. The interventions promoted for preventing ventilator-associated pneumonia included semirecumbent positioning, daily interruption of sedation infusions, and prophylaxis for peptic ulcer disease and deep venous thrombosis.

The researchers received no financial support for the study. However, they received funding from the Agency for Healthcare Research and Quality, the National Patient Safety Agency, and private philanthropic groups to expand the Keystone project to all 50 states.

A public health project aimed at reducing rates of health care–associated infections in Michigan intensive care units is associated with reduced mortality among patients aged 65 years and older, according to a retrospective study comparing Michigan ICU patients to ICU patients in other Midwest hospitals.

The study examined the impact of a quality improvement initiative, known as the Michigan Keystone ICU project, which used a series of evidence-based practices to reduce rates of catheter-related bloodstream infections and ventilator-associated pneumonia. While previous studies have shown that the Keystone project substantially reduced infection rates for up to 36 months after implementation, this is the first study to show a significant reduction in hospital mortality following implementation of the project. The study was published on Jan. 31 in the British Medical Journal (doi: 10.1136/bmj.d219).

Using Medicare claims data for patients aged 65 years and older who were admitted to ICUs, the researchers compared mortality and length of stay among patients in 95 Michigan ICUs and patients in 364 ICUs in surrounding Midwest states. The researchers compared mortality and length of stay before implementation of the Keystone project, during the project’s initiation and implementation, and post implementation.

They found that reductions in mortality were significantly greater during the postimplementation months for the study group. The adjust odds ratios for mortality at postimplementation months 1-12 were 0.83 vs. 0.88 for the study vs. the comparison group, respectively. During months 13-22, those odds ratios were 0.76 vs. 0.84.

There was no significant difference in length of stay between the two hospital groups. Although the length of stay was shorter among the Michigan ICUs after implementation of the Keystone project, there was not a statistically significant difference compared to baseline.

Although study involved data from more than 1 million ICU admissions, the researchers acknowledged that it was underpowered to detect the 0.1 day length of stay reduction they had originally projected.

"We knew that when we applied safety science principles to the delivery of health care, we would dramatically reduce infections in intensive care units, and now we know we are also saving lives," Dr. Peter J. Pronovost, one of the study authors and a professor of anesthesiology and critical care medicine at the Johns Hopkins University, Baltimore, said in a statement.

The Keystone Project, which was launched in 2003, has been touted as a national model by the Obama administration. The initiative promotes a culture of patient safety, encourages better communication among ICU staff, and uses checklists to remind providers to perform certain tasks. To prevent catheter-related bloodstream infections, the project promotes hand washing, full barrier precautions, skin antisepsis with chlorhexidine, avoiding the femoral site during catheter insertion, and removing unnecessary catheters. The interventions promoted for preventing ventilator-associated pneumonia included semirecumbent positioning, daily interruption of sedation infusions, and prophylaxis for peptic ulcer disease and deep venous thrombosis.

The researchers received no financial support for the study. However, they received funding from the Agency for Healthcare Research and Quality, the National Patient Safety Agency, and private philanthropic groups to expand the Keystone project to all 50 states.

As one of the early hospitalists, Dr. Bradley Flansbaum has seen the good, the bad, and the ugly of hospital medicine.

Dr. Flansbaum, of Lenox Hill Hospital in New York City, said that he's weathered personnel changes, financial setbacks, and takeovers by larger systems during his 15 years as a hospitalist working in New York. "I've seen a lot of change," he said.

But instead of turning him off from the specialty, experiencing the turmoil that can occur in a hospitalist program only served to fuel his fascination with hospital functions, economics, and health policy.

Today, Dr. Flansbaum enjoys taking a macro view of the health care system, focusing on policy issues and population health. "I've become less involved with the nuts and I've become more aware of the big picture," he said.

For instance, last year he helped launch a cooking and nutrition class for residents at Lenox Hill. During the class, residents get six lecture sessions on diet and nutrition followed by hands-on cooking classes at the Institute of Culinary Education. The cooking classes focus on teaching residents to prepare a variety of healthy foods on a small budget. Dr. Flansbaum is one of the instructors, as is his colleague Dr. Robert Graham, associate program director in the department of medicine at Lenox Hill.

The idea is for the residents to take what they learn in the class and use it when counseling their patients in the hospital, but it remains a challenge, Dr. Flansbaum said. Physicians only have a few encounters over a few days to make a lasting impression. Even when residents focus on a single lesson, such as reducing consumption of soda, it's unlikely to be effective if it's not reinforced after leaving the hospital, he said.

And it can't just be physicians who try to deal with society's bad dietary and exercise habits. The policies need to come from the government and work their way down to food manufacturers as well as to health care providers. "The physician community can't be looked upon as the sole answer for eliminating a lot of the potentially reversible causes of morbidity and mortality," he said.

As a founding member of the Society of Hospital Medicine, Dr. Flansbaum has a good view on how far the specialty has come. Last November, the hospitalist society was granted official membership in the American Medical Association, to which Dr. Flansbaum is the SHM's delegate. The upgrade to membership means that the society will have a vote in the AMA's House of Delegates.

There is some important symbolism in being accepted into the AMA. "Sitting at the table is important because it does give us a voice and it does give us some heft to say that we're recognized professionally and that we're a real society and we're a real recognized career," he said.

But whether it will advance the SHM's public policy agenda any faster is anybody's guess, Dr. Flansbaum said. Right now, many hospitalists and other specialists question the AMA's relevance and whether their "home" is really with the AMA. Regardless, the AMA is still seen as the voice of organized medicine by the public, he said, and often by lawmakers too.

For his part, Dr. Flansbaum said that he feels most at home within SHM. He remembers when the society had just 50 members, not 10,000. And it's the interaction with his hospitalist colleagues around the country that keeps him energized, he said.

"It's broadened my horizons getting to know people who practice hospital medicine around the country," Dr. Flansbaum said. "You have a bigger world view."

As one of the early hospitalists, Dr. Bradley Flansbaum has seen the good, the bad, and the ugly of hospital medicine.

Dr. Flansbaum, of Lenox Hill Hospital in New York City, said that he's weathered personnel changes, financial setbacks, and takeovers by larger systems during his 15 years as a hospitalist working in New York. "I've seen a lot of change," he said.

But instead of turning him off from the specialty, experiencing the turmoil that can occur in a hospitalist program only served to fuel his fascination with hospital functions, economics, and health policy.

Today, Dr. Flansbaum enjoys taking a macro view of the health care system, focusing on policy issues and population health. "I've become less involved with the nuts and I've become more aware of the big picture," he said.

For instance, last year he helped launch a cooking and nutrition class for residents at Lenox Hill. During the class, residents get six lecture sessions on diet and nutrition followed by hands-on cooking classes at the Institute of Culinary Education. The cooking classes focus on teaching residents to prepare a variety of healthy foods on a small budget. Dr. Flansbaum is one of the instructors, as is his colleague Dr. Robert Graham, associate program director in the department of medicine at Lenox Hill.

The idea is for the residents to take what they learn in the class and use it when counseling their patients in the hospital, but it remains a challenge, Dr. Flansbaum said. Physicians only have a few encounters over a few days to make a lasting impression. Even when residents focus on a single lesson, such as reducing consumption of soda, it's unlikely to be effective if it's not reinforced after leaving the hospital, he said.

And it can't just be physicians who try to deal with society's bad dietary and exercise habits. The policies need to come from the government and work their way down to food manufacturers as well as to health care providers. "The physician community can't be looked upon as the sole answer for eliminating a lot of the potentially reversible causes of morbidity and mortality," he said.

As a founding member of the Society of Hospital Medicine, Dr. Flansbaum has a good view on how far the specialty has come. Last November, the hospitalist society was granted official membership in the American Medical Association, to which Dr. Flansbaum is the SHM's delegate. The upgrade to membership means that the society will have a vote in the AMA's House of Delegates.

There is some important symbolism in being accepted into the AMA. "Sitting at the table is important because it does give us a voice and it does give us some heft to say that we're recognized professionally and that we're a real society and we're a real recognized career," he said.

But whether it will advance the SHM's public policy agenda any faster is anybody's guess, Dr. Flansbaum said. Right now, many hospitalists and other specialists question the AMA's relevance and whether their "home" is really with the AMA. Regardless, the AMA is still seen as the voice of organized medicine by the public, he said, and often by lawmakers too.

For his part, Dr. Flansbaum said that he feels most at home within SHM. He remembers when the society had just 50 members, not 10,000. And it's the interaction with his hospitalist colleagues around the country that keeps him energized, he said.

"It's broadened my horizons getting to know people who practice hospital medicine around the country," Dr. Flansbaum said. "You have a bigger world view."

As one of the early hospitalists, Dr. Bradley Flansbaum has seen the good, the bad, and the ugly of hospital medicine.

Dr. Flansbaum, of Lenox Hill Hospital in New York City, said that he's weathered personnel changes, financial setbacks, and takeovers by larger systems during his 15 years as a hospitalist working in New York. "I've seen a lot of change," he said.

But instead of turning him off from the specialty, experiencing the turmoil that can occur in a hospitalist program only served to fuel his fascination with hospital functions, economics, and health policy.

Today, Dr. Flansbaum enjoys taking a macro view of the health care system, focusing on policy issues and population health. "I've become less involved with the nuts and I've become more aware of the big picture," he said.

For instance, last year he helped launch a cooking and nutrition class for residents at Lenox Hill. During the class, residents get six lecture sessions on diet and nutrition followed by hands-on cooking classes at the Institute of Culinary Education. The cooking classes focus on teaching residents to prepare a variety of healthy foods on a small budget. Dr. Flansbaum is one of the instructors, as is his colleague Dr. Robert Graham, associate program director in the department of medicine at Lenox Hill.

The idea is for the residents to take what they learn in the class and use it when counseling their patients in the hospital, but it remains a challenge, Dr. Flansbaum said. Physicians only have a few encounters over a few days to make a lasting impression. Even when residents focus on a single lesson, such as reducing consumption of soda, it's unlikely to be effective if it's not reinforced after leaving the hospital, he said.

And it can't just be physicians who try to deal with society's bad dietary and exercise habits. The policies need to come from the government and work their way down to food manufacturers as well as to health care providers. "The physician community can't be looked upon as the sole answer for eliminating a lot of the potentially reversible causes of morbidity and mortality," he said.

As a founding member of the Society of Hospital Medicine, Dr. Flansbaum has a good view on how far the specialty has come. Last November, the hospitalist society was granted official membership in the American Medical Association, to which Dr. Flansbaum is the SHM's delegate. The upgrade to membership means that the society will have a vote in the AMA's House of Delegates.

There is some important symbolism in being accepted into the AMA. "Sitting at the table is important because it does give us a voice and it does give us some heft to say that we're recognized professionally and that we're a real society and we're a real recognized career," he said.

But whether it will advance the SHM's public policy agenda any faster is anybody's guess, Dr. Flansbaum said. Right now, many hospitalists and other specialists question the AMA's relevance and whether their "home" is really with the AMA. Regardless, the AMA is still seen as the voice of organized medicine by the public, he said, and often by lawmakers too.

For his part, Dr. Flansbaum said that he feels most at home within SHM. He remembers when the society had just 50 members, not 10,000. And it's the interaction with his hospitalist colleagues around the country that keeps him energized, he said.

"It's broadened my horizons getting to know people who practice hospital medicine around the country," Dr. Flansbaum said. "You have a bigger world view."

A new federal initiative offering bonus payments to physicians who successfully implement electronic health records launched Jan. 3, and early signs indicate it could help spur adoption of the technology.

Officials in the Office of the National Coordinator for Health Information Technology recently released two surveys showing that more than 40% of office-based physicians and 80% of hospitals plan to seek federal incentives for the adoption and use of EHRs under Medicare and Medicaid.

The incentive programs, which launched at the start of the year, offer payments to physicians for using health information technology (HIT) to improve patient care. The federal government recently issued regulations detailing how physicians and hospitals can meet standards for so-called “meaningful use” of the technology. Physicians who meet the criteria are eligible to receive up to $44,000 over 5 years under the Medicare program or $63,750 in 6 years under the Medicaid program. Eligible hospitals could receive millions of dollars, according to the Centers for Medicare and Medicaid Services (CMS).

The survey of office-based physicians, conducted by the Centers for Disease Control and Prevention, found that 41% plan to achieve meaningful use and seek federal incentive payments. Of those, about 80% said that they plan to enroll during first stage of the program, this year or next.

A separate survey, conducted by the American Hospital Association, found that 81% of hospitals plan to achieve meaningful use and apply for incentive payments, with about 65% enrolling in the same time frame.

Although the federal government has promoted these incentives for more than a year, it was uncertain whether physicians would choose to participate.

Officials at the American Academy of Family Physicians said that while they do not have concrete data, informal polls of their members show high interest in the incentives. Dr. Steven Waldren, director of the Center for Health IT at the AAFP, said that among physicians who attended lectures on meaningful use at the group's annual meeting last fall, about 80% reported that they use an EHR in their practice and about 90% said they plan to try to achieve meaningful use this year.

It's a biased sample, Dr. Waldren said, but it still paints a picture. “What it kind of tells us is that there are a lot of doctors out there, especially those who have adopted the technology, [who] are trying to figure out how to be meaningful users in 2011.”

Dr. Waldren recommended that physicians seek out the Regional Extension Centers set up by the federal government. These centers have been established around the country and are specifically charged with aiding small practices, primary care physicians, and those working in underserved areas. But he also cautioned that the level of expertise may vary by center.

While many of the barriers to EHR adoption remain the same, the financial incentives seem to be helping physicians who were “on the fence,” move in the direction of purchasing a system, said Dr. Michael S. Barr, a senior vice president at the American College of Physicians.

The success of the program can't be judged, he said, at least until figures are available on how many physicians met the stage 1 meaningful use standards, said Dr. Barr, who also serves on the Health IT Policy Committee's meaningful use workgroup. As the incentive program progresses and the quality measures become more robust, the data that are reported should also show whether the program has resulted in improvements in clinical quality of care, he said.

A lot of doctors out there are trying to figure out how to be meaningful users in 2011.

Source DR. WALDREN

A new federal initiative offering bonus payments to physicians who successfully implement electronic health records launched Jan. 3, and early signs indicate it could help spur adoption of the technology.

Officials in the Office of the National Coordinator for Health Information Technology recently released two surveys showing that more than 40% of office-based physicians and 80% of hospitals plan to seek federal incentives for the adoption and use of EHRs under Medicare and Medicaid.

The incentive programs, which launched at the start of the year, offer payments to physicians for using health information technology (HIT) to improve patient care. The federal government recently issued regulations detailing how physicians and hospitals can meet standards for so-called “meaningful use” of the technology. Physicians who meet the criteria are eligible to receive up to $44,000 over 5 years under the Medicare program or $63,750 in 6 years under the Medicaid program. Eligible hospitals could receive millions of dollars, according to the Centers for Medicare and Medicaid Services (CMS).

The survey of office-based physicians, conducted by the Centers for Disease Control and Prevention, found that 41% plan to achieve meaningful use and seek federal incentive payments. Of those, about 80% said that they plan to enroll during first stage of the program, this year or next.

A separate survey, conducted by the American Hospital Association, found that 81% of hospitals plan to achieve meaningful use and apply for incentive payments, with about 65% enrolling in the same time frame.

Although the federal government has promoted these incentives for more than a year, it was uncertain whether physicians would choose to participate.

Officials at the American Academy of Family Physicians said that while they do not have concrete data, informal polls of their members show high interest in the incentives. Dr. Steven Waldren, director of the Center for Health IT at the AAFP, said that among physicians who attended lectures on meaningful use at the group's annual meeting last fall, about 80% reported that they use an EHR in their practice and about 90% said they plan to try to achieve meaningful use this year.

It's a biased sample, Dr. Waldren said, but it still paints a picture. “What it kind of tells us is that there are a lot of doctors out there, especially those who have adopted the technology, [who] are trying to figure out how to be meaningful users in 2011.”

Dr. Waldren recommended that physicians seek out the Regional Extension Centers set up by the federal government. These centers have been established around the country and are specifically charged with aiding small practices, primary care physicians, and those working in underserved areas. But he also cautioned that the level of expertise may vary by center.

While many of the barriers to EHR adoption remain the same, the financial incentives seem to be helping physicians who were “on the fence,” move in the direction of purchasing a system, said Dr. Michael S. Barr, a senior vice president at the American College of Physicians.

The success of the program can't be judged, he said, at least until figures are available on how many physicians met the stage 1 meaningful use standards, said Dr. Barr, who also serves on the Health IT Policy Committee's meaningful use workgroup. As the incentive program progresses and the quality measures become more robust, the data that are reported should also show whether the program has resulted in improvements in clinical quality of care, he said.

A lot of doctors out there are trying to figure out how to be meaningful users in 2011.

Source DR. WALDREN

A new federal initiative offering bonus payments to physicians who successfully implement electronic health records launched Jan. 3, and early signs indicate it could help spur adoption of the technology.

Officials in the Office of the National Coordinator for Health Information Technology recently released two surveys showing that more than 40% of office-based physicians and 80% of hospitals plan to seek federal incentives for the adoption and use of EHRs under Medicare and Medicaid.

The incentive programs, which launched at the start of the year, offer payments to physicians for using health information technology (HIT) to improve patient care. The federal government recently issued regulations detailing how physicians and hospitals can meet standards for so-called “meaningful use” of the technology. Physicians who meet the criteria are eligible to receive up to $44,000 over 5 years under the Medicare program or $63,750 in 6 years under the Medicaid program. Eligible hospitals could receive millions of dollars, according to the Centers for Medicare and Medicaid Services (CMS).

The survey of office-based physicians, conducted by the Centers for Disease Control and Prevention, found that 41% plan to achieve meaningful use and seek federal incentive payments. Of those, about 80% said that they plan to enroll during first stage of the program, this year or next.

A separate survey, conducted by the American Hospital Association, found that 81% of hospitals plan to achieve meaningful use and apply for incentive payments, with about 65% enrolling in the same time frame.

Although the federal government has promoted these incentives for more than a year, it was uncertain whether physicians would choose to participate.

Officials at the American Academy of Family Physicians said that while they do not have concrete data, informal polls of their members show high interest in the incentives. Dr. Steven Waldren, director of the Center for Health IT at the AAFP, said that among physicians who attended lectures on meaningful use at the group's annual meeting last fall, about 80% reported that they use an EHR in their practice and about 90% said they plan to try to achieve meaningful use this year.

It's a biased sample, Dr. Waldren said, but it still paints a picture. “What it kind of tells us is that there are a lot of doctors out there, especially those who have adopted the technology, [who] are trying to figure out how to be meaningful users in 2011.”

Dr. Waldren recommended that physicians seek out the Regional Extension Centers set up by the federal government. These centers have been established around the country and are specifically charged with aiding small practices, primary care physicians, and those working in underserved areas. But he also cautioned that the level of expertise may vary by center.

While many of the barriers to EHR adoption remain the same, the financial incentives seem to be helping physicians who were “on the fence,” move in the direction of purchasing a system, said Dr. Michael S. Barr, a senior vice president at the American College of Physicians.

The success of the program can't be judged, he said, at least until figures are available on how many physicians met the stage 1 meaningful use standards, said Dr. Barr, who also serves on the Health IT Policy Committee's meaningful use workgroup. As the incentive program progresses and the quality measures become more robust, the data that are reported should also show whether the program has resulted in improvements in clinical quality of care, he said.

A lot of doctors out there are trying to figure out how to be meaningful users in 2011.

Source DR. WALDREN

Medical schools should devote more time to teaching students about care coordination, population health, and electronic health records so that students will be ready to be a part of the patient-centered medical home, according to a new report from four groups representing primary care physicians.

In a joint principles document, the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, and American Osteopathic Association outlined how all medical schools can provide students with a foundation in the elements of the medical home, regardless of whether they plan to pursue a career in primary care.

The groups recommend that students learn about the principles of the medical home, such as being a personal physician, leading a team of providers, providing care for the “whole person,” coordinating care across the health care system, improving the quality and safety of care, and providing enhanced access.

For example, as part of the principle of whole-person orientation, the groups recommend that medical students practice motivational interviewing as way of encouraging behavioral change. They also recommend that students work with health coaches who care for patients with complex conditions.

In learning about care coordination, the groups call for students to become familiar with electronic health records, e-visits, and electronic billing; learn to access online medical information; and use health information technology in their own continuing education.

The report also recommends that medical schools teach physician payment methodologies and current trends in health care costs.

While medical schools today teach some elements of the medical home model, such as the continuum of care, there's not a focus on the medical home itself, said Dr. O. Marion Burton, president of the AAP and associate dean for clinical affairs at the University of South Carolina, Columbia.

He said that he expects medical schools to embrace the recommendations for teaching the medical home, but that it will take 3–4 years for most institutions to do so. The first step, which could take a year or more, will be to recruit new faculty members with experience with the medical home concepts. The next step will be to determine exactly how to teach the model, whether through lectures or more hands-on training, or some combination of approaches. And it may take another year to integrate the subject matter into the existing curriculum, he said.

The major sticking point may simply be finding the time in an already packed curriculum, said Dr. Michael S. Barr, an ACP senior vice president. The challenge for medical school officials, he said in an interview, will be figuring out what to take out of the current curriculum while still ensuring that physicians are prepared to enter residency training.

Medical schools should devote more time to teaching students about care coordination, population health, and electronic health records so that students will be ready to be a part of the patient-centered medical home, according to a new report from four groups representing primary care physicians.

In a joint principles document, the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, and American Osteopathic Association outlined how all medical schools can provide students with a foundation in the elements of the medical home, regardless of whether they plan to pursue a career in primary care.

The groups recommend that students learn about the principles of the medical home, such as being a personal physician, leading a team of providers, providing care for the “whole person,” coordinating care across the health care system, improving the quality and safety of care, and providing enhanced access.

For example, as part of the principle of whole-person orientation, the groups recommend that medical students practice motivational interviewing as way of encouraging behavioral change. They also recommend that students work with health coaches who care for patients with complex conditions.

In learning about care coordination, the groups call for students to become familiar with electronic health records, e-visits, and electronic billing; learn to access online medical information; and use health information technology in their own continuing education.

The report also recommends that medical schools teach physician payment methodologies and current trends in health care costs.

While medical schools today teach some elements of the medical home model, such as the continuum of care, there's not a focus on the medical home itself, said Dr. O. Marion Burton, president of the AAP and associate dean for clinical affairs at the University of South Carolina, Columbia.

He said that he expects medical schools to embrace the recommendations for teaching the medical home, but that it will take 3–4 years for most institutions to do so. The first step, which could take a year or more, will be to recruit new faculty members with experience with the medical home concepts. The next step will be to determine exactly how to teach the model, whether through lectures or more hands-on training, or some combination of approaches. And it may take another year to integrate the subject matter into the existing curriculum, he said.

The major sticking point may simply be finding the time in an already packed curriculum, said Dr. Michael S. Barr, an ACP senior vice president. The challenge for medical school officials, he said in an interview, will be figuring out what to take out of the current curriculum while still ensuring that physicians are prepared to enter residency training.

Medical schools should devote more time to teaching students about care coordination, population health, and electronic health records so that students will be ready to be a part of the patient-centered medical home, according to a new report from four groups representing primary care physicians.

In a joint principles document, the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, and American Osteopathic Association outlined how all medical schools can provide students with a foundation in the elements of the medical home, regardless of whether they plan to pursue a career in primary care.

The groups recommend that students learn about the principles of the medical home, such as being a personal physician, leading a team of providers, providing care for the “whole person,” coordinating care across the health care system, improving the quality and safety of care, and providing enhanced access.

For example, as part of the principle of whole-person orientation, the groups recommend that medical students practice motivational interviewing as way of encouraging behavioral change. They also recommend that students work with health coaches who care for patients with complex conditions.

In learning about care coordination, the groups call for students to become familiar with electronic health records, e-visits, and electronic billing; learn to access online medical information; and use health information technology in their own continuing education.

The report also recommends that medical schools teach physician payment methodologies and current trends in health care costs.

While medical schools today teach some elements of the medical home model, such as the continuum of care, there's not a focus on the medical home itself, said Dr. O. Marion Burton, president of the AAP and associate dean for clinical affairs at the University of South Carolina, Columbia.

He said that he expects medical schools to embrace the recommendations for teaching the medical home, but that it will take 3–4 years for most institutions to do so. The first step, which could take a year or more, will be to recruit new faculty members with experience with the medical home concepts. The next step will be to determine exactly how to teach the model, whether through lectures or more hands-on training, or some combination of approaches. And it may take another year to integrate the subject matter into the existing curriculum, he said.

The major sticking point may simply be finding the time in an already packed curriculum, said Dr. Michael S. Barr, an ACP senior vice president. The challenge for medical school officials, he said in an interview, will be figuring out what to take out of the current curriculum while still ensuring that physicians are prepared to enter residency training.

Medicare officials on Dec. 30 launched a new online tool that allows consumers to locate physicians in their communities and get information about their specialties, degrees, and other training.

The new tool, called Physician Compare, is available online at www.medicare.gov/find-a-doctorwww.hospitalcompare.hhs.gov

Currently, the Physician Compare Web site contains mostly practice information. However, it does let consumers know whether the practice reported quality data to the Centers for Medicare and Medicaid Services under the Physician Quality Reporting System. The PQRI is a voluntary program “that rewards physicians and other eligible healthcare professionals for reporting data on quality measures related to services furnished to Medicare beneficiaries,” according to the press release announcing the launch of Physician Compare. More than 200,000 physicians and other health care providers reported data to the CMS under the voluntary system in 2009.

“The new Physician Compare tool begins to fill an important gap in our online tools by providing more information about physicians and other health care workers,” Dr. Donald Berwick, CMS administrator, said in a statement. “This helps to pave the way for consumers” to have information about physicians as they do for nursing homes, home health agencies, and health and drug plans, Dr. Berwick noted.

Later this year, officials at the CMS plan to add information to Physician Compare about whether doctors are participating in the voluntary electronic prescribing program. Under the Affordable Care Act, the CMS is required to expand the Web site to include information on quality of care and patient experience data by 2013.

Medicare officials on Dec. 30 launched a new online tool that allows consumers to locate physicians in their communities and get information about their specialties, degrees, and other training.

The new tool, called Physician Compare, is available online at www.medicare.gov/find-a-doctorwww.hospitalcompare.hhs.gov

Currently, the Physician Compare Web site contains mostly practice information. However, it does let consumers know whether the practice reported quality data to the Centers for Medicare and Medicaid Services under the Physician Quality Reporting System. The PQRI is a voluntary program “that rewards physicians and other eligible healthcare professionals for reporting data on quality measures related to services furnished to Medicare beneficiaries,” according to the press release announcing the launch of Physician Compare. More than 200,000 physicians and other health care providers reported data to the CMS under the voluntary system in 2009.

“The new Physician Compare tool begins to fill an important gap in our online tools by providing more information about physicians and other health care workers,” Dr. Donald Berwick, CMS administrator, said in a statement. “This helps to pave the way for consumers” to have information about physicians as they do for nursing homes, home health agencies, and health and drug plans, Dr. Berwick noted.

Later this year, officials at the CMS plan to add information to Physician Compare about whether doctors are participating in the voluntary electronic prescribing program. Under the Affordable Care Act, the CMS is required to expand the Web site to include information on quality of care and patient experience data by 2013.

Medicare officials on Dec. 30 launched a new online tool that allows consumers to locate physicians in their communities and get information about their specialties, degrees, and other training.

The new tool, called Physician Compare, is available online at www.medicare.gov/find-a-doctorwww.hospitalcompare.hhs.gov

Currently, the Physician Compare Web site contains mostly practice information. However, it does let consumers know whether the practice reported quality data to the Centers for Medicare and Medicaid Services under the Physician Quality Reporting System. The PQRI is a voluntary program “that rewards physicians and other eligible healthcare professionals for reporting data on quality measures related to services furnished to Medicare beneficiaries,” according to the press release announcing the launch of Physician Compare. More than 200,000 physicians and other health care providers reported data to the CMS under the voluntary system in 2009.

“The new Physician Compare tool begins to fill an important gap in our online tools by providing more information about physicians and other health care workers,” Dr. Donald Berwick, CMS administrator, said in a statement. “This helps to pave the way for consumers” to have information about physicians as they do for nursing homes, home health agencies, and health and drug plans, Dr. Berwick noted.

Later this year, officials at the CMS plan to add information to Physician Compare about whether doctors are participating in the voluntary electronic prescribing program. Under the Affordable Care Act, the CMS is required to expand the Web site to include information on quality of care and patient experience data by 2013.

With lawsuits and regulatory scrutiny increasing, pharmaceutical companies are tightening the reins on their promotional programs. But now physicians are pushing back, asserting their right to go off the script even when they're being paid by the drug companies.

“No respectable speaker wants to recite a company's [slide] deck,” said Dr. Selim R. Benbadis, director of the comprehensive epilepsy program at the University of South Florida and Tampa General Hospital, who also does promotional speaking for drug companies at so-called dinner talks.

For Dr. Benbadis, getting the drug companies to give back some of the control over these promotional talks has become a “crusade” of sorts. He has reached out to many notable physicians in the epilepsy community and to the drug companies themselves in an effort to find some common ground.

Last fall, he and five other academic epilepsy specialists penned an open letter to the pharmaceutical industry, telling them in no uncertain terms that they would not simply present a company's slide deck.

“No expertise is needed to recite the company's slides, and this can be easily done by pharmaceutical representatives ('drug reps'),” they wrote. “We want to educate physicians more broadly, and believe it can be done ethically and legally while still delivering a useful message for both sides.” The letter was published in the journal Epilepsy & Behavior (2010;19:544-5).

Although most drug companies have long maintained an official policy that their slides be presented without editing, the common practice of speakers has been to add some of their own slides to try to craft a talk that was broader and more informative than a presentation on a single drug.

“The companies never liked this, but they had what I call a 'don't ask, don't tell' policy,” Dr. Benbadis said.

But in the last couple of years, largely because of lawsuits about off-label promotion, the pharmaceutical companies have begun to enforce their existing policies. That shift has been frustrating for many physicians who give these types of promotional talks, Dr. Benbadis said. The lack of freedom to add their own slides makes physicians less likely to want to give the presentations, he said, but it also makes the talks much less interesting for attendees.

The Pharmaceutical Research and Manufacturers of America (PhRMA), which represents the drug and biotechnology industry, said that companies provide physician speakers with materials to ensure that the content of these talks complies with language approved by the Food and Drug Administration.

“While companies take great pains to ensure that the physicians they engage to speak on their behalf are experts in their field, the companies themselves remain responsible for the content of the program,” Diane Bieri, PhRMA executive vice president and general counsel, said in a statement. “At the end of the day, [the FDA] expects and demands compliance, and rightly so.”

The open letter published in Epilepsy & Behavior offered a few suggestions for new ways to approach these talks. The preferred option, the authors wrote, would be for drug companies to give unrestricted educational grants to CME-granting institutions for educational programs for physicians. Short of that, the companies could make the faculty responsible for the content of the talk. For example, pharmaceutical companies could ask their faculty speakers to sign a waiver exonerating the company of liability for any claims they make.

Another possibility would be to create a new type of educational event that would be not quite CME but not quite a promotional program.

Finally, the authors suggested that companies could allow a two-part program with a promotional portion and an educational portion.

Since the letter was published, there has been some progress, Dr. Benbadis said. In general, representatives from the drug companies agree that some type of accommodation needs to be made, he said, although some are more willing than others to do this. A couple of the companies are working with their speakers to create a large set of company-approved slides that include not only promotional material on the drug, but also disease-state slides. That would allow speakers to put together a talk from a larger and more diverse pool of company-approved materials.

Meanwhile, other companies have signaled their willingness to allow speakers to create different talks, and have approved those talks on an individual basis. But because the process is time consuming, Dr. Benbadis said those companies aren't advertising the availability of that option.

A shift back toward greater flexibility is critical if these talks are going to survive, Dr. Benbadis said. “These talks serve a purpose, I think, for the companies and for us and for the community.”

But other physicians see CME talks as a better alternative for physician education.

Dr. Jacqueline A. French, a professor of neurology at New York University and the president of the Epilepsy Study Consortium, said that the restrictions currently in place regarding the dinner talks make it very difficult to provide open and unbiased information.

Promotional talks do help to fill a gap in education. Dr. French, who does not give promotional talks, said that a cessation of the dinner talks would make it harder for physicians in private practice to get practical information about drug treatments. Generally, physicians in private practice don't attend grand rounds–type lectures, which are usually focused on the science behind a disease rather than on therapeutics. But restrictions on what physicians can say about off-label prescribing severely limit what can be discussed at a dinner talk, she said, making such talks a less-viable option.

The situation highlights the gap that exists in medical education, she said. Educators need to start thinking of creative ways to get information out to physicians so they can stay up to date on new therapeutics, Dr. French said.

Susan Chimonas, Ph.D., codirector of research at the Institute on Medicine as a Profession at Columbia University, New York, agrees that providing medical education under the umbrella of CME is a better option. Although the authors of the open letter are well intentioned, Dr. Chimonas said, there are many proposals for better ways to organize medical education, and physicians would be better served by working toward that goal rather than trying to figure out how to tweak the industry talks so that they are “less offensive.”

Promotional talks are useful for the drug companies, but they tend to undermine public trust in the medical profession and put physicians into the uncomfortable position of being drug marketers, she said.

“I suspect that this practice is sticking around because it works for industry and it works for the people who participate in it,” Dr. Chimonas said. “If you take it away, industry will move on and figure out other ways to influence and physicians will find other ways, that are probably better, to stay up to date,” she said.

With lawsuits and regulatory scrutiny increasing, pharmaceutical companies are tightening the reins on their promotional programs. But now physicians are pushing back, asserting their right to go off the script even when they're being paid by the drug companies.

“No respectable speaker wants to recite a company's [slide] deck,” said Dr. Selim R. Benbadis, director of the comprehensive epilepsy program at the University of South Florida and Tampa General Hospital, who also does promotional speaking for drug companies at so-called dinner talks.

For Dr. Benbadis, getting the drug companies to give back some of the control over these promotional talks has become a “crusade” of sorts. He has reached out to many notable physicians in the epilepsy community and to the drug companies themselves in an effort to find some common ground.

Last fall, he and five other academic epilepsy specialists penned an open letter to the pharmaceutical industry, telling them in no uncertain terms that they would not simply present a company's slide deck.

“No expertise is needed to recite the company's slides, and this can be easily done by pharmaceutical representatives ('drug reps'),” they wrote. “We want to educate physicians more broadly, and believe it can be done ethically and legally while still delivering a useful message for both sides.” The letter was published in the journal Epilepsy & Behavior (2010;19:544-5).

Although most drug companies have long maintained an official policy that their slides be presented without editing, the common practice of speakers has been to add some of their own slides to try to craft a talk that was broader and more informative than a presentation on a single drug.

“The companies never liked this, but they had what I call a 'don't ask, don't tell' policy,” Dr. Benbadis said.

But in the last couple of years, largely because of lawsuits about off-label promotion, the pharmaceutical companies have begun to enforce their existing policies. That shift has been frustrating for many physicians who give these types of promotional talks, Dr. Benbadis said. The lack of freedom to add their own slides makes physicians less likely to want to give the presentations, he said, but it also makes the talks much less interesting for attendees.

The Pharmaceutical Research and Manufacturers of America (PhRMA), which represents the drug and biotechnology industry, said that companies provide physician speakers with materials to ensure that the content of these talks complies with language approved by the Food and Drug Administration.

“While companies take great pains to ensure that the physicians they engage to speak on their behalf are experts in their field, the companies themselves remain responsible for the content of the program,” Diane Bieri, PhRMA executive vice president and general counsel, said in a statement. “At the end of the day, [the FDA] expects and demands compliance, and rightly so.”

The open letter published in Epilepsy & Behavior offered a few suggestions for new ways to approach these talks. The preferred option, the authors wrote, would be for drug companies to give unrestricted educational grants to CME-granting institutions for educational programs for physicians. Short of that, the companies could make the faculty responsible for the content of the talk. For example, pharmaceutical companies could ask their faculty speakers to sign a waiver exonerating the company of liability for any claims they make.

Another possibility would be to create a new type of educational event that would be not quite CME but not quite a promotional program.

Finally, the authors suggested that companies could allow a two-part program with a promotional portion and an educational portion.

Since the letter was published, there has been some progress, Dr. Benbadis said. In general, representatives from the drug companies agree that some type of accommodation needs to be made, he said, although some are more willing than others to do this. A couple of the companies are working with their speakers to create a large set of company-approved slides that include not only promotional material on the drug, but also disease-state slides. That would allow speakers to put together a talk from a larger and more diverse pool of company-approved materials.

Meanwhile, other companies have signaled their willingness to allow speakers to create different talks, and have approved those talks on an individual basis. But because the process is time consuming, Dr. Benbadis said those companies aren't advertising the availability of that option.

A shift back toward greater flexibility is critical if these talks are going to survive, Dr. Benbadis said. “These talks serve a purpose, I think, for the companies and for us and for the community.”

But other physicians see CME talks as a better alternative for physician education.

Dr. Jacqueline A. French, a professor of neurology at New York University and the president of the Epilepsy Study Consortium, said that the restrictions currently in place regarding the dinner talks make it very difficult to provide open and unbiased information.

Promotional talks do help to fill a gap in education. Dr. French, who does not give promotional talks, said that a cessation of the dinner talks would make it harder for physicians in private practice to get practical information about drug treatments. Generally, physicians in private practice don't attend grand rounds–type lectures, which are usually focused on the science behind a disease rather than on therapeutics. But restrictions on what physicians can say about off-label prescribing severely limit what can be discussed at a dinner talk, she said, making such talks a less-viable option.

The situation highlights the gap that exists in medical education, she said. Educators need to start thinking of creative ways to get information out to physicians so they can stay up to date on new therapeutics, Dr. French said.

Susan Chimonas, Ph.D., codirector of research at the Institute on Medicine as a Profession at Columbia University, New York, agrees that providing medical education under the umbrella of CME is a better option. Although the authors of the open letter are well intentioned, Dr. Chimonas said, there are many proposals for better ways to organize medical education, and physicians would be better served by working toward that goal rather than trying to figure out how to tweak the industry talks so that they are “less offensive.”

Promotional talks are useful for the drug companies, but they tend to undermine public trust in the medical profession and put physicians into the uncomfortable position of being drug marketers, she said.

“I suspect that this practice is sticking around because it works for industry and it works for the people who participate in it,” Dr. Chimonas said. “If you take it away, industry will move on and figure out other ways to influence and physicians will find other ways, that are probably better, to stay up to date,” she said.

With lawsuits and regulatory scrutiny increasing, pharmaceutical companies are tightening the reins on their promotional programs. But now physicians are pushing back, asserting their right to go off the script even when they're being paid by the drug companies.

“No respectable speaker wants to recite a company's [slide] deck,” said Dr. Selim R. Benbadis, director of the comprehensive epilepsy program at the University of South Florida and Tampa General Hospital, who also does promotional speaking for drug companies at so-called dinner talks.

For Dr. Benbadis, getting the drug companies to give back some of the control over these promotional talks has become a “crusade” of sorts. He has reached out to many notable physicians in the epilepsy community and to the drug companies themselves in an effort to find some common ground.

Last fall, he and five other academic epilepsy specialists penned an open letter to the pharmaceutical industry, telling them in no uncertain terms that they would not simply present a company's slide deck.

“No expertise is needed to recite the company's slides, and this can be easily done by pharmaceutical representatives ('drug reps'),” they wrote. “We want to educate physicians more broadly, and believe it can be done ethically and legally while still delivering a useful message for both sides.” The letter was published in the journal Epilepsy & Behavior (2010;19:544-5).

Although most drug companies have long maintained an official policy that their slides be presented without editing, the common practice of speakers has been to add some of their own slides to try to craft a talk that was broader and more informative than a presentation on a single drug.

“The companies never liked this, but they had what I call a 'don't ask, don't tell' policy,” Dr. Benbadis said.

But in the last couple of years, largely because of lawsuits about off-label promotion, the pharmaceutical companies have begun to enforce their existing policies. That shift has been frustrating for many physicians who give these types of promotional talks, Dr. Benbadis said. The lack of freedom to add their own slides makes physicians less likely to want to give the presentations, he said, but it also makes the talks much less interesting for attendees.

The Pharmaceutical Research and Manufacturers of America (PhRMA), which represents the drug and biotechnology industry, said that companies provide physician speakers with materials to ensure that the content of these talks complies with language approved by the Food and Drug Administration.

“While companies take great pains to ensure that the physicians they engage to speak on their behalf are experts in their field, the companies themselves remain responsible for the content of the program,” Diane Bieri, PhRMA executive vice president and general counsel, said in a statement. “At the end of the day, [the FDA] expects and demands compliance, and rightly so.”

The open letter published in Epilepsy & Behavior offered a few suggestions for new ways to approach these talks. The preferred option, the authors wrote, would be for drug companies to give unrestricted educational grants to CME-granting institutions for educational programs for physicians. Short of that, the companies could make the faculty responsible for the content of the talk. For example, pharmaceutical companies could ask their faculty speakers to sign a waiver exonerating the company of liability for any claims they make.

Another possibility would be to create a new type of educational event that would be not quite CME but not quite a promotional program.

Finally, the authors suggested that companies could allow a two-part program with a promotional portion and an educational portion.

Since the letter was published, there has been some progress, Dr. Benbadis said. In general, representatives from the drug companies agree that some type of accommodation needs to be made, he said, although some are more willing than others to do this. A couple of the companies are working with their speakers to create a large set of company-approved slides that include not only promotional material on the drug, but also disease-state slides. That would allow speakers to put together a talk from a larger and more diverse pool of company-approved materials.

Meanwhile, other companies have signaled their willingness to allow speakers to create different talks, and have approved those talks on an individual basis. But because the process is time consuming, Dr. Benbadis said those companies aren't advertising the availability of that option.

A shift back toward greater flexibility is critical if these talks are going to survive, Dr. Benbadis said. “These talks serve a purpose, I think, for the companies and for us and for the community.”

But other physicians see CME talks as a better alternative for physician education.

Dr. Jacqueline A. French, a professor of neurology at New York University and the president of the Epilepsy Study Consortium, said that the restrictions currently in place regarding the dinner talks make it very difficult to provide open and unbiased information.

Promotional talks do help to fill a gap in education. Dr. French, who does not give promotional talks, said that a cessation of the dinner talks would make it harder for physicians in private practice to get practical information about drug treatments. Generally, physicians in private practice don't attend grand rounds–type lectures, which are usually focused on the science behind a disease rather than on therapeutics. But restrictions on what physicians can say about off-label prescribing severely limit what can be discussed at a dinner talk, she said, making such talks a less-viable option.

The situation highlights the gap that exists in medical education, she said. Educators need to start thinking of creative ways to get information out to physicians so they can stay up to date on new therapeutics, Dr. French said.

Susan Chimonas, Ph.D., codirector of research at the Institute on Medicine as a Profession at Columbia University, New York, agrees that providing medical education under the umbrella of CME is a better option. Although the authors of the open letter are well intentioned, Dr. Chimonas said, there are many proposals for better ways to organize medical education, and physicians would be better served by working toward that goal rather than trying to figure out how to tweak the industry talks so that they are “less offensive.”

Promotional talks are useful for the drug companies, but they tend to undermine public trust in the medical profession and put physicians into the uncomfortable position of being drug marketers, she said.

“I suspect that this practice is sticking around because it works for industry and it works for the people who participate in it,” Dr. Chimonas said. “If you take it away, industry will move on and figure out other ways to influence and physicians will find other ways, that are probably better, to stay up to date,” she said.

Surgeon General: Breast Is Best

In a “Call to Action,” U.S. Surgeon General Regina Benjamin identified ways that physicians and others can help new mothers stick with breastfeeding. For example, clinicians can get training in how to care for breastfeeding mothers and babies and then give mothers proper how-to advice. About 75% of mothers breastfeed their babies initially, but that number falls to 43% at the end of 6 months, according to 2010 data from the Centers for Disease Control and Prevention. “Many barriers exist for mothers who want to breastfeed,” Dr. Benjamin said in a statement accompanying the report. “They shouldn't have to go it alone. Whether you're a clinician, a family member, a friend, or an employer, you can play an important part in helping mothers who want to breastfeed.” But Dr. Benjamin said that breastfeeding is a personal decision and that women shouldn't be made to feel guilty if they choose not to.

Law Eased Medicaid Expansions

The Affordable Care Act made it easier for states to expand their Medicaid family planning services, according to the Guttmacher Institute. Previously, that could be done only through a waiver process that typically took 2 years to complete, according to the Guttmacher report. But under the health reform law, states have the authority to expand Medicaid without a waiver. 'A strong body of research demonstrates the significant impact of these programs in enabling women to avoid unintended pregnancies and the abortions and births that follow,” said Adam Sonfield, the report's lead author, in a statement. New York, for example, could save $1.6 million a year by avoiding some unintended births, according to the report. The research was supported by a grant from the Centers for Disease Control and Prevention.

New Laws Restrict Abortion

State laws passed in 2010 were far more restrictive of abortion than in favor of abortion rights or access to contraception, according to NARAL Pro-Choice America. Last year, 16 states passed 34 measures that NARAL deemed “antichoice,” the organization reported. For example, Arizona, Louisiana, Mississippi, Missouri, and Tennessee enacted laws that ban abortion coverage in the state-based insurance exchanges set to launch in 2014 under the Affordable Care Act. In contrast, nine states enacted measures that NARAL categorized as “prochoice.” California, for instance, increased protections for the confidentiality of reproductive-health professionals and patients. NARAL President Nancy Keenan said she is concerned that more abortion restrictions will emerge in the coming years because many abortion opponents were elected to Congress, state legislatures, and governorships last fall.

Medicaid Hospital Admissions Rise

Medicaid hospital admissions rose 30% from 1997 to 2008, while admissions of privately insured patients rose only 5%, the Agency for Healthcare Research and Quality found in another analysis. By 2008, Medicaid paid for 18% of the nearly 40 million hospital stays by U.S. patients, with maternity-related and newborn care accounting for about half of the Medicaid-financed hospitalizations. In that year, the public insurance program spent $51 billion on hospital care, compared with $117 billion paid by private insurers and a cost of $15 billion for the care of uninsured patients.

Federal Abortion Law Introduced

Abortion opponents in the House have introduced the “No Taxpayer Funding for Abortion Act” (H.R. 3) to both further restrict abortion funding and outlaw discrimination against providers who refuse to perform abortions. The bill states that no federal funding can go to any health-benefits plan that includes abortion coverage and that federal tax credits can't be claimed for a health plan that covers abortion, except in cases of rape, incest, and where the life of the mother is in danger. But abortion-rights supporters say the legislation goes too far. Nancy Northrop, president of the Center for Reproductive Rights, said the legislation would create “new tax penalties” aimed at making abortion coverage unavailable even under private health insurance.

AMA Issues Social Media Policy

Physicians using social media sites such as Facebook and Twitter should carefully guard patient privacy while monitoring their own Internet presence in order to make sure it is accurate and appropriate, the American Medical Association said in a new policy statement. During its semiannual policy meeting in San Diego, the association called for physicians to “recognize that actions online and content posted can negatively affect their reputations among patients and colleagues, and may even have consequences for their medical careers.” The AMA urges physicians to set privacy settings on Web sites at their highest levels, maintain appropriate boundaries when interacting with patients online, and consider separating personal and professional content online.

Surgeon General: Breast Is Best

In a “Call to Action,” U.S. Surgeon General Regina Benjamin identified ways that physicians and others can help new mothers stick with breastfeeding. For example, clinicians can get training in how to care for breastfeeding mothers and babies and then give mothers proper how-to advice. About 75% of mothers breastfeed their babies initially, but that number falls to 43% at the end of 6 months, according to 2010 data from the Centers for Disease Control and Prevention. “Many barriers exist for mothers who want to breastfeed,” Dr. Benjamin said in a statement accompanying the report. “They shouldn't have to go it alone. Whether you're a clinician, a family member, a friend, or an employer, you can play an important part in helping mothers who want to breastfeed.” But Dr. Benjamin said that breastfeeding is a personal decision and that women shouldn't be made to feel guilty if they choose not to.

Law Eased Medicaid Expansions

The Affordable Care Act made it easier for states to expand their Medicaid family planning services, according to the Guttmacher Institute. Previously, that could be done only through a waiver process that typically took 2 years to complete, according to the Guttmacher report. But under the health reform law, states have the authority to expand Medicaid without a waiver. 'A strong body of research demonstrates the significant impact of these programs in enabling women to avoid unintended pregnancies and the abortions and births that follow,” said Adam Sonfield, the report's lead author, in a statement. New York, for example, could save $1.6 million a year by avoiding some unintended births, according to the report. The research was supported by a grant from the Centers for Disease Control and Prevention.

New Laws Restrict Abortion

State laws passed in 2010 were far more restrictive of abortion than in favor of abortion rights or access to contraception, according to NARAL Pro-Choice America. Last year, 16 states passed 34 measures that NARAL deemed “antichoice,” the organization reported. For example, Arizona, Louisiana, Mississippi, Missouri, and Tennessee enacted laws that ban abortion coverage in the state-based insurance exchanges set to launch in 2014 under the Affordable Care Act. In contrast, nine states enacted measures that NARAL categorized as “prochoice.” California, for instance, increased protections for the confidentiality of reproductive-health professionals and patients. NARAL President Nancy Keenan said she is concerned that more abortion restrictions will emerge in the coming years because many abortion opponents were elected to Congress, state legislatures, and governorships last fall.

Medicaid Hospital Admissions Rise

Medicaid hospital admissions rose 30% from 1997 to 2008, while admissions of privately insured patients rose only 5%, the Agency for Healthcare Research and Quality found in another analysis. By 2008, Medicaid paid for 18% of the nearly 40 million hospital stays by U.S. patients, with maternity-related and newborn care accounting for about half of the Medicaid-financed hospitalizations. In that year, the public insurance program spent $51 billion on hospital care, compared with $117 billion paid by private insurers and a cost of $15 billion for the care of uninsured patients.

Federal Abortion Law Introduced

Abortion opponents in the House have introduced the “No Taxpayer Funding for Abortion Act” (H.R. 3) to both further restrict abortion funding and outlaw discrimination against providers who refuse to perform abortions. The bill states that no federal funding can go to any health-benefits plan that includes abortion coverage and that federal tax credits can't be claimed for a health plan that covers abortion, except in cases of rape, incest, and where the life of the mother is in danger. But abortion-rights supporters say the legislation goes too far. Nancy Northrop, president of the Center for Reproductive Rights, said the legislation would create “new tax penalties” aimed at making abortion coverage unavailable even under private health insurance.

AMA Issues Social Media Policy

Physicians using social media sites such as Facebook and Twitter should carefully guard patient privacy while monitoring their own Internet presence in order to make sure it is accurate and appropriate, the American Medical Association said in a new policy statement. During its semiannual policy meeting in San Diego, the association called for physicians to “recognize that actions online and content posted can negatively affect their reputations among patients and colleagues, and may even have consequences for their medical careers.” The AMA urges physicians to set privacy settings on Web sites at their highest levels, maintain appropriate boundaries when interacting with patients online, and consider separating personal and professional content online.

Surgeon General: Breast Is Best

In a “Call to Action,” U.S. Surgeon General Regina Benjamin identified ways that physicians and others can help new mothers stick with breastfeeding. For example, clinicians can get training in how to care for breastfeeding mothers and babies and then give mothers proper how-to advice. About 75% of mothers breastfeed their babies initially, but that number falls to 43% at the end of 6 months, according to 2010 data from the Centers for Disease Control and Prevention. “Many barriers exist for mothers who want to breastfeed,” Dr. Benjamin said in a statement accompanying the report. “They shouldn't have to go it alone. Whether you're a clinician, a family member, a friend, or an employer, you can play an important part in helping mothers who want to breastfeed.” But Dr. Benjamin said that breastfeeding is a personal decision and that women shouldn't be made to feel guilty if they choose not to.

Law Eased Medicaid Expansions

The Affordable Care Act made it easier for states to expand their Medicaid family planning services, according to the Guttmacher Institute. Previously, that could be done only through a waiver process that typically took 2 years to complete, according to the Guttmacher report. But under the health reform law, states have the authority to expand Medicaid without a waiver. 'A strong body of research demonstrates the significant impact of these programs in enabling women to avoid unintended pregnancies and the abortions and births that follow,” said Adam Sonfield, the report's lead author, in a statement. New York, for example, could save $1.6 million a year by avoiding some unintended births, according to the report. The research was supported by a grant from the Centers for Disease Control and Prevention.

New Laws Restrict Abortion

State laws passed in 2010 were far more restrictive of abortion than in favor of abortion rights or access to contraception, according to NARAL Pro-Choice America. Last year, 16 states passed 34 measures that NARAL deemed “antichoice,” the organization reported. For example, Arizona, Louisiana, Mississippi, Missouri, and Tennessee enacted laws that ban abortion coverage in the state-based insurance exchanges set to launch in 2014 under the Affordable Care Act. In contrast, nine states enacted measures that NARAL categorized as “prochoice.” California, for instance, increased protections for the confidentiality of reproductive-health professionals and patients. NARAL President Nancy Keenan said she is concerned that more abortion restrictions will emerge in the coming years because many abortion opponents were elected to Congress, state legislatures, and governorships last fall.

Medicaid Hospital Admissions Rise

Medicaid hospital admissions rose 30% from 1997 to 2008, while admissions of privately insured patients rose only 5%, the Agency for Healthcare Research and Quality found in another analysis. By 2008, Medicaid paid for 18% of the nearly 40 million hospital stays by U.S. patients, with maternity-related and newborn care accounting for about half of the Medicaid-financed hospitalizations. In that year, the public insurance program spent $51 billion on hospital care, compared with $117 billion paid by private insurers and a cost of $15 billion for the care of uninsured patients.

Federal Abortion Law Introduced

Abortion opponents in the House have introduced the “No Taxpayer Funding for Abortion Act” (H.R. 3) to both further restrict abortion funding and outlaw discrimination against providers who refuse to perform abortions. The bill states that no federal funding can go to any health-benefits plan that includes abortion coverage and that federal tax credits can't be claimed for a health plan that covers abortion, except in cases of rape, incest, and where the life of the mother is in danger. But abortion-rights supporters say the legislation goes too far. Nancy Northrop, president of the Center for Reproductive Rights, said the legislation would create “new tax penalties” aimed at making abortion coverage unavailable even under private health insurance.

AMA Issues Social Media Policy

Physicians using social media sites such as Facebook and Twitter should carefully guard patient privacy while monitoring their own Internet presence in order to make sure it is accurate and appropriate, the American Medical Association said in a new policy statement. During its semiannual policy meeting in San Diego, the association called for physicians to “recognize that actions online and content posted can negatively affect their reputations among patients and colleagues, and may even have consequences for their medical careers.” The AMA urges physicians to set privacy settings on Web sites at their highest levels, maintain appropriate boundaries when interacting with patients online, and consider separating personal and professional content online.