Mary Ellen Schneider

Racial and ethnic minorities and lower income individuals continue to experience worse health outcomes and less access to health care services in the United States, according to a Jan. 13 report from the Centers for Disease Control and Prevention.

The report found persistent health disparities in a range of areas including infant mortality, coronary heart disease, potentially preventable hospitalizations, and new HIV infections.

[Blacks May Be More Severely Affected by Parkinsonism Than Whites]

The report, "CDC Health Disparities and Inequalities in the United States–2011," is the first in a series of reports that will catalogue disparities in certain social and health indicators (MMWR 2011, Jan 14;60(suppl.):[1-116]). It compiles the most recent national data on disparities in mortality, morbidity, behavioral risk factors, health care access, and preventive health services.

"This first of its kind analysis and reporting of recent trends is designed to spur action and accountability at the federal, tribal, state, and local levels to achieve health equity in this country," Dr. Thomas R. Frieden, CDC Director, said in a statement.

Key among the findings:

• Racial and ethnic minorities continue to experience higher rates of infant deaths. In 2006, the highest infant mortality rate was among non-Hispanic black women at 13.35/1,000 live births, compared with the national average of 6.68 and a rate of 5.58 among non-Hispanic white women. Rates were higher for American Indian/Alaska Native women (8.28) and Puerto Rican women (8.01) than among white women.

• Death from coronary heart disease was highest among blacks, compared with whites, Asian/Pacific Islanders, and American Indian/Alaska Natives. In 2006, the age-adjusted mortality rate for blacks was 161.6/100,000 population, vs. 134.2 among whites. Rates were lower among the other racial groups. Similarly, the age-adjusted mortality rate for stroke was 32.3% higher for blacks than for whites (61.6 vs. 41.7). Hispanics had lower death rates for both coronary heart disease and stroke than did non-Hispanics.

• From 2004 through 2007, the rate of hospitalizations that potentially could have been prevented by better primary care was higher among non-Hispanic blacks and Hispanics than among non-Hispanic whites. Americans with lower incomes also had more potentially preventable hospitalizations, according to the report.

• In 2008, blacks had the highest estimated rate of HIV diagnoses at 73.7/100,000 population, compared with 8.2 among whites. The next highest rate of diagnoses was among Hispanic/Latino individuals at 25/100,000.

[Health Disparities Teased Out Between Elderly Blacks, Whites]

The new CDC report is intended to be a benchmark to help officials measure future trends.

Racial and ethnic minorities and lower income individuals continue to experience worse health outcomes and less access to health care services in the United States, according to a Jan. 13 report from the Centers for Disease Control and Prevention.

The report found persistent health disparities in a range of areas including infant mortality, coronary heart disease, potentially preventable hospitalizations, and new HIV infections.

[Blacks May Be More Severely Affected by Parkinsonism Than Whites]

The report, "CDC Health Disparities and Inequalities in the United States–2011," is the first in a series of reports that will catalogue disparities in certain social and health indicators (MMWR 2011, Jan 14;60(suppl.):[1-116]). It compiles the most recent national data on disparities in mortality, morbidity, behavioral risk factors, health care access, and preventive health services.

"This first of its kind analysis and reporting of recent trends is designed to spur action and accountability at the federal, tribal, state, and local levels to achieve health equity in this country," Dr. Thomas R. Frieden, CDC Director, said in a statement.

Key among the findings:

• Racial and ethnic minorities continue to experience higher rates of infant deaths. In 2006, the highest infant mortality rate was among non-Hispanic black women at 13.35/1,000 live births, compared with the national average of 6.68 and a rate of 5.58 among non-Hispanic white women. Rates were higher for American Indian/Alaska Native women (8.28) and Puerto Rican women (8.01) than among white women.

• Death from coronary heart disease was highest among blacks, compared with whites, Asian/Pacific Islanders, and American Indian/Alaska Natives. In 2006, the age-adjusted mortality rate for blacks was 161.6/100,000 population, vs. 134.2 among whites. Rates were lower among the other racial groups. Similarly, the age-adjusted mortality rate for stroke was 32.3% higher for blacks than for whites (61.6 vs. 41.7). Hispanics had lower death rates for both coronary heart disease and stroke than did non-Hispanics.

• From 2004 through 2007, the rate of hospitalizations that potentially could have been prevented by better primary care was higher among non-Hispanic blacks and Hispanics than among non-Hispanic whites. Americans with lower incomes also had more potentially preventable hospitalizations, according to the report.

• In 2008, blacks had the highest estimated rate of HIV diagnoses at 73.7/100,000 population, compared with 8.2 among whites. The next highest rate of diagnoses was among Hispanic/Latino individuals at 25/100,000.

[Health Disparities Teased Out Between Elderly Blacks, Whites]

The new CDC report is intended to be a benchmark to help officials measure future trends.

Racial and ethnic minorities and lower income individuals continue to experience worse health outcomes and less access to health care services in the United States, according to a Jan. 13 report from the Centers for Disease Control and Prevention.

The report found persistent health disparities in a range of areas including infant mortality, coronary heart disease, potentially preventable hospitalizations, and new HIV infections.

[Blacks May Be More Severely Affected by Parkinsonism Than Whites]

The report, "CDC Health Disparities and Inequalities in the United States–2011," is the first in a series of reports that will catalogue disparities in certain social and health indicators (MMWR 2011, Jan 14;60(suppl.):[1-116]). It compiles the most recent national data on disparities in mortality, morbidity, behavioral risk factors, health care access, and preventive health services.

"This first of its kind analysis and reporting of recent trends is designed to spur action and accountability at the federal, tribal, state, and local levels to achieve health equity in this country," Dr. Thomas R. Frieden, CDC Director, said in a statement.

Key among the findings:

• Racial and ethnic minorities continue to experience higher rates of infant deaths. In 2006, the highest infant mortality rate was among non-Hispanic black women at 13.35/1,000 live births, compared with the national average of 6.68 and a rate of 5.58 among non-Hispanic white women. Rates were higher for American Indian/Alaska Native women (8.28) and Puerto Rican women (8.01) than among white women.

• Death from coronary heart disease was highest among blacks, compared with whites, Asian/Pacific Islanders, and American Indian/Alaska Natives. In 2006, the age-adjusted mortality rate for blacks was 161.6/100,000 population, vs. 134.2 among whites. Rates were lower among the other racial groups. Similarly, the age-adjusted mortality rate for stroke was 32.3% higher for blacks than for whites (61.6 vs. 41.7). Hispanics had lower death rates for both coronary heart disease and stroke than did non-Hispanics.

• From 2004 through 2007, the rate of hospitalizations that potentially could have been prevented by better primary care was higher among non-Hispanic blacks and Hispanics than among non-Hispanic whites. Americans with lower incomes also had more potentially preventable hospitalizations, according to the report.

• In 2008, blacks had the highest estimated rate of HIV diagnoses at 73.7/100,000 population, compared with 8.2 among whites. The next highest rate of diagnoses was among Hispanic/Latino individuals at 25/100,000.

[Health Disparities Teased Out Between Elderly Blacks, Whites]

The new CDC report is intended to be a benchmark to help officials measure future trends.

Dr. Matthew Schreiber is no stranger to change.

A decade ago he was a primary care physician in rural Georgia. By 2007, he was managing the hospitalist program across the Piedmont Healthcare system in Atlanta. And today, he is the chief medical officer at Piedmont Hospital, the system’s flagship facility. Along the way he has implemented systems changes aimed at improving care and satisfaction.

"My advice is to do something different – wrong," Dr. Schreiber said.

His take is that most people spend too much time and energy preparing for change and then analyzing data. But more time needs to be spent actually changing behavior and verifying that the change has been effectively implemented. "I’d rather see us make a change without having any data or any infrastructure," he said.

Sometimes you can tell if something is going to work just by whether you see a smile on the face of a patient, he said.

Smiles aside, Dr. Schreiber and his team at Piedmont Hospital have seen measurable improvements in length of stay and readmissions following a series of systems changes they implemented beginning in 2008.

Shortly after taking over as the director of hospitalist services for the Piedmont Healthcare system, he set up a sort of experimental hospitalist unit at Piedmont Hospital where he could test a series of changes. The primary outcomes were length of stay; readmission rates; and the satisfaction of patients, physicians, and staff.

"That was really a commitment to re-engineer the patient experience from door to discharge from a patient-centered view," he said.

Among the successful changes was a switch to having geographically designated hospitalists, changing hospitalist schedules, and shifting responsibilities. Dr. Schreiber also became involved in Project BOOST (Better Outcomes for Older adults through Safe Transitions). The quality improvement project addresses the discharge process so that patients experience fewer readmissions and lower mortality rates. The project, which is coordinated by the Society of Hospital Medicine, is being touted as a way for hospitals to get up to speed on forthcoming Medicare requirements to reduce readmission under the Affordable Care Act.

Being a part of the BOOST project was a big help, Dr. Schreiber said, because it allowed him to use a set of evidence-based tools designed by experts, rather than having to re-engineer the discharge process from scratch.

When the BOOST program was implemented at Piedmont Hospital in September 2008, the length of stay in the hospitalist unit was 5.83 days, but has dropped to 5.17 days on average today. Similarly, readmission rates dropped from 13.1% to 4.0% among patients under age 70. For patients age 70 and older, the readmission rate started at 15.9% and dropped to 11.2%.

Achieving these outcomes wasn’t easy, Dr. Schreiber admits. But strong leadership and communication helped overcome resistance to change. Getting on board with changes that improve the discharge process and reduce readmission rates will be essential for hospitalists who want to thrive in the post–health reform environment, he said. "Readmissions are going to be the next big thing."

Dr. Matthew Schreiber is no stranger to change.

A decade ago he was a primary care physician in rural Georgia. By 2007, he was managing the hospitalist program across the Piedmont Healthcare system in Atlanta. And today, he is the chief medical officer at Piedmont Hospital, the system’s flagship facility. Along the way he has implemented systems changes aimed at improving care and satisfaction.

"My advice is to do something different – wrong," Dr. Schreiber said.

His take is that most people spend too much time and energy preparing for change and then analyzing data. But more time needs to be spent actually changing behavior and verifying that the change has been effectively implemented. "I’d rather see us make a change without having any data or any infrastructure," he said.

Sometimes you can tell if something is going to work just by whether you see a smile on the face of a patient, he said.

Smiles aside, Dr. Schreiber and his team at Piedmont Hospital have seen measurable improvements in length of stay and readmissions following a series of systems changes they implemented beginning in 2008.

Shortly after taking over as the director of hospitalist services for the Piedmont Healthcare system, he set up a sort of experimental hospitalist unit at Piedmont Hospital where he could test a series of changes. The primary outcomes were length of stay; readmission rates; and the satisfaction of patients, physicians, and staff.

"That was really a commitment to re-engineer the patient experience from door to discharge from a patient-centered view," he said.

Among the successful changes was a switch to having geographically designated hospitalists, changing hospitalist schedules, and shifting responsibilities. Dr. Schreiber also became involved in Project BOOST (Better Outcomes for Older adults through Safe Transitions). The quality improvement project addresses the discharge process so that patients experience fewer readmissions and lower mortality rates. The project, which is coordinated by the Society of Hospital Medicine, is being touted as a way for hospitals to get up to speed on forthcoming Medicare requirements to reduce readmission under the Affordable Care Act.

Being a part of the BOOST project was a big help, Dr. Schreiber said, because it allowed him to use a set of evidence-based tools designed by experts, rather than having to re-engineer the discharge process from scratch.

When the BOOST program was implemented at Piedmont Hospital in September 2008, the length of stay in the hospitalist unit was 5.83 days, but has dropped to 5.17 days on average today. Similarly, readmission rates dropped from 13.1% to 4.0% among patients under age 70. For patients age 70 and older, the readmission rate started at 15.9% and dropped to 11.2%.

Achieving these outcomes wasn’t easy, Dr. Schreiber admits. But strong leadership and communication helped overcome resistance to change. Getting on board with changes that improve the discharge process and reduce readmission rates will be essential for hospitalists who want to thrive in the post–health reform environment, he said. "Readmissions are going to be the next big thing."

Dr. Matthew Schreiber is no stranger to change.

A decade ago he was a primary care physician in rural Georgia. By 2007, he was managing the hospitalist program across the Piedmont Healthcare system in Atlanta. And today, he is the chief medical officer at Piedmont Hospital, the system’s flagship facility. Along the way he has implemented systems changes aimed at improving care and satisfaction.

"My advice is to do something different – wrong," Dr. Schreiber said.

His take is that most people spend too much time and energy preparing for change and then analyzing data. But more time needs to be spent actually changing behavior and verifying that the change has been effectively implemented. "I’d rather see us make a change without having any data or any infrastructure," he said.

Sometimes you can tell if something is going to work just by whether you see a smile on the face of a patient, he said.

Smiles aside, Dr. Schreiber and his team at Piedmont Hospital have seen measurable improvements in length of stay and readmissions following a series of systems changes they implemented beginning in 2008.

Shortly after taking over as the director of hospitalist services for the Piedmont Healthcare system, he set up a sort of experimental hospitalist unit at Piedmont Hospital where he could test a series of changes. The primary outcomes were length of stay; readmission rates; and the satisfaction of patients, physicians, and staff.

"That was really a commitment to re-engineer the patient experience from door to discharge from a patient-centered view," he said.

Among the successful changes was a switch to having geographically designated hospitalists, changing hospitalist schedules, and shifting responsibilities. Dr. Schreiber also became involved in Project BOOST (Better Outcomes for Older adults through Safe Transitions). The quality improvement project addresses the discharge process so that patients experience fewer readmissions and lower mortality rates. The project, which is coordinated by the Society of Hospital Medicine, is being touted as a way for hospitals to get up to speed on forthcoming Medicare requirements to reduce readmission under the Affordable Care Act.

Being a part of the BOOST project was a big help, Dr. Schreiber said, because it allowed him to use a set of evidence-based tools designed by experts, rather than having to re-engineer the discharge process from scratch.

When the BOOST program was implemented at Piedmont Hospital in September 2008, the length of stay in the hospitalist unit was 5.83 days, but has dropped to 5.17 days on average today. Similarly, readmission rates dropped from 13.1% to 4.0% among patients under age 70. For patients age 70 and older, the readmission rate started at 15.9% and dropped to 11.2%.

Achieving these outcomes wasn’t easy, Dr. Schreiber admits. But strong leadership and communication helped overcome resistance to change. Getting on board with changes that improve the discharge process and reduce readmission rates will be essential for hospitalists who want to thrive in the post–health reform environment, he said. "Readmissions are going to be the next big thing."

Federal officials have created a permanent pathway for health information technology developers to get their products certified under the new Medicare and Medicaid Electronic Health Record Incentive Programs.

In a final rule issued on Jan. 3, the Office of the National Coordinator for Health Information Technology spelled out the criteria that products must meet starting in 2012. EHR products are currently being certified through a temporary program that will sunset once the permanent program is up and running, likely in early 2012.

The new permanent certification program requires organizations to be accredited in order to test or certify health information technology products. The certification bodies, which will be authorized by the National Coordinator for Health Information Technology, are required to conduct post-certification surveillance.

The availability of certified EHR products will pave the way for physicians, hospitals, and other eligible providers to participate in the Medicare and Medicaid EHR Incentive programs. Physicians can earn up to $44,000 over 5 years under the Medicare program and about $63,000 over 6 years under the Medicaid program.

Registration for the new program began on Jan. 3.

Federal officials have created a permanent pathway for health information technology developers to get their products certified under the new Medicare and Medicaid Electronic Health Record Incentive Programs.

In a final rule issued on Jan. 3, the Office of the National Coordinator for Health Information Technology spelled out the criteria that products must meet starting in 2012. EHR products are currently being certified through a temporary program that will sunset once the permanent program is up and running, likely in early 2012.

The new permanent certification program requires organizations to be accredited in order to test or certify health information technology products. The certification bodies, which will be authorized by the National Coordinator for Health Information Technology, are required to conduct post-certification surveillance.

The availability of certified EHR products will pave the way for physicians, hospitals, and other eligible providers to participate in the Medicare and Medicaid EHR Incentive programs. Physicians can earn up to $44,000 over 5 years under the Medicare program and about $63,000 over 6 years under the Medicaid program.

Registration for the new program began on Jan. 3.

Federal officials have created a permanent pathway for health information technology developers to get their products certified under the new Medicare and Medicaid Electronic Health Record Incentive Programs.

In a final rule issued on Jan. 3, the Office of the National Coordinator for Health Information Technology spelled out the criteria that products must meet starting in 2012. EHR products are currently being certified through a temporary program that will sunset once the permanent program is up and running, likely in early 2012.

The new permanent certification program requires organizations to be accredited in order to test or certify health information technology products. The certification bodies, which will be authorized by the National Coordinator for Health Information Technology, are required to conduct post-certification surveillance.

The availability of certified EHR products will pave the way for physicians, hospitals, and other eligible providers to participate in the Medicare and Medicaid EHR Incentive programs. Physicians can earn up to $44,000 over 5 years under the Medicare program and about $63,000 over 6 years under the Medicaid program.

Registration for the new program began on Jan. 3.

Federal officials have created a permanent pathway for health information technology developers to get their products certified under the new Medicare and Medicaid Electronic Health Record Incentive Programs.

In a final rule issued on Jan. 3, the Office of the National Coordinator for Health Information Technology spelled out the criteria that products must meet starting in 2012. EHR products are currently being certified through a temporary program that will sunset once the permanent program is up and running, likely in early 2012.

The new permanent certification program requires organizations to be accredited in order to test or certify health information technology products. The certification bodies, which will be authorized by the National Coordinator for Health Information Technology, are required to conduct post-certification surveillance.

The availability of certified EHR products will pave the way for physicians, hospitals, and other eligible providers to participate in the Medicare and Medicaid EHR Incentive programs. Physicians can earn up to $44,000 over 5 years under the Medicare program and about $63,000 over 6 years under the Medicaid program.

Registration for the new program began on Jan. 3.

Federal officials have created a permanent pathway for health information technology developers to get their products certified under the new Medicare and Medicaid Electronic Health Record Incentive Programs.

In a final rule issued on Jan. 3, the Office of the National Coordinator for Health Information Technology spelled out the criteria that products must meet starting in 2012. EHR products are currently being certified through a temporary program that will sunset once the permanent program is up and running, likely in early 2012.

The new permanent certification program requires organizations to be accredited in order to test or certify health information technology products. The certification bodies, which will be authorized by the National Coordinator for Health Information Technology, are required to conduct post-certification surveillance.

The availability of certified EHR products will pave the way for physicians, hospitals, and other eligible providers to participate in the Medicare and Medicaid EHR Incentive programs. Physicians can earn up to $44,000 over 5 years under the Medicare program and about $63,000 over 6 years under the Medicaid program.

Registration for the new program began on Jan. 3.

Federal officials have created a permanent pathway for health information technology developers to get their products certified under the new Medicare and Medicaid Electronic Health Record Incentive Programs.

In a final rule issued on Jan. 3, the Office of the National Coordinator for Health Information Technology spelled out the criteria that products must meet starting in 2012. EHR products are currently being certified through a temporary program that will sunset once the permanent program is up and running, likely in early 2012.

The new permanent certification program requires organizations to be accredited in order to test or certify health information technology products. The certification bodies, which will be authorized by the National Coordinator for Health Information Technology, are required to conduct post-certification surveillance.

The availability of certified EHR products will pave the way for physicians, hospitals, and other eligible providers to participate in the Medicare and Medicaid EHR Incentive programs. Physicians can earn up to $44,000 over 5 years under the Medicare program and about $63,000 over 6 years under the Medicaid program.

Registration for the new program began on Jan. 3.

Federal officials have created a permanent pathway for health information technology developers to get their products certified under the new Medicare and Medicaid Electronic Health Record Incentive Programs.

In a final rule issued on Jan. 3, the Office of the National Coordinator for Health Information Technology spelled out the criteria that products must meet starting in 2012. EHR products are currently being certified through a temporary program that will sunset once the permanent program is up and running, likely in early 2012.

The new permanent certification program requires organizations to be accredited in order to test or certify health information technology products. The certification bodies, which will be authorized by the National Coordinator for Health Information Technology, are required to conduct post-certification surveillance.

The availability of certified EHR products will pave the way for physicians, hospitals, and other eligible providers to participate in the Medicare and Medicaid EHR Incentive programs. Physicians can earn up to $44,000 over 5 years under the Medicare program and about $63,000 over 6 years under the Medicaid program.

Registration for the new program began on Jan. 3.

Federal officials have created a permanent pathway for health information technology developers to get their products certified under the new Medicare and Medicaid Electronic Health Record Incentive Programs.

In a final rule issued on Jan. 3, the Office of the National Coordinator for Health Information Technology spelled out the criteria that products must meet starting in 2012. EHR products are currently being certified through a temporary program that will sunset once the permanent program is up and running, likely in early 2012.

The new permanent certification program requires organizations to be accredited in order to test or certify health information technology products. The certification bodies, which will be authorized by the National Coordinator for Health Information Technology, are required to conduct post-certification surveillance.

The availability of certified EHR products will pave the way for physicians, hospitals, and other eligible providers to participate in the Medicare and Medicaid EHR Incentive programs. Physicians can earn up to $44,000 over 5 years under the Medicare program and about $63,000 over 6 years under the Medicaid program.

Registration for the new program began on Jan. 3.

Federal officials have created a permanent pathway for health information technology developers to get their products certified under the new Medicare and Medicaid Electronic Health Record Incentive Programs.

In a final rule issued on Jan. 3, the Office of the National Coordinator for Health Information Technology spelled out the criteria that products must meet starting in 2012. EHR products are currently being certified through a temporary program that will sunset once the permanent program is up and running, likely in early 2012.

The new permanent certification program requires organizations to be accredited in order to test or certify health information technology products. The certification bodies, which will be authorized by the National Coordinator for Health Information Technology, are required to conduct post-certification surveillance.

The availability of certified EHR products will pave the way for physicians, hospitals, and other eligible providers to participate in the Medicare and Medicaid EHR Incentive programs. Physicians can earn up to $44,000 over 5 years under the Medicare program and about $63,000 over 6 years under the Medicaid program.

Registration for the new program began on Jan. 3.

Sustaining a mild traumatic brain injury during combat is not associated with long-term negative psychosocial symptoms, unless combined with posttraumatic stress disorder, according to a study published Jan. 3 in the Archives of General Psychiatry.

Researchers at the Minneapolis Veterans Affairs Health Care System and the University of Minnesota Medical School analyzed survey results from 953 U.S. National Guard soldiers serving in Iraq both 1 month before returning home and 1 year later (Arch. Gen. Psychiatry 2011; 68:79-89). After the investigators controlled for PTSD symptoms at the time of the second survey, no differences were found between soldiers who reported a mild traumatic brain injury and those who had not sustained a brain injury in terms of depression, problematic drinking, social functioning, and quality of life.

The researchers also found that there were no differences on postdeployment psychosocial outcomes between soldiers with comorbid mild traumatic brain injury and PTSD, and those with only PTSD. Soldiers with PTSD-only also reported higher levels of depression, lower social functioning, and lower quality of life than did soldiers with mild traumatic brain injury alone, according to the study. The study does not address the impact of repeated concussions or of moderate to severe traumatic brain injury.

The findings are consistent with previous research in the civilian population, which showed that a history of concussion does not result in negative health effects beyond a few weeks, Melissa A. Polusny, Ph.D., the lead study investigator and a staff psychologist at the Minneapolis VA Medical Center, said in an interview. "We haven’t known in the veteran literature whether combat-related concussion may somehow be different and what the long-term impact of those experiences might be," she said. "Once you account for the effects of PTSD, we’re not seeing a lot of long-term impact from mild TBI."

For clinicians, one of the take home messages of the study is that if a veteran reports postconcussive symptoms months or a year after the event, it is important to thoroughly assess for PTSD, since PTSD could be driving those symptoms. "One of the things we know is that there are very effective treatments for PTSD and so making sure that veterans are appropriately assessed for PTSD symptoms and given access to evidence-based treatment for PTSD is really crucial," Dr. Polusny said.

The study also revealed a significant increase in reports of concussion/mild traumatic brain injury in the second survey given to the soldiers. The rate of self-reported concussion/mild traumatic brain injury sustained in Iraq was 9.2% at 1 month before returning home, but jumped to 22% a year later. The difference could be attributable to recall bias, poor reliability of the survey instrument, or other factors such as a reluctance to report health problems while serving in combat. More research is needed to figure out why the reports of injury increased.

The researchers reported no financial conflicts. The study was based on work supported in part by the Department of Veterans Affairs.

Sustaining a mild traumatic brain injury during combat is not associated with long-term negative psychosocial symptoms, unless combined with posttraumatic stress disorder, according to a study published Jan. 3 in the Archives of General Psychiatry.

Researchers at the Minneapolis Veterans Affairs Health Care System and the University of Minnesota Medical School analyzed survey results from 953 U.S. National Guard soldiers serving in Iraq both 1 month before returning home and 1 year later (Arch. Gen. Psychiatry 2011; 68:79-89). After the investigators controlled for PTSD symptoms at the time of the second survey, no differences were found between soldiers who reported a mild traumatic brain injury and those who had not sustained a brain injury in terms of depression, problematic drinking, social functioning, and quality of life.

The researchers also found that there were no differences on postdeployment psychosocial outcomes between soldiers with comorbid mild traumatic brain injury and PTSD, and those with only PTSD. Soldiers with PTSD-only also reported higher levels of depression, lower social functioning, and lower quality of life than did soldiers with mild traumatic brain injury alone, according to the study. The study does not address the impact of repeated concussions or of moderate to severe traumatic brain injury.

The findings are consistent with previous research in the civilian population, which showed that a history of concussion does not result in negative health effects beyond a few weeks, Melissa A. Polusny, Ph.D., the lead study investigator and a staff psychologist at the Minneapolis VA Medical Center, said in an interview. "We haven’t known in the veteran literature whether combat-related concussion may somehow be different and what the long-term impact of those experiences might be," she said. "Once you account for the effects of PTSD, we’re not seeing a lot of long-term impact from mild TBI."

For clinicians, one of the take home messages of the study is that if a veteran reports postconcussive symptoms months or a year after the event, it is important to thoroughly assess for PTSD, since PTSD could be driving those symptoms. "One of the things we know is that there are very effective treatments for PTSD and so making sure that veterans are appropriately assessed for PTSD symptoms and given access to evidence-based treatment for PTSD is really crucial," Dr. Polusny said.

The study also revealed a significant increase in reports of concussion/mild traumatic brain injury in the second survey given to the soldiers. The rate of self-reported concussion/mild traumatic brain injury sustained in Iraq was 9.2% at 1 month before returning home, but jumped to 22% a year later. The difference could be attributable to recall bias, poor reliability of the survey instrument, or other factors such as a reluctance to report health problems while serving in combat. More research is needed to figure out why the reports of injury increased.

The researchers reported no financial conflicts. The study was based on work supported in part by the Department of Veterans Affairs.

Sustaining a mild traumatic brain injury during combat is not associated with long-term negative psychosocial symptoms, unless combined with posttraumatic stress disorder, according to a study published Jan. 3 in the Archives of General Psychiatry.

Researchers at the Minneapolis Veterans Affairs Health Care System and the University of Minnesota Medical School analyzed survey results from 953 U.S. National Guard soldiers serving in Iraq both 1 month before returning home and 1 year later (Arch. Gen. Psychiatry 2011; 68:79-89). After the investigators controlled for PTSD symptoms at the time of the second survey, no differences were found between soldiers who reported a mild traumatic brain injury and those who had not sustained a brain injury in terms of depression, problematic drinking, social functioning, and quality of life.

The researchers also found that there were no differences on postdeployment psychosocial outcomes between soldiers with comorbid mild traumatic brain injury and PTSD, and those with only PTSD. Soldiers with PTSD-only also reported higher levels of depression, lower social functioning, and lower quality of life than did soldiers with mild traumatic brain injury alone, according to the study. The study does not address the impact of repeated concussions or of moderate to severe traumatic brain injury.

The findings are consistent with previous research in the civilian population, which showed that a history of concussion does not result in negative health effects beyond a few weeks, Melissa A. Polusny, Ph.D., the lead study investigator and a staff psychologist at the Minneapolis VA Medical Center, said in an interview. "We haven’t known in the veteran literature whether combat-related concussion may somehow be different and what the long-term impact of those experiences might be," she said. "Once you account for the effects of PTSD, we’re not seeing a lot of long-term impact from mild TBI."

For clinicians, one of the take home messages of the study is that if a veteran reports postconcussive symptoms months or a year after the event, it is important to thoroughly assess for PTSD, since PTSD could be driving those symptoms. "One of the things we know is that there are very effective treatments for PTSD and so making sure that veterans are appropriately assessed for PTSD symptoms and given access to evidence-based treatment for PTSD is really crucial," Dr. Polusny said.

The study also revealed a significant increase in reports of concussion/mild traumatic brain injury in the second survey given to the soldiers. The rate of self-reported concussion/mild traumatic brain injury sustained in Iraq was 9.2% at 1 month before returning home, but jumped to 22% a year later. The difference could be attributable to recall bias, poor reliability of the survey instrument, or other factors such as a reluctance to report health problems while serving in combat. More research is needed to figure out why the reports of injury increased.

The researchers reported no financial conflicts. The study was based on work supported in part by the Department of Veterans Affairs.

Dr. Matthew Schreiber is no stranger to change.

A decade ago he was a primary care physician in rural Georgia. By 2007, he was managing the hospitalist program across the Piedmont Healthcare system in Atlanta. And today, he is the chief medical officer at Piedmont Hospital, the system's flagship facility. Along the way he has implemented systems changes aimed at improving care and satisfaction.

"My advice is to do something different - wrong," Dr. Schreiber said.

His take is that most people spend too much time and energy preparing for change and then analyzing data. But more time needs to be spent actually changing behavior and verifying that the change has been effectively implemented. "I'd rather see us make a change without having any data or any infrastructure," he said.

Sometimes you can tell if something is going to work just by whether you see a smile on the face of a patient, he said.

Smiles aside, Dr. Schreiber and his team at Piedmont Hospital have seen measurable improvements in length of stay and readmissions following a series of systems changes they implemented beginning in 2008.

Shortly after taking over as the director of hospitalist services for the Piedmont Healthcare system, he set up a sort of experimental hospitalist unit at Piedmont Hospital where he could test a series of changes. The primary outcomes were length of stay; readmission rates; and the satisfaction of patients, physicians, and staff.

"That was really a commitment to re-engineer the patient experience from door to discharge from a patient-centered view," he said.

Among the successful changes was a switch to having geographically designated hospitalists, changing hospitalist schedules, and shifting responsibilities. Dr. Schreiber also became involved in Project BOOST (Better Outcomes for Older adults through Safe Transitions). The quality improvement project addresses the discharge process so that patients experience fewer readmissions and lower mortality rates. The project, which is coordinated by the Society of Hospital Medicine, is being touted as a way for hospitals to get up to speed on forthcoming Medicare requirements to reduce readmission under the Affordable Care Act.

Being a part of the BOOST project was a big help, Dr. Schreiber said, because it allowed him to use a set of evidence-based tools designed by experts, rather than having to re-engineer the discharge process from scratch.

When the BOOST program was implemented at Piedmont Hospital in September 2008, the length of stay in the hospitalist unit was 5.83 days, but has dropped to 5.17 days on average today. Similarly, readmission rates dropped from 13.1% to 4.0% among patients under age 70. For patients age 70 and older, the readmission rate started at 15.9% and dropped to 11.2%.

Achieving these outcomes wasn't easy, Dr. Schreiber admits. But strong leadership and communication helped overcome resistance to change. Getting on board with changes that improve the discharge process and reduce readmission rates will be essential for hospitalists who want to thrive in the post-health reform environment, he said. "Readmissions are going to be the next big thing."

Dr. Matthew Schreiber is no stranger to change.

A decade ago he was a primary care physician in rural Georgia. By 2007, he was managing the hospitalist program across the Piedmont Healthcare system in Atlanta. And today, he is the chief medical officer at Piedmont Hospital, the system's flagship facility. Along the way he has implemented systems changes aimed at improving care and satisfaction.

"My advice is to do something different - wrong," Dr. Schreiber said.

His take is that most people spend too much time and energy preparing for change and then analyzing data. But more time needs to be spent actually changing behavior and verifying that the change has been effectively implemented. "I'd rather see us make a change without having any data or any infrastructure," he said.

Sometimes you can tell if something is going to work just by whether you see a smile on the face of a patient, he said.

Smiles aside, Dr. Schreiber and his team at Piedmont Hospital have seen measurable improvements in length of stay and readmissions following a series of systems changes they implemented beginning in 2008.

Shortly after taking over as the director of hospitalist services for the Piedmont Healthcare system, he set up a sort of experimental hospitalist unit at Piedmont Hospital where he could test a series of changes. The primary outcomes were length of stay; readmission rates; and the satisfaction of patients, physicians, and staff.

"That was really a commitment to re-engineer the patient experience from door to discharge from a patient-centered view," he said.

Among the successful changes was a switch to having geographically designated hospitalists, changing hospitalist schedules, and shifting responsibilities. Dr. Schreiber also became involved in Project BOOST (Better Outcomes for Older adults through Safe Transitions). The quality improvement project addresses the discharge process so that patients experience fewer readmissions and lower mortality rates. The project, which is coordinated by the Society of Hospital Medicine, is being touted as a way for hospitals to get up to speed on forthcoming Medicare requirements to reduce readmission under the Affordable Care Act.

Being a part of the BOOST project was a big help, Dr. Schreiber said, because it allowed him to use a set of evidence-based tools designed by experts, rather than having to re-engineer the discharge process from scratch.

When the BOOST program was implemented at Piedmont Hospital in September 2008, the length of stay in the hospitalist unit was 5.83 days, but has dropped to 5.17 days on average today. Similarly, readmission rates dropped from 13.1% to 4.0% among patients under age 70. For patients age 70 and older, the readmission rate started at 15.9% and dropped to 11.2%.

Achieving these outcomes wasn't easy, Dr. Schreiber admits. But strong leadership and communication helped overcome resistance to change. Getting on board with changes that improve the discharge process and reduce readmission rates will be essential for hospitalists who want to thrive in the post-health reform environment, he said. "Readmissions are going to be the next big thing."

Dr. Matthew Schreiber is no stranger to change.

A decade ago he was a primary care physician in rural Georgia. By 2007, he was managing the hospitalist program across the Piedmont Healthcare system in Atlanta. And today, he is the chief medical officer at Piedmont Hospital, the system's flagship facility. Along the way he has implemented systems changes aimed at improving care and satisfaction.

"My advice is to do something different - wrong," Dr. Schreiber said.

His take is that most people spend too much time and energy preparing for change and then analyzing data. But more time needs to be spent actually changing behavior and verifying that the change has been effectively implemented. "I'd rather see us make a change without having any data or any infrastructure," he said.

Sometimes you can tell if something is going to work just by whether you see a smile on the face of a patient, he said.

Smiles aside, Dr. Schreiber and his team at Piedmont Hospital have seen measurable improvements in length of stay and readmissions following a series of systems changes they implemented beginning in 2008.

Shortly after taking over as the director of hospitalist services for the Piedmont Healthcare system, he set up a sort of experimental hospitalist unit at Piedmont Hospital where he could test a series of changes. The primary outcomes were length of stay; readmission rates; and the satisfaction of patients, physicians, and staff.

"That was really a commitment to re-engineer the patient experience from door to discharge from a patient-centered view," he said.

Among the successful changes was a switch to having geographically designated hospitalists, changing hospitalist schedules, and shifting responsibilities. Dr. Schreiber also became involved in Project BOOST (Better Outcomes for Older adults through Safe Transitions). The quality improvement project addresses the discharge process so that patients experience fewer readmissions and lower mortality rates. The project, which is coordinated by the Society of Hospital Medicine, is being touted as a way for hospitals to get up to speed on forthcoming Medicare requirements to reduce readmission under the Affordable Care Act.

Being a part of the BOOST project was a big help, Dr. Schreiber said, because it allowed him to use a set of evidence-based tools designed by experts, rather than having to re-engineer the discharge process from scratch.

When the BOOST program was implemented at Piedmont Hospital in September 2008, the length of stay in the hospitalist unit was 5.83 days, but has dropped to 5.17 days on average today. Similarly, readmission rates dropped from 13.1% to 4.0% among patients under age 70. For patients age 70 and older, the readmission rate started at 15.9% and dropped to 11.2%.

Achieving these outcomes wasn't easy, Dr. Schreiber admits. But strong leadership and communication helped overcome resistance to change. Getting on board with changes that improve the discharge process and reduce readmission rates will be essential for hospitalists who want to thrive in the post-health reform environment, he said. "Readmissions are going to be the next big thing."

Women's Care Graded 'U'

The United States has once again deserved an overall grade of “unsatisfactory” in meeting women's health needs, according to a new report card from the National Women's Law Center. The report, which is the fifth produced by the group, graded the nation “satisfactory” on only three indicators of women's health: those aged 40 and older receiving regular mammograms, annual visits to the dentist, and women aged 50 and older getting colorectal cancer screening. But the United States received a failing grade on 13 of 26 indicators. The country dropped from “satisfactory minus” in the center's 2007 report to “failing” today in the proportion of women who report binge drinking, and the percentage of women getting a regular Pap test declined from a grade of “unsatisfactory” to “failing.” The nation improved on only one indicator, rising from “unsatisfactory” to “satisfactory minus” in cholesterol screening for women.

Court Rejects Abortion Challenge

Abortion opponents failed to gain ground in an attempt to defeat the Affordable Care Act in court. On Nov. 30, a U.S. district court judge in Virginia dismissed a case charging, in part, that the new health care reform law is unconstitutional because it allows for coverage of abortions. In the suit, Liberty University, a Virginia-based Christian college, and five individuals claimed that the new law would force them to violate their religious conviction against subsidizing abortions. But the U.S. District Judge Norman K. Moon said in his decision that the plaintiffs had failed to show how any of the payments required under the new law would be used to fund abortion. In fact, the judge wrote, the law contains “strict safeguards at multiple levels to prevent federal funds from being used to pay for abortion services beyond those in cases of rape or incest, or where the life of the woman would be endangered.”

Unsafe Abortions Continue

More than 21 million unsafe abortions were performed worldwide in 2008, according to new data from the World Health Organization. The WHO defines unsafe abortions as cases in which either the provider lacks necessary skills or the setting fails to meet minimum medical standards. The WHO estimates that about 47,000 women, almost exclusively in developing countries, died in 2008 because of complications from these procedures. The figures were reported in the journal Reproductive Health Matters. The number of unsafe abortions rose from 19.7 million in 2003 to 21.6 million in 2008, but the increase resulted from the rise in the number of women of reproductive age around the world, according to the report. The actual rate of unsafe abortions stayed the same, at 14 per 1,000 women aged 15–44 years. Overall, unsafe abortions were most prevalent in areas of the world where women had less access to contraception and abortion services were restricted.

New 2020 Maternal-Health Goals

The federal government has issued its new goals for improving public health by 2020, and they include a few new benchmarks for maternal health that touch on both preconception and postpartum wellness. For example, “Healthy People 2020” calls for a decrease in the rate of postpartum relapse of smoking among women who quit while pregnant. Another 10-year benchmark is an increase in the percentage of women attending postpartum visits with health care workers. The federal government is also seeking an increase in the percentage of employers who have worksite lactation programs. Focusing on women before they become pregnant, “Healthy People 2020” calls for more to get preconception care services and to practice key behaviors such as maintaining a healthy weight prior to pregnancy. The objectives are available online at

www.healthypeople.gov/2020/topicsobjectives2020/default.aspx

New Tobacco Warnings Required

Cigarette manufacturers would be forced to cover large swaths of their packaging with bold warnings and graphic images showing the health consequences of smoking in a strategy unveiled by the Department of Health and Human Services. Potential images include a photo of a corpse with a toe tag, a man smoking through a hole in his throat, and side-by-side photographs of diseased and healthy lungs. The new warnings include “Cigarettes can harm your children,” “Smoking During Pregnancy Can Harm Your Baby,” and “Smoking Can Kill You.” The public can comment on the proposed images and warnings through Jan. 9, 2011. By next June, the Food and Drug Administration will select nine images and accompanying warnings, and cigarette manufacturers will need to include them on all packages by October 2012. Still, the new warnings come at a time when states are cutting tobacco prevention programs drastically to save money, according to a report from a coalition of public health organizations. Most states fall far short of meeting recommended funding levels for tobacco prevention programs set by the Centers for Disease Control and Prevention.

Women's Care Graded 'U'

The United States has once again deserved an overall grade of “unsatisfactory” in meeting women's health needs, according to a new report card from the National Women's Law Center. The report, which is the fifth produced by the group, graded the nation “satisfactory” on only three indicators of women's health: those aged 40 and older receiving regular mammograms, annual visits to the dentist, and women aged 50 and older getting colorectal cancer screening. But the United States received a failing grade on 13 of 26 indicators. The country dropped from “satisfactory minus” in the center's 2007 report to “failing” today in the proportion of women who report binge drinking, and the percentage of women getting a regular Pap test declined from a grade of “unsatisfactory” to “failing.” The nation improved on only one indicator, rising from “unsatisfactory” to “satisfactory minus” in cholesterol screening for women.

Court Rejects Abortion Challenge

Abortion opponents failed to gain ground in an attempt to defeat the Affordable Care Act in court. On Nov. 30, a U.S. district court judge in Virginia dismissed a case charging, in part, that the new health care reform law is unconstitutional because it allows for coverage of abortions. In the suit, Liberty University, a Virginia-based Christian college, and five individuals claimed that the new law would force them to violate their religious conviction against subsidizing abortions. But the U.S. District Judge Norman K. Moon said in his decision that the plaintiffs had failed to show how any of the payments required under the new law would be used to fund abortion. In fact, the judge wrote, the law contains “strict safeguards at multiple levels to prevent federal funds from being used to pay for abortion services beyond those in cases of rape or incest, or where the life of the woman would be endangered.”

Unsafe Abortions Continue

More than 21 million unsafe abortions were performed worldwide in 2008, according to new data from the World Health Organization. The WHO defines unsafe abortions as cases in which either the provider lacks necessary skills or the setting fails to meet minimum medical standards. The WHO estimates that about 47,000 women, almost exclusively in developing countries, died in 2008 because of complications from these procedures. The figures were reported in the journal Reproductive Health Matters. The number of unsafe abortions rose from 19.7 million in 2003 to 21.6 million in 2008, but the increase resulted from the rise in the number of women of reproductive age around the world, according to the report. The actual rate of unsafe abortions stayed the same, at 14 per 1,000 women aged 15–44 years. Overall, unsafe abortions were most prevalent in areas of the world where women had less access to contraception and abortion services were restricted.

New 2020 Maternal-Health Goals

The federal government has issued its new goals for improving public health by 2020, and they include a few new benchmarks for maternal health that touch on both preconception and postpartum wellness. For example, “Healthy People 2020” calls for a decrease in the rate of postpartum relapse of smoking among women who quit while pregnant. Another 10-year benchmark is an increase in the percentage of women attending postpartum visits with health care workers. The federal government is also seeking an increase in the percentage of employers who have worksite lactation programs. Focusing on women before they become pregnant, “Healthy People 2020” calls for more to get preconception care services and to practice key behaviors such as maintaining a healthy weight prior to pregnancy. The objectives are available online at

www.healthypeople.gov/2020/topicsobjectives2020/default.aspx

New Tobacco Warnings Required

Cigarette manufacturers would be forced to cover large swaths of their packaging with bold warnings and graphic images showing the health consequences of smoking in a strategy unveiled by the Department of Health and Human Services. Potential images include a photo of a corpse with a toe tag, a man smoking through a hole in his throat, and side-by-side photographs of diseased and healthy lungs. The new warnings include “Cigarettes can harm your children,” “Smoking During Pregnancy Can Harm Your Baby,” and “Smoking Can Kill You.” The public can comment on the proposed images and warnings through Jan. 9, 2011. By next June, the Food and Drug Administration will select nine images and accompanying warnings, and cigarette manufacturers will need to include them on all packages by October 2012. Still, the new warnings come at a time when states are cutting tobacco prevention programs drastically to save money, according to a report from a coalition of public health organizations. Most states fall far short of meeting recommended funding levels for tobacco prevention programs set by the Centers for Disease Control and Prevention.

Women's Care Graded 'U'

The United States has once again deserved an overall grade of “unsatisfactory” in meeting women's health needs, according to a new report card from the National Women's Law Center. The report, which is the fifth produced by the group, graded the nation “satisfactory” on only three indicators of women's health: those aged 40 and older receiving regular mammograms, annual visits to the dentist, and women aged 50 and older getting colorectal cancer screening. But the United States received a failing grade on 13 of 26 indicators. The country dropped from “satisfactory minus” in the center's 2007 report to “failing” today in the proportion of women who report binge drinking, and the percentage of women getting a regular Pap test declined from a grade of “unsatisfactory” to “failing.” The nation improved on only one indicator, rising from “unsatisfactory” to “satisfactory minus” in cholesterol screening for women.

Court Rejects Abortion Challenge

Abortion opponents failed to gain ground in an attempt to defeat the Affordable Care Act in court. On Nov. 30, a U.S. district court judge in Virginia dismissed a case charging, in part, that the new health care reform law is unconstitutional because it allows for coverage of abortions. In the suit, Liberty University, a Virginia-based Christian college, and five individuals claimed that the new law would force them to violate their religious conviction against subsidizing abortions. But the U.S. District Judge Norman K. Moon said in his decision that the plaintiffs had failed to show how any of the payments required under the new law would be used to fund abortion. In fact, the judge wrote, the law contains “strict safeguards at multiple levels to prevent federal funds from being used to pay for abortion services beyond those in cases of rape or incest, or where the life of the woman would be endangered.”

Unsafe Abortions Continue

More than 21 million unsafe abortions were performed worldwide in 2008, according to new data from the World Health Organization. The WHO defines unsafe abortions as cases in which either the provider lacks necessary skills or the setting fails to meet minimum medical standards. The WHO estimates that about 47,000 women, almost exclusively in developing countries, died in 2008 because of complications from these procedures. The figures were reported in the journal Reproductive Health Matters. The number of unsafe abortions rose from 19.7 million in 2003 to 21.6 million in 2008, but the increase resulted from the rise in the number of women of reproductive age around the world, according to the report. The actual rate of unsafe abortions stayed the same, at 14 per 1,000 women aged 15–44 years. Overall, unsafe abortions were most prevalent in areas of the world where women had less access to contraception and abortion services were restricted.

New 2020 Maternal-Health Goals

The federal government has issued its new goals for improving public health by 2020, and they include a few new benchmarks for maternal health that touch on both preconception and postpartum wellness. For example, “Healthy People 2020” calls for a decrease in the rate of postpartum relapse of smoking among women who quit while pregnant. Another 10-year benchmark is an increase in the percentage of women attending postpartum visits with health care workers. The federal government is also seeking an increase in the percentage of employers who have worksite lactation programs. Focusing on women before they become pregnant, “Healthy People 2020” calls for more to get preconception care services and to practice key behaviors such as maintaining a healthy weight prior to pregnancy. The objectives are available online at

www.healthypeople.gov/2020/topicsobjectives2020/default.aspx

New Tobacco Warnings Required

Cigarette manufacturers would be forced to cover large swaths of their packaging with bold warnings and graphic images showing the health consequences of smoking in a strategy unveiled by the Department of Health and Human Services. Potential images include a photo of a corpse with a toe tag, a man smoking through a hole in his throat, and side-by-side photographs of diseased and healthy lungs. The new warnings include “Cigarettes can harm your children,” “Smoking During Pregnancy Can Harm Your Baby,” and “Smoking Can Kill You.” The public can comment on the proposed images and warnings through Jan. 9, 2011. By next June, the Food and Drug Administration will select nine images and accompanying warnings, and cigarette manufacturers will need to include them on all packages by October 2012. Still, the new warnings come at a time when states are cutting tobacco prevention programs drastically to save money, according to a report from a coalition of public health organizations. Most states fall far short of meeting recommended funding levels for tobacco prevention programs set by the Centers for Disease Control and Prevention.

The federal government cannot require individuals to purchase health insurance under the recently passed Affordable Care Act, according to a Dec. 13 ruling by a U.S. District Court judge in Richmond, Va.

In his decision, Judge Henry E. Hudson wrote that it is outside the constitutional powers of Congress to regulate whether a person purchases a product. As a result, his decision effectively severs section 1501 – the Minimum Essential Coverage provision – from the Affordable Care Act but leaves the remainder of the health reform law intact.

The case, Commonwealth of Virginia v. Kathleen Sebelius, was brought by Virginia Attorney General Ken Cuccinelli. Mr. Cuccinelli was asking the court to grant an injunction against the implementation of the entire health reform law if the individual mandate was deemed to be unconstitutional.

The U.S. Department of Justice is expected appeal the decision, which could end up in the Supreme Court. However, if Judge Hudson's ruling stands, the removal of the individual mandate could create serious problems for the overall implementation of the Affordable Care Act.

In their defense of the law, lawyers for the federal government noted that the success of other portions of the law, such as the provision barring insurers from discriminating against people based on pre-existing medical conditions, depends on the ability to insure all Americans.

This is the first time that opponents of the law have been successful in challenging a portion of the Affordable Care Act. Other challenges to the law in Michigan and Virginia have been dismissed.

The federal government cannot require individuals to purchase health insurance under the recently passed Affordable Care Act, according to a Dec. 13 ruling by a U.S. District Court judge in Richmond, Va.

In his decision, Judge Henry E. Hudson wrote that it is outside the constitutional powers of Congress to regulate whether a person purchases a product. As a result, his decision effectively severs section 1501 – the Minimum Essential Coverage provision – from the Affordable Care Act but leaves the remainder of the health reform law intact.

The case, Commonwealth of Virginia v. Kathleen Sebelius, was brought by Virginia Attorney General Ken Cuccinelli. Mr. Cuccinelli was asking the court to grant an injunction against the implementation of the entire health reform law if the individual mandate was deemed to be unconstitutional.

The U.S. Department of Justice is expected appeal the decision, which could end up in the Supreme Court. However, if Judge Hudson's ruling stands, the removal of the individual mandate could create serious problems for the overall implementation of the Affordable Care Act.

In their defense of the law, lawyers for the federal government noted that the success of other portions of the law, such as the provision barring insurers from discriminating against people based on pre-existing medical conditions, depends on the ability to insure all Americans.

This is the first time that opponents of the law have been successful in challenging a portion of the Affordable Care Act. Other challenges to the law in Michigan and Virginia have been dismissed.

The federal government cannot require individuals to purchase health insurance under the recently passed Affordable Care Act, according to a Dec. 13 ruling by a U.S. District Court judge in Richmond, Va.

In his decision, Judge Henry E. Hudson wrote that it is outside the constitutional powers of Congress to regulate whether a person purchases a product. As a result, his decision effectively severs section 1501 – the Minimum Essential Coverage provision – from the Affordable Care Act but leaves the remainder of the health reform law intact.

The case, Commonwealth of Virginia v. Kathleen Sebelius, was brought by Virginia Attorney General Ken Cuccinelli. Mr. Cuccinelli was asking the court to grant an injunction against the implementation of the entire health reform law if the individual mandate was deemed to be unconstitutional.

The U.S. Department of Justice is expected appeal the decision, which could end up in the Supreme Court. However, if Judge Hudson's ruling stands, the removal of the individual mandate could create serious problems for the overall implementation of the Affordable Care Act.

In their defense of the law, lawyers for the federal government noted that the success of other portions of the law, such as the provision barring insurers from discriminating against people based on pre-existing medical conditions, depends on the ability to insure all Americans.

This is the first time that opponents of the law have been successful in challenging a portion of the Affordable Care Act. Other challenges to the law in Michigan and Virginia have been dismissed.

Congress passed legislation clarifying its definition of a “creditor” under the Red Flags rule, a move that could help bolster the case that physicians should not have to abide by the new identity theft safeguards.

The Federal Trade Commission was set to begin enforcing the Red Flags rule on Jan. 1. The rule was written to implement provisions of the Fair and Accurate Credit Transactions Act, which calls on creditors and financial institutions to address the risk of identity theft.

The rule requires creditors to develop formal identity theft–prevention programs that would allow an organization to identify, detect, and respond to any suspicious practices (“red flags”) that could indicate identity theft. However, physician groups have long asserted that they are not creditors, and should be exempt from the requirements, which they consider overly burdensome.

Under the new legislation (S. 3987), which was passed by the House on Dec. 7 and by the Senate on Nov. 30, Congress clarifies that a creditor is not someone who simply “advances funds on behalf of a person for expenses” related to a service. The American Medical Association and other physician groups are hopeful that the clarification will be enough to convince officials at the Federal Trade Commission to exempt physicians from the Red Flags rule.

“The AMA is pleased that this legislation supports AMA's long-standing argument to the FTC that physicians are not creditors. This bill will help eliminate the current confusion about the rule's application to physicians,” AMA President Cecil B. Wilson said in a statement. “We hope that the FTC will now withdraw its assertion that the red flags rule applies to physicians.”

The Red Flags rule became effective on Jan. 1, 2008, with an original enforcement deadline of Nov. 1, 2008. However, the FTC has delayed enforcement of the rule five times, first to give organizations more time to become familiar with the requirements, and later at the request of members of Congress.

In May 2010, the AMA joined the American Osteopathic Association and the Medical Society of the District of Columbia in a federal lawsuit that seeks to prevent the FTC from applying the Red Flags rule to physicians.

Congress passed legislation clarifying its definition of a “creditor” under the Red Flags rule, a move that could help bolster the case that physicians should not have to abide by the new identity theft safeguards.

The Federal Trade Commission was set to begin enforcing the Red Flags rule on Jan. 1. The rule was written to implement provisions of the Fair and Accurate Credit Transactions Act, which calls on creditors and financial institutions to address the risk of identity theft.

The rule requires creditors to develop formal identity theft–prevention programs that would allow an organization to identify, detect, and respond to any suspicious practices (“red flags”) that could indicate identity theft. However, physician groups have long asserted that they are not creditors, and should be exempt from the requirements, which they consider overly burdensome.

Under the new legislation (S. 3987), which was passed by the House on Dec. 7 and by the Senate on Nov. 30, Congress clarifies that a creditor is not someone who simply “advances funds on behalf of a person for expenses” related to a service. The American Medical Association and other physician groups are hopeful that the clarification will be enough to convince officials at the Federal Trade Commission to exempt physicians from the Red Flags rule.

“The AMA is pleased that this legislation supports AMA's long-standing argument to the FTC that physicians are not creditors. This bill will help eliminate the current confusion about the rule's application to physicians,” AMA President Cecil B. Wilson said in a statement. “We hope that the FTC will now withdraw its assertion that the red flags rule applies to physicians.”

The Red Flags rule became effective on Jan. 1, 2008, with an original enforcement deadline of Nov. 1, 2008. However, the FTC has delayed enforcement of the rule five times, first to give organizations more time to become familiar with the requirements, and later at the request of members of Congress.

In May 2010, the AMA joined the American Osteopathic Association and the Medical Society of the District of Columbia in a federal lawsuit that seeks to prevent the FTC from applying the Red Flags rule to physicians.

Congress passed legislation clarifying its definition of a “creditor” under the Red Flags rule, a move that could help bolster the case that physicians should not have to abide by the new identity theft safeguards.

The Federal Trade Commission was set to begin enforcing the Red Flags rule on Jan. 1. The rule was written to implement provisions of the Fair and Accurate Credit Transactions Act, which calls on creditors and financial institutions to address the risk of identity theft.

The rule requires creditors to develop formal identity theft–prevention programs that would allow an organization to identify, detect, and respond to any suspicious practices (“red flags”) that could indicate identity theft. However, physician groups have long asserted that they are not creditors, and should be exempt from the requirements, which they consider overly burdensome.

Under the new legislation (S. 3987), which was passed by the House on Dec. 7 and by the Senate on Nov. 30, Congress clarifies that a creditor is not someone who simply “advances funds on behalf of a person for expenses” related to a service. The American Medical Association and other physician groups are hopeful that the clarification will be enough to convince officials at the Federal Trade Commission to exempt physicians from the Red Flags rule.

“The AMA is pleased that this legislation supports AMA's long-standing argument to the FTC that physicians are not creditors. This bill will help eliminate the current confusion about the rule's application to physicians,” AMA President Cecil B. Wilson said in a statement. “We hope that the FTC will now withdraw its assertion that the red flags rule applies to physicians.”

The Red Flags rule became effective on Jan. 1, 2008, with an original enforcement deadline of Nov. 1, 2008. However, the FTC has delayed enforcement of the rule five times, first to give organizations more time to become familiar with the requirements, and later at the request of members of Congress.

In May 2010, the AMA joined the American Osteopathic Association and the Medical Society of the District of Columbia in a federal lawsuit that seeks to prevent the FTC from applying the Red Flags rule to physicians.