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High-volume, low-mortality hospitals have lowest postsurgical readmissions
Hospitals that conduct a high volume of surgical procedures and have a low 30-day mortality rate have lower readmission rates, according to a new study. Even so, about one in seven patients discharged after major surgery is readmitted in the first 30 days, the authors found.
The researchers also showed that strictly following surgical process measures – such as infection control techniques – was only weakly associated with reduced readmissions.
The results are not terribly surprising, according to the authors, Dr. Thomas C. Tsai and his colleagues from Harvard University, Brigham and Women’s Hospital, and the Veterans Affairs Boston Healthcare System. The researchers could not specifically determine why the higher-volume, lower-mortality hospitals had lower readmission rates, but they speculated that these facilities have systems in place to protect surgical patients from bad outcomes that might bring them back to the hospital. Their study was published Sept. 18 in the New England Journal of Medicine (2013;369:1134-42).
The Medicare program now penalizes hospitals for excess readmissions after discharge for heart failure, heart attack, and pneumonia. For fiscal year 2013, which ends on Oct. 1, hospitals will be penalized 1% of their total Medicare billings if readmissions are too high. In fiscal 2014, chronic obstructive pulmonary disease and coronary artery bypass grafting will be added to the list of monitored conditions. The penalty rises to 2% in fiscal year 2014 and 3% in fiscal 2015. In coming years, the Centers for Medicare and Medicaid Services is expected to add more surgical procedures to the readmission penalty list.
The researchers analyzed national Medicare data, which comprised 479,471 discharges from 3,004 hospitals. These hospitals accounted for 90% of the discharges for the six major procedures studied: coronary artery bypass grafting, pulmonary lobectomy, endovascular repair of abdominal aortic aneurysm, open repair of AAA, colectomy, and hip replacement. The authors also analyzed Hospital Quality Alliance (HQA) surgical care scores. The HQA score is calculated based on how well hospitals perform on process measures established by the Surgical Care Improvement Project.
The three measures of surgical quality included the HQA score, procedure volume, and 30-day mortality. The primary outcome measure was a hospital-level composite of the six procedure-specific, risk-adjusted readmission rates at 30 days. The authors compared the characteristics of patients who were readmitted within 30 days with those who were not, and compared the characteristics of hospitals that had composite readmission rates above the median with those that had rates below the median.
The median composite risk-adjusted 30-day readmission rate was 13%. Patients who were readmitted tended to be older (78 years vs. 77 years) and had more comorbidities. The hospitals with readmission rates below the median were more likely to be nonprofit, nonteaching, and located in the West. They also had a higher number of full-time nurses per 1,000 patient-days and a lower proportion of Medicaid patients.
There was no significant difference between urban and rural hospitals.
The authors used multivariate models to gauge the impact of quality measures on readmission rates. After accounting for hospital characteristics, they found that hospitals with the highest volume of procedures had a readmission rate just under the median, compared with those with the lowest procedure volumes, which had a readmission rate of close to 17%.
Hospitals in the lowest quartile for mortality rates had a 13% readmission rate, compared with 14% for those in the highest mortality quartile.
Overall, there was no significant difference in readmissions between the hospitals that performed the best on the HQA score and those that were the poorest performers. That might be because there was only a very small variation in performance on the HQA score – with a median of 99% for high performers and 92% for low performers, said the authors.
Policymakers should be reassured by their consistent findings that readmissions are linked to certain quality measures – volume and mortality, the investigators said. But a direct link is still not definitive, said Dr. Tsai and his colleagues. Previous studies have indicated that volume did help reduce readmissions, while others have shown no relationship.
But those studies were conducted before the widespread use of minimally invasive procedures and process measures aimed at reducing postsurgical complications, the authors said.
The authors reported no relevant conflicts of interest.
On Twitter @aliciaault
Readmissions have clearly become a tremendous focus for payers and oversight agencies. The Readmission Reduction Program put forth by the Centers for Medicare and Medicaid Services (CMS) will potentially penalize hospitals up to 3% for high readmission rates in fiscal year 2015. This penalty is higher than for any other CMS pay-for-performance programs. The main CMS measure compares hospitals on risk-adjusted all-cause hospital-wide readmissions.
The study by Tsai and his colleagues concluded that surgical readmission rates are a relevant and valid approach to measure surgical quality. However, this has been the topic of much debate in the surgical community, and admittedly, my thinking has evolved on this topic.
Readmissions have gained momentum because they are undoubtedly costly, but they also certainly adversely affect quality of life for the patient. Readmission quality metrics were initially pioneered for medical admissions. Medical readmissions were thought to be caused by issues with the transition from the inpatient team to the outpatient physicians; thus there was potentially a systems-based intervention that could be implemented. Hospitals were able to reduce readmission rates with early postdischarge follow-up visits to intervene (e.g., weigh patients, assess symptoms, and adjust diuretics for heart failure patients) and better coordination of care.
Surgeons have argued that readmissions after medical admissions differ considerably from readmissions after surgery. Surgical readmissions are almost entirely caused by postoperative complications, whereas readmissions after medical admissions are due to worsening of the clinical problem or issues with coordination of care. Thus, surgeons have suggested that surgical readmissions are not preventable with a change in postoperative follow-up visits or an improvement in coordination of care. Thus, some may argue that readmissions are unavoidable and simply an aggregate measure of postdischarge postoperative complications. Some also suggest that surgeons are penalized twice: once for the postoperative complication and again for the readmission that is likely related to the complication.
While this was my initial inclination, I do now believe there is value in readmission as a quality measure. There are likely many opportunities for hospitals to reduce readmissions and cost by dealing with more complications in the outpatient setting. For example, if a hospital has a high readmission rate and they find it is caused by surgical site infection (SSI), they could implement an outpatient system to deal with SSIs without needing to readmit patients. Hospitals have had success with this approach and have been able to insert PICC lines for antibiotics, open incisions, debride wounds, and place negative pressure wound therapy in the outpatient clinic.
In 2014, the American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP) will provide hospitals with risk-adjusted readmission rates. Since the CMS measure only provides an overall, hospital-wide rate, hospitals will need to examine their readmission performance for surgical patients overall and for individual surgeries to identify targeted opportunities for improvement. The ACS NSQIP will fill this need. Moreover, since the ACS NSQIP data abstractors record the reason for the readmission and other patient variables, ACS NSQIP hospitals will be able to better understand why the readmission happened and develop strategies to reduce readmissions. Hospitals will also be able to share experiences and best practices through the ACS NSQIP community to drive down readmission rates.
While readmission may not initially make intuitive sense as a surgical quality measure, it will likely prompt improvements in care for the patients and reduce costs for payers and hospitals, making it a worthwhile focus for quality improvement efforts.
Dr. Karl Bilimoria is an ACS Faculty Scholar and a surgical oncologist at Northwestern Memorial Hospital, Chicago, and an assistant professor of surgery at the Northwestern University Feinberg School of Medicine. He is also director of the Surgical Outcomes and Quality Improvement Center at Northwestern University.
Readmissions have clearly become a tremendous focus for payers and oversight agencies. The Readmission Reduction Program put forth by the Centers for Medicare and Medicaid Services (CMS) will potentially penalize hospitals up to 3% for high readmission rates in fiscal year 2015. This penalty is higher than for any other CMS pay-for-performance programs. The main CMS measure compares hospitals on risk-adjusted all-cause hospital-wide readmissions.
The study by Tsai and his colleagues concluded that surgical readmission rates are a relevant and valid approach to measure surgical quality. However, this has been the topic of much debate in the surgical community, and admittedly, my thinking has evolved on this topic.
Readmissions have gained momentum because they are undoubtedly costly, but they also certainly adversely affect quality of life for the patient. Readmission quality metrics were initially pioneered for medical admissions. Medical readmissions were thought to be caused by issues with the transition from the inpatient team to the outpatient physicians; thus there was potentially a systems-based intervention that could be implemented. Hospitals were able to reduce readmission rates with early postdischarge follow-up visits to intervene (e.g., weigh patients, assess symptoms, and adjust diuretics for heart failure patients) and better coordination of care.
Surgeons have argued that readmissions after medical admissions differ considerably from readmissions after surgery. Surgical readmissions are almost entirely caused by postoperative complications, whereas readmissions after medical admissions are due to worsening of the clinical problem or issues with coordination of care. Thus, surgeons have suggested that surgical readmissions are not preventable with a change in postoperative follow-up visits or an improvement in coordination of care. Thus, some may argue that readmissions are unavoidable and simply an aggregate measure of postdischarge postoperative complications. Some also suggest that surgeons are penalized twice: once for the postoperative complication and again for the readmission that is likely related to the complication.
While this was my initial inclination, I do now believe there is value in readmission as a quality measure. There are likely many opportunities for hospitals to reduce readmissions and cost by dealing with more complications in the outpatient setting. For example, if a hospital has a high readmission rate and they find it is caused by surgical site infection (SSI), they could implement an outpatient system to deal with SSIs without needing to readmit patients. Hospitals have had success with this approach and have been able to insert PICC lines for antibiotics, open incisions, debride wounds, and place negative pressure wound therapy in the outpatient clinic.
In 2014, the American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP) will provide hospitals with risk-adjusted readmission rates. Since the CMS measure only provides an overall, hospital-wide rate, hospitals will need to examine their readmission performance for surgical patients overall and for individual surgeries to identify targeted opportunities for improvement. The ACS NSQIP will fill this need. Moreover, since the ACS NSQIP data abstractors record the reason for the readmission and other patient variables, ACS NSQIP hospitals will be able to better understand why the readmission happened and develop strategies to reduce readmissions. Hospitals will also be able to share experiences and best practices through the ACS NSQIP community to drive down readmission rates.
While readmission may not initially make intuitive sense as a surgical quality measure, it will likely prompt improvements in care for the patients and reduce costs for payers and hospitals, making it a worthwhile focus for quality improvement efforts.
Dr. Karl Bilimoria is an ACS Faculty Scholar and a surgical oncologist at Northwestern Memorial Hospital, Chicago, and an assistant professor of surgery at the Northwestern University Feinberg School of Medicine. He is also director of the Surgical Outcomes and Quality Improvement Center at Northwestern University.
Readmissions have clearly become a tremendous focus for payers and oversight agencies. The Readmission Reduction Program put forth by the Centers for Medicare and Medicaid Services (CMS) will potentially penalize hospitals up to 3% for high readmission rates in fiscal year 2015. This penalty is higher than for any other CMS pay-for-performance programs. The main CMS measure compares hospitals on risk-adjusted all-cause hospital-wide readmissions.
The study by Tsai and his colleagues concluded that surgical readmission rates are a relevant and valid approach to measure surgical quality. However, this has been the topic of much debate in the surgical community, and admittedly, my thinking has evolved on this topic.
Readmissions have gained momentum because they are undoubtedly costly, but they also certainly adversely affect quality of life for the patient. Readmission quality metrics were initially pioneered for medical admissions. Medical readmissions were thought to be caused by issues with the transition from the inpatient team to the outpatient physicians; thus there was potentially a systems-based intervention that could be implemented. Hospitals were able to reduce readmission rates with early postdischarge follow-up visits to intervene (e.g., weigh patients, assess symptoms, and adjust diuretics for heart failure patients) and better coordination of care.
Surgeons have argued that readmissions after medical admissions differ considerably from readmissions after surgery. Surgical readmissions are almost entirely caused by postoperative complications, whereas readmissions after medical admissions are due to worsening of the clinical problem or issues with coordination of care. Thus, surgeons have suggested that surgical readmissions are not preventable with a change in postoperative follow-up visits or an improvement in coordination of care. Thus, some may argue that readmissions are unavoidable and simply an aggregate measure of postdischarge postoperative complications. Some also suggest that surgeons are penalized twice: once for the postoperative complication and again for the readmission that is likely related to the complication.
While this was my initial inclination, I do now believe there is value in readmission as a quality measure. There are likely many opportunities for hospitals to reduce readmissions and cost by dealing with more complications in the outpatient setting. For example, if a hospital has a high readmission rate and they find it is caused by surgical site infection (SSI), they could implement an outpatient system to deal with SSIs without needing to readmit patients. Hospitals have had success with this approach and have been able to insert PICC lines for antibiotics, open incisions, debride wounds, and place negative pressure wound therapy in the outpatient clinic.
In 2014, the American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP) will provide hospitals with risk-adjusted readmission rates. Since the CMS measure only provides an overall, hospital-wide rate, hospitals will need to examine their readmission performance for surgical patients overall and for individual surgeries to identify targeted opportunities for improvement. The ACS NSQIP will fill this need. Moreover, since the ACS NSQIP data abstractors record the reason for the readmission and other patient variables, ACS NSQIP hospitals will be able to better understand why the readmission happened and develop strategies to reduce readmissions. Hospitals will also be able to share experiences and best practices through the ACS NSQIP community to drive down readmission rates.
While readmission may not initially make intuitive sense as a surgical quality measure, it will likely prompt improvements in care for the patients and reduce costs for payers and hospitals, making it a worthwhile focus for quality improvement efforts.
Dr. Karl Bilimoria is an ACS Faculty Scholar and a surgical oncologist at Northwestern Memorial Hospital, Chicago, and an assistant professor of surgery at the Northwestern University Feinberg School of Medicine. He is also director of the Surgical Outcomes and Quality Improvement Center at Northwestern University.
Hospitals that conduct a high volume of surgical procedures and have a low 30-day mortality rate have lower readmission rates, according to a new study. Even so, about one in seven patients discharged after major surgery is readmitted in the first 30 days, the authors found.
The researchers also showed that strictly following surgical process measures – such as infection control techniques – was only weakly associated with reduced readmissions.
The results are not terribly surprising, according to the authors, Dr. Thomas C. Tsai and his colleagues from Harvard University, Brigham and Women’s Hospital, and the Veterans Affairs Boston Healthcare System. The researchers could not specifically determine why the higher-volume, lower-mortality hospitals had lower readmission rates, but they speculated that these facilities have systems in place to protect surgical patients from bad outcomes that might bring them back to the hospital. Their study was published Sept. 18 in the New England Journal of Medicine (2013;369:1134-42).
The Medicare program now penalizes hospitals for excess readmissions after discharge for heart failure, heart attack, and pneumonia. For fiscal year 2013, which ends on Oct. 1, hospitals will be penalized 1% of their total Medicare billings if readmissions are too high. In fiscal 2014, chronic obstructive pulmonary disease and coronary artery bypass grafting will be added to the list of monitored conditions. The penalty rises to 2% in fiscal year 2014 and 3% in fiscal 2015. In coming years, the Centers for Medicare and Medicaid Services is expected to add more surgical procedures to the readmission penalty list.
The researchers analyzed national Medicare data, which comprised 479,471 discharges from 3,004 hospitals. These hospitals accounted for 90% of the discharges for the six major procedures studied: coronary artery bypass grafting, pulmonary lobectomy, endovascular repair of abdominal aortic aneurysm, open repair of AAA, colectomy, and hip replacement. The authors also analyzed Hospital Quality Alliance (HQA) surgical care scores. The HQA score is calculated based on how well hospitals perform on process measures established by the Surgical Care Improvement Project.
The three measures of surgical quality included the HQA score, procedure volume, and 30-day mortality. The primary outcome measure was a hospital-level composite of the six procedure-specific, risk-adjusted readmission rates at 30 days. The authors compared the characteristics of patients who were readmitted within 30 days with those who were not, and compared the characteristics of hospitals that had composite readmission rates above the median with those that had rates below the median.
The median composite risk-adjusted 30-day readmission rate was 13%. Patients who were readmitted tended to be older (78 years vs. 77 years) and had more comorbidities. The hospitals with readmission rates below the median were more likely to be nonprofit, nonteaching, and located in the West. They also had a higher number of full-time nurses per 1,000 patient-days and a lower proportion of Medicaid patients.
There was no significant difference between urban and rural hospitals.
The authors used multivariate models to gauge the impact of quality measures on readmission rates. After accounting for hospital characteristics, they found that hospitals with the highest volume of procedures had a readmission rate just under the median, compared with those with the lowest procedure volumes, which had a readmission rate of close to 17%.
Hospitals in the lowest quartile for mortality rates had a 13% readmission rate, compared with 14% for those in the highest mortality quartile.
Overall, there was no significant difference in readmissions between the hospitals that performed the best on the HQA score and those that were the poorest performers. That might be because there was only a very small variation in performance on the HQA score – with a median of 99% for high performers and 92% for low performers, said the authors.
Policymakers should be reassured by their consistent findings that readmissions are linked to certain quality measures – volume and mortality, the investigators said. But a direct link is still not definitive, said Dr. Tsai and his colleagues. Previous studies have indicated that volume did help reduce readmissions, while others have shown no relationship.
But those studies were conducted before the widespread use of minimally invasive procedures and process measures aimed at reducing postsurgical complications, the authors said.
The authors reported no relevant conflicts of interest.
On Twitter @aliciaault
Hospitals that conduct a high volume of surgical procedures and have a low 30-day mortality rate have lower readmission rates, according to a new study. Even so, about one in seven patients discharged after major surgery is readmitted in the first 30 days, the authors found.
The researchers also showed that strictly following surgical process measures – such as infection control techniques – was only weakly associated with reduced readmissions.
The results are not terribly surprising, according to the authors, Dr. Thomas C. Tsai and his colleagues from Harvard University, Brigham and Women’s Hospital, and the Veterans Affairs Boston Healthcare System. The researchers could not specifically determine why the higher-volume, lower-mortality hospitals had lower readmission rates, but they speculated that these facilities have systems in place to protect surgical patients from bad outcomes that might bring them back to the hospital. Their study was published Sept. 18 in the New England Journal of Medicine (2013;369:1134-42).
The Medicare program now penalizes hospitals for excess readmissions after discharge for heart failure, heart attack, and pneumonia. For fiscal year 2013, which ends on Oct. 1, hospitals will be penalized 1% of their total Medicare billings if readmissions are too high. In fiscal 2014, chronic obstructive pulmonary disease and coronary artery bypass grafting will be added to the list of monitored conditions. The penalty rises to 2% in fiscal year 2014 and 3% in fiscal 2015. In coming years, the Centers for Medicare and Medicaid Services is expected to add more surgical procedures to the readmission penalty list.
The researchers analyzed national Medicare data, which comprised 479,471 discharges from 3,004 hospitals. These hospitals accounted for 90% of the discharges for the six major procedures studied: coronary artery bypass grafting, pulmonary lobectomy, endovascular repair of abdominal aortic aneurysm, open repair of AAA, colectomy, and hip replacement. The authors also analyzed Hospital Quality Alliance (HQA) surgical care scores. The HQA score is calculated based on how well hospitals perform on process measures established by the Surgical Care Improvement Project.
The three measures of surgical quality included the HQA score, procedure volume, and 30-day mortality. The primary outcome measure was a hospital-level composite of the six procedure-specific, risk-adjusted readmission rates at 30 days. The authors compared the characteristics of patients who were readmitted within 30 days with those who were not, and compared the characteristics of hospitals that had composite readmission rates above the median with those that had rates below the median.
The median composite risk-adjusted 30-day readmission rate was 13%. Patients who were readmitted tended to be older (78 years vs. 77 years) and had more comorbidities. The hospitals with readmission rates below the median were more likely to be nonprofit, nonteaching, and located in the West. They also had a higher number of full-time nurses per 1,000 patient-days and a lower proportion of Medicaid patients.
There was no significant difference between urban and rural hospitals.
The authors used multivariate models to gauge the impact of quality measures on readmission rates. After accounting for hospital characteristics, they found that hospitals with the highest volume of procedures had a readmission rate just under the median, compared with those with the lowest procedure volumes, which had a readmission rate of close to 17%.
Hospitals in the lowest quartile for mortality rates had a 13% readmission rate, compared with 14% for those in the highest mortality quartile.
Overall, there was no significant difference in readmissions between the hospitals that performed the best on the HQA score and those that were the poorest performers. That might be because there was only a very small variation in performance on the HQA score – with a median of 99% for high performers and 92% for low performers, said the authors.
Policymakers should be reassured by their consistent findings that readmissions are linked to certain quality measures – volume and mortality, the investigators said. But a direct link is still not definitive, said Dr. Tsai and his colleagues. Previous studies have indicated that volume did help reduce readmissions, while others have shown no relationship.
But those studies were conducted before the widespread use of minimally invasive procedures and process measures aimed at reducing postsurgical complications, the authors said.
The authors reported no relevant conflicts of interest.
On Twitter @aliciaault
FROM THE NEW ENGLAND JOURNAL OF MEDICINE
Major finding: Hospitals with the highest surgical volume and lowest 30-day mortality rates had the lowest 30-day readmission rates for six major surgical procedures.
Data source: A bivariate and multivariate analysis of Medicare data on 479,471 discharges from 3,004 hospitals.
Disclosures: The authors reported no relevant conflicts of interest.
Continued slowdown in health spending not due to health reform
WASHINGTON – The nation’s health bill is slated to continue to grow slowly through the end of this year, but that trend is not attributable to the Affordable Care Act. Instead, health reform is likely to increase health spending in 2014, as potentially 11 million Americans gain health insurance through the law next year, according to government economists.
By 2022, the ACA is expected to cut the number of uninsured by 30 million, but also add about 0.1% to the nation’s health tab each year, adding up to an additional $621 billion over the next decade, according to an annual estimate of trends in health spending by analysts from the Centers for Medicare and Medicaid Services published in Health Affairs Sept. 18. (doi:10.1377/hlthaff.2013.0721).
The economists found that in 2012 spending overall grew only 3.9%, to $2.8 trillion. Spending is likely to stay under 4% in 2013, in line with the historically low rate of growth seen over the past few years, said the economists.
The decrease in health spending cannot be attributed to the Affordable Care Act, which became law in 2010, they said.
"In our projections, we have incorporated some modest savings regarding delivery system reforms, however, at this time it’s a little too early to tell how substantial those savings will be in the longer term," Gigi Cuckler, an economist in the CMS Office of the Actuary, told reporters.
The most recent downturn in spending is being driven by bigger trends. What has been seen over the past 50 years is that when the economy shrinks, so does health spending, said Ms. Cuckler. When the economy recovers, the nation spends more on health care.
"Until we see evidence that relationship has been broken, it’s very difficult for us to conclude that something structural has occurred," said Stephen Heffler, also of the Office of the Actuary at the CMS.
CMS Administrator Marilyn Tavenner, however, said that the trends showed that "we are on the right track to controlling health care costs, thanks in part to the Affordable Care Act." She added that the CMS had "identified several areas where our reforms to control costs are making progress, and we must build on those efforts in the years ahead."
Health costs also slowed in 2012, and likely will this year as well, because of a continued ratcheting down of costs in Medicare and Medicaid. Employers also shifted more workers into high-deductible, high-cost health plans, so they, in turn, cut back on their use of physician services and prescription drugs.
Medicare spending grew by 4.6% in 2012, down from 6.2% growth in 2011. Factors included lower spending on skilled nursing facilities; lower spending on prescriptions drugs such as Plavix (clopidogrel) , which went off-patent; and lower payments to some providers mandated by the ACA. This year, Medicare spending will grow even more slowly, in part from a continued slowdown in spending on hospitals and physicians. The automatic 2% spending cut mandated by sequestration will also play a role.
Medicaid spending grew just over 2% in 2012, in part because the federal government reduced its matching rate and because states employed major cost-containment efforts. But Medicaid is expected to grow by almost 5% in 2013, partly because primary care physicians were being paid at the higher Medicare rate.
In 2014, when millions of Americans are expected to gain insurance coverage through the ACA, health spending is expected to grow by 6% – that’s almost 2% faster than would have been expected if the law were not in effect. The main spending drivers in 2014 will be growth in Medicaid and growth in private health insurance. Even though only about half of the states have said they will expand Medicaid eligibility, the expansion will lead to a 12% increase in spending on the program, primarily by the federal government.
The CMS economists said they expected the newly insured to be mostly young and healthy, and therefore likely to spend less on acute care and hospitalizations but more on prescription drugs and physician services. They projected a 7% increase in overall spending on physician services in 2014 – compared to just under 5% in 2012 and around 4% in 2013. But that 7% figure would drop to a little under 5% if Congress allows the scheduled 25% cut in physician payment rates – mandated by Medicare’s Sustainable Growth Rate formula – to go into effect in January.
During 2015-2018, physician spending is expected to grow by at least 5% a year, in part because of increased demand with more people gaining insurance, said the CMS economists.
Looking ahead to 2022, the nation’s overall health spending is expected to creep up some, especially for Medicare. The population is aging, which will increase both enrollment and per-enrollee spending, said the economists.
Medicare spending is expected to be restrained somewhat as the program limits growth in fee-for-service payment increases. The economists also said they expected spending to be restrained by the Independent Payment Advisory Board (IPAB), which was established by the ACA. That board’s recommendations for spending targets are supposed to start in 2015. So far, the White House has not appointed any member to the board. Physician organizations are hoping to derail the IPAB before it gets started.
On Twitter @aliciaault
WASHINGTON – The nation’s health bill is slated to continue to grow slowly through the end of this year, but that trend is not attributable to the Affordable Care Act. Instead, health reform is likely to increase health spending in 2014, as potentially 11 million Americans gain health insurance through the law next year, according to government economists.
By 2022, the ACA is expected to cut the number of uninsured by 30 million, but also add about 0.1% to the nation’s health tab each year, adding up to an additional $621 billion over the next decade, according to an annual estimate of trends in health spending by analysts from the Centers for Medicare and Medicaid Services published in Health Affairs Sept. 18. (doi:10.1377/hlthaff.2013.0721).
The economists found that in 2012 spending overall grew only 3.9%, to $2.8 trillion. Spending is likely to stay under 4% in 2013, in line with the historically low rate of growth seen over the past few years, said the economists.
The decrease in health spending cannot be attributed to the Affordable Care Act, which became law in 2010, they said.
"In our projections, we have incorporated some modest savings regarding delivery system reforms, however, at this time it’s a little too early to tell how substantial those savings will be in the longer term," Gigi Cuckler, an economist in the CMS Office of the Actuary, told reporters.
The most recent downturn in spending is being driven by bigger trends. What has been seen over the past 50 years is that when the economy shrinks, so does health spending, said Ms. Cuckler. When the economy recovers, the nation spends more on health care.
"Until we see evidence that relationship has been broken, it’s very difficult for us to conclude that something structural has occurred," said Stephen Heffler, also of the Office of the Actuary at the CMS.
CMS Administrator Marilyn Tavenner, however, said that the trends showed that "we are on the right track to controlling health care costs, thanks in part to the Affordable Care Act." She added that the CMS had "identified several areas where our reforms to control costs are making progress, and we must build on those efforts in the years ahead."
Health costs also slowed in 2012, and likely will this year as well, because of a continued ratcheting down of costs in Medicare and Medicaid. Employers also shifted more workers into high-deductible, high-cost health plans, so they, in turn, cut back on their use of physician services and prescription drugs.
Medicare spending grew by 4.6% in 2012, down from 6.2% growth in 2011. Factors included lower spending on skilled nursing facilities; lower spending on prescriptions drugs such as Plavix (clopidogrel) , which went off-patent; and lower payments to some providers mandated by the ACA. This year, Medicare spending will grow even more slowly, in part from a continued slowdown in spending on hospitals and physicians. The automatic 2% spending cut mandated by sequestration will also play a role.
Medicaid spending grew just over 2% in 2012, in part because the federal government reduced its matching rate and because states employed major cost-containment efforts. But Medicaid is expected to grow by almost 5% in 2013, partly because primary care physicians were being paid at the higher Medicare rate.
In 2014, when millions of Americans are expected to gain insurance coverage through the ACA, health spending is expected to grow by 6% – that’s almost 2% faster than would have been expected if the law were not in effect. The main spending drivers in 2014 will be growth in Medicaid and growth in private health insurance. Even though only about half of the states have said they will expand Medicaid eligibility, the expansion will lead to a 12% increase in spending on the program, primarily by the federal government.
The CMS economists said they expected the newly insured to be mostly young and healthy, and therefore likely to spend less on acute care and hospitalizations but more on prescription drugs and physician services. They projected a 7% increase in overall spending on physician services in 2014 – compared to just under 5% in 2012 and around 4% in 2013. But that 7% figure would drop to a little under 5% if Congress allows the scheduled 25% cut in physician payment rates – mandated by Medicare’s Sustainable Growth Rate formula – to go into effect in January.
During 2015-2018, physician spending is expected to grow by at least 5% a year, in part because of increased demand with more people gaining insurance, said the CMS economists.
Looking ahead to 2022, the nation’s overall health spending is expected to creep up some, especially for Medicare. The population is aging, which will increase both enrollment and per-enrollee spending, said the economists.
Medicare spending is expected to be restrained somewhat as the program limits growth in fee-for-service payment increases. The economists also said they expected spending to be restrained by the Independent Payment Advisory Board (IPAB), which was established by the ACA. That board’s recommendations for spending targets are supposed to start in 2015. So far, the White House has not appointed any member to the board. Physician organizations are hoping to derail the IPAB before it gets started.
On Twitter @aliciaault
WASHINGTON – The nation’s health bill is slated to continue to grow slowly through the end of this year, but that trend is not attributable to the Affordable Care Act. Instead, health reform is likely to increase health spending in 2014, as potentially 11 million Americans gain health insurance through the law next year, according to government economists.
By 2022, the ACA is expected to cut the number of uninsured by 30 million, but also add about 0.1% to the nation’s health tab each year, adding up to an additional $621 billion over the next decade, according to an annual estimate of trends in health spending by analysts from the Centers for Medicare and Medicaid Services published in Health Affairs Sept. 18. (doi:10.1377/hlthaff.2013.0721).
The economists found that in 2012 spending overall grew only 3.9%, to $2.8 trillion. Spending is likely to stay under 4% in 2013, in line with the historically low rate of growth seen over the past few years, said the economists.
The decrease in health spending cannot be attributed to the Affordable Care Act, which became law in 2010, they said.
"In our projections, we have incorporated some modest savings regarding delivery system reforms, however, at this time it’s a little too early to tell how substantial those savings will be in the longer term," Gigi Cuckler, an economist in the CMS Office of the Actuary, told reporters.
The most recent downturn in spending is being driven by bigger trends. What has been seen over the past 50 years is that when the economy shrinks, so does health spending, said Ms. Cuckler. When the economy recovers, the nation spends more on health care.
"Until we see evidence that relationship has been broken, it’s very difficult for us to conclude that something structural has occurred," said Stephen Heffler, also of the Office of the Actuary at the CMS.
CMS Administrator Marilyn Tavenner, however, said that the trends showed that "we are on the right track to controlling health care costs, thanks in part to the Affordable Care Act." She added that the CMS had "identified several areas where our reforms to control costs are making progress, and we must build on those efforts in the years ahead."
Health costs also slowed in 2012, and likely will this year as well, because of a continued ratcheting down of costs in Medicare and Medicaid. Employers also shifted more workers into high-deductible, high-cost health plans, so they, in turn, cut back on their use of physician services and prescription drugs.
Medicare spending grew by 4.6% in 2012, down from 6.2% growth in 2011. Factors included lower spending on skilled nursing facilities; lower spending on prescriptions drugs such as Plavix (clopidogrel) , which went off-patent; and lower payments to some providers mandated by the ACA. This year, Medicare spending will grow even more slowly, in part from a continued slowdown in spending on hospitals and physicians. The automatic 2% spending cut mandated by sequestration will also play a role.
Medicaid spending grew just over 2% in 2012, in part because the federal government reduced its matching rate and because states employed major cost-containment efforts. But Medicaid is expected to grow by almost 5% in 2013, partly because primary care physicians were being paid at the higher Medicare rate.
In 2014, when millions of Americans are expected to gain insurance coverage through the ACA, health spending is expected to grow by 6% – that’s almost 2% faster than would have been expected if the law were not in effect. The main spending drivers in 2014 will be growth in Medicaid and growth in private health insurance. Even though only about half of the states have said they will expand Medicaid eligibility, the expansion will lead to a 12% increase in spending on the program, primarily by the federal government.
The CMS economists said they expected the newly insured to be mostly young and healthy, and therefore likely to spend less on acute care and hospitalizations but more on prescription drugs and physician services. They projected a 7% increase in overall spending on physician services in 2014 – compared to just under 5% in 2012 and around 4% in 2013. But that 7% figure would drop to a little under 5% if Congress allows the scheduled 25% cut in physician payment rates – mandated by Medicare’s Sustainable Growth Rate formula – to go into effect in January.
During 2015-2018, physician spending is expected to grow by at least 5% a year, in part because of increased demand with more people gaining insurance, said the CMS economists.
Looking ahead to 2022, the nation’s overall health spending is expected to creep up some, especially for Medicare. The population is aging, which will increase both enrollment and per-enrollee spending, said the economists.
Medicare spending is expected to be restrained somewhat as the program limits growth in fee-for-service payment increases. The economists also said they expected spending to be restrained by the Independent Payment Advisory Board (IPAB), which was established by the ACA. That board’s recommendations for spending targets are supposed to start in 2015. So far, the White House has not appointed any member to the board. Physician organizations are hoping to derail the IPAB before it gets started.
On Twitter @aliciaault
FROM A HEALTH AFFAIRS BRIEFING
SGR replacement cost now up to $176 billion
The price tag to replace the Medicare Sustainable Growth Rate formula has grown to an estimated $176 billion over 10 years, up $40 billion from the most recent estimates, according to a Sept. 13 Congressional Budget Office analysis.
This time, the nonpartisan CBO analyzed the Medicare Patient Access and Quality Improvement Act of 2013 (H.R. 2810), which was approved unanimously by the House Energy and Commerce Committee in July. The bill has not seen any further movement since that time, but it is expected that Congress will take up SGR reform again this fall.
In its analysis, the CBO said that it thought that H.R. 2810, in part because it continues to rely largely on fee-for-service, would continue to drive up Medicare spending. Between 2014 and 2018, the bill proposes to increase physician fees by a flat 0.5%.
Starting in 2019, physicians will be paid based on performance in a program that gives rewards for quality, or on so-called alternative payment models.
The CBO said it believed that physicians would choose payment models that would increase their fees, which would, in turn, create a rise in Medicare spending. The pay increases for 2014-2018 will likely cost $64 billion, according to the agency. From 2019 to 2023, spending on physician fees is expected to hit $112 billion.
In addition, the agency said that Medicare would end up spending about $0.3 billion on other payment reforms proposed in the legislation, including modifying payment rates in certain California counties, adjusting relative value units for certain physicians’ services, and requiring the development of payment codes to encourage care coordination and the use of medical homes.
On Twitter @aliciaault
The price tag to replace the Medicare Sustainable Growth Rate formula has grown to an estimated $176 billion over 10 years, up $40 billion from the most recent estimates, according to a Sept. 13 Congressional Budget Office analysis.
This time, the nonpartisan CBO analyzed the Medicare Patient Access and Quality Improvement Act of 2013 (H.R. 2810), which was approved unanimously by the House Energy and Commerce Committee in July. The bill has not seen any further movement since that time, but it is expected that Congress will take up SGR reform again this fall.
In its analysis, the CBO said that it thought that H.R. 2810, in part because it continues to rely largely on fee-for-service, would continue to drive up Medicare spending. Between 2014 and 2018, the bill proposes to increase physician fees by a flat 0.5%.
Starting in 2019, physicians will be paid based on performance in a program that gives rewards for quality, or on so-called alternative payment models.
The CBO said it believed that physicians would choose payment models that would increase their fees, which would, in turn, create a rise in Medicare spending. The pay increases for 2014-2018 will likely cost $64 billion, according to the agency. From 2019 to 2023, spending on physician fees is expected to hit $112 billion.
In addition, the agency said that Medicare would end up spending about $0.3 billion on other payment reforms proposed in the legislation, including modifying payment rates in certain California counties, adjusting relative value units for certain physicians’ services, and requiring the development of payment codes to encourage care coordination and the use of medical homes.
On Twitter @aliciaault
The price tag to replace the Medicare Sustainable Growth Rate formula has grown to an estimated $176 billion over 10 years, up $40 billion from the most recent estimates, according to a Sept. 13 Congressional Budget Office analysis.
This time, the nonpartisan CBO analyzed the Medicare Patient Access and Quality Improvement Act of 2013 (H.R. 2810), which was approved unanimously by the House Energy and Commerce Committee in July. The bill has not seen any further movement since that time, but it is expected that Congress will take up SGR reform again this fall.
In its analysis, the CBO said that it thought that H.R. 2810, in part because it continues to rely largely on fee-for-service, would continue to drive up Medicare spending. Between 2014 and 2018, the bill proposes to increase physician fees by a flat 0.5%.
Starting in 2019, physicians will be paid based on performance in a program that gives rewards for quality, or on so-called alternative payment models.
The CBO said it believed that physicians would choose payment models that would increase their fees, which would, in turn, create a rise in Medicare spending. The pay increases for 2014-2018 will likely cost $64 billion, according to the agency. From 2019 to 2023, spending on physician fees is expected to hit $112 billion.
In addition, the agency said that Medicare would end up spending about $0.3 billion on other payment reforms proposed in the legislation, including modifying payment rates in certain California counties, adjusting relative value units for certain physicians’ services, and requiring the development of payment codes to encourage care coordination and the use of medical homes.
On Twitter @aliciaault
Docs: Major responsibility for cost control not ours
When it comes to reducing health costs, physicians believe burden of responsibility lies primarily with plaintiffs attorneys, followed by insurers, hospitals, drug and device makers, patients, and, lastly, themselves. Those conclusions are based on 2,438 responses from some 3,900 physicians randomly surveyed in 2012. Dr. Jon C. Tilburt of the Mayo Clinic, Rochester, Minn., and his colleagues reported their findings.
When asked whether individual physicians should have a major responsibility in reducing health costs, 36% of respondents said yes. Sixty percent said that trial lawyers bore the major burden, with health insurers coming in a close second.
More than half said that drug and device companies, hospitals and health systems, and patients also should have major responsibility for cost containment. A total of 44% said the government had that responsibility (JAMA 2013;310:380-8).
Physicians also were asked about their enthusiasm for various cost-control strategies and to examine their own role in cost containment by assessing their knowledge of prices of procedures and tests and their desire to personally curb costs in their practice. The authors asked about and analyzed potential barriers to physicians becoming more cost conscious, as well.
Doctors were very enthusiastic about improving the quality and efficiency of care, primarily through promoting continuity of care and going after fraud and abuse. Expanding access to preventive care was also warmly received. Physicians were also enthusiastic about limiting access to expensive treatments that had shown little benefit, using cost-effectiveness data to choose a therapy, and promoting head-to-head trials of competing therapies.
Just over half of respondents said that cutting pay for the highest-paid specialists should be embraced.
Eliminating fee for service altogether was rejected by 70% of respondents. Ninety percent said that they weren’t enthusiastic about letting the Medicare Sustainable Growth Rate cuts take effect. Two-thirds said that bundled pay and penalties for readmissions – both cost-control keystones advanced by the Obama administration – were not attractive.
Not surprisingly, increasing use of electronic health records also got a strong negative response, with 29% saying they were "not enthusiastic."
When it came to their own practice, 76% said they were aware of the costs of treatments or tests they recommended, and 84% said that cost is important whether a patient pays out of pocket or not.
When it comes to individual physicians’ responsibility for reducing health costs, the responses were very mixed. The survey participants largely agreed that "trying to contain costs is the responsibility of every physician" (85%) and that physicians should take a more prominent role in eliminating unnecessary tests (89%). But by almost the same percentages, physicians also said that they should be devoted to their individual patients, even if a test or therapy was expensive, and that they should not deny services to their patients because someone else might need it more.
"This apparent inconsistency may reflect inherent tensions in professional roles to serve patients individually and society as a whole," Dr. Tilburt and colleagues wrote.
Finally, physicians overwhelmingly said that fear of malpractice had substantially decreased their enjoyment of practicing medicine. The authors rated that fear as a barrier to cost-conscious practice.
They also found that 43% of physicians admitted they ordered more tests when they did not know the patient as well. Half said that being more cost conscious was the right thing to do, but large numbers said that it might not make a difference or could make things worse. A total of 40% said it would not limit unreasonable patient demands, and 28% said it could erode patients’ trust.
Dr. Tilburt and his colleagues pointed out that the findings should be viewed with caution in part because it could not fully reflect the opinions of all American physicians. Further, opinions could be in flux, given how much things are changing.
The study was funded by the Greenwall Foundation and the Mayo Clinic. The authors reported having no financial conflicts.
If there were ever an "all-hands-on-deck" moment in the history of health care, that moment is now. The findings of this study suggest that physician do not yet have the mentality this historical moment demands. Indeed, this survey suggests that in the face of this new and uncertain moment in the reform of the health care system, physicians are lapsing into the well-known, cautious, instinctual approaches humans adopt whenever confronted by uncertainty: Blame others and persevere with "business as usual."
Physicians have moved beyond denying that health care costs are a problem. Yet, they are not quite willing to accept physicians’ primary responsibility and take action. The study findings suggest that physicians are ambivalent; they reject transformative solutions, such as eliminating fee-for-service or bundled payments, which address the seriousness of the cost problem.
This study by Tilburt et al. indicates that the medical profession is not there yet – that many physicians would prefer to sit on the sidelines while other actors in the health care system do the real work of reform.
This could marginalize and demote physicians.
Dr. Ezekiel J. Emanuel is an ethicist at the University of Pennsylvania, Philadelphia. He reported no related conflicts. These remarks were taken from an editorial accompanying Dr. Tilburt’s study (JAMA 2013;310:374-5).
If there were ever an "all-hands-on-deck" moment in the history of health care, that moment is now. The findings of this study suggest that physician do not yet have the mentality this historical moment demands. Indeed, this survey suggests that in the face of this new and uncertain moment in the reform of the health care system, physicians are lapsing into the well-known, cautious, instinctual approaches humans adopt whenever confronted by uncertainty: Blame others and persevere with "business as usual."
Physicians have moved beyond denying that health care costs are a problem. Yet, they are not quite willing to accept physicians’ primary responsibility and take action. The study findings suggest that physicians are ambivalent; they reject transformative solutions, such as eliminating fee-for-service or bundled payments, which address the seriousness of the cost problem.
This study by Tilburt et al. indicates that the medical profession is not there yet – that many physicians would prefer to sit on the sidelines while other actors in the health care system do the real work of reform.
This could marginalize and demote physicians.
Dr. Ezekiel J. Emanuel is an ethicist at the University of Pennsylvania, Philadelphia. He reported no related conflicts. These remarks were taken from an editorial accompanying Dr. Tilburt’s study (JAMA 2013;310:374-5).
If there were ever an "all-hands-on-deck" moment in the history of health care, that moment is now. The findings of this study suggest that physician do not yet have the mentality this historical moment demands. Indeed, this survey suggests that in the face of this new and uncertain moment in the reform of the health care system, physicians are lapsing into the well-known, cautious, instinctual approaches humans adopt whenever confronted by uncertainty: Blame others and persevere with "business as usual."
Physicians have moved beyond denying that health care costs are a problem. Yet, they are not quite willing to accept physicians’ primary responsibility and take action. The study findings suggest that physicians are ambivalent; they reject transformative solutions, such as eliminating fee-for-service or bundled payments, which address the seriousness of the cost problem.
This study by Tilburt et al. indicates that the medical profession is not there yet – that many physicians would prefer to sit on the sidelines while other actors in the health care system do the real work of reform.
This could marginalize and demote physicians.
Dr. Ezekiel J. Emanuel is an ethicist at the University of Pennsylvania, Philadelphia. He reported no related conflicts. These remarks were taken from an editorial accompanying Dr. Tilburt’s study (JAMA 2013;310:374-5).
When it comes to reducing health costs, physicians believe burden of responsibility lies primarily with plaintiffs attorneys, followed by insurers, hospitals, drug and device makers, patients, and, lastly, themselves. Those conclusions are based on 2,438 responses from some 3,900 physicians randomly surveyed in 2012. Dr. Jon C. Tilburt of the Mayo Clinic, Rochester, Minn., and his colleagues reported their findings.
When asked whether individual physicians should have a major responsibility in reducing health costs, 36% of respondents said yes. Sixty percent said that trial lawyers bore the major burden, with health insurers coming in a close second.
More than half said that drug and device companies, hospitals and health systems, and patients also should have major responsibility for cost containment. A total of 44% said the government had that responsibility (JAMA 2013;310:380-8).
Physicians also were asked about their enthusiasm for various cost-control strategies and to examine their own role in cost containment by assessing their knowledge of prices of procedures and tests and their desire to personally curb costs in their practice. The authors asked about and analyzed potential barriers to physicians becoming more cost conscious, as well.
Doctors were very enthusiastic about improving the quality and efficiency of care, primarily through promoting continuity of care and going after fraud and abuse. Expanding access to preventive care was also warmly received. Physicians were also enthusiastic about limiting access to expensive treatments that had shown little benefit, using cost-effectiveness data to choose a therapy, and promoting head-to-head trials of competing therapies.
Just over half of respondents said that cutting pay for the highest-paid specialists should be embraced.
Eliminating fee for service altogether was rejected by 70% of respondents. Ninety percent said that they weren’t enthusiastic about letting the Medicare Sustainable Growth Rate cuts take effect. Two-thirds said that bundled pay and penalties for readmissions – both cost-control keystones advanced by the Obama administration – were not attractive.
Not surprisingly, increasing use of electronic health records also got a strong negative response, with 29% saying they were "not enthusiastic."
When it came to their own practice, 76% said they were aware of the costs of treatments or tests they recommended, and 84% said that cost is important whether a patient pays out of pocket or not.
When it comes to individual physicians’ responsibility for reducing health costs, the responses were very mixed. The survey participants largely agreed that "trying to contain costs is the responsibility of every physician" (85%) and that physicians should take a more prominent role in eliminating unnecessary tests (89%). But by almost the same percentages, physicians also said that they should be devoted to their individual patients, even if a test or therapy was expensive, and that they should not deny services to their patients because someone else might need it more.
"This apparent inconsistency may reflect inherent tensions in professional roles to serve patients individually and society as a whole," Dr. Tilburt and colleagues wrote.
Finally, physicians overwhelmingly said that fear of malpractice had substantially decreased their enjoyment of practicing medicine. The authors rated that fear as a barrier to cost-conscious practice.
They also found that 43% of physicians admitted they ordered more tests when they did not know the patient as well. Half said that being more cost conscious was the right thing to do, but large numbers said that it might not make a difference or could make things worse. A total of 40% said it would not limit unreasonable patient demands, and 28% said it could erode patients’ trust.
Dr. Tilburt and his colleagues pointed out that the findings should be viewed with caution in part because it could not fully reflect the opinions of all American physicians. Further, opinions could be in flux, given how much things are changing.
The study was funded by the Greenwall Foundation and the Mayo Clinic. The authors reported having no financial conflicts.
When it comes to reducing health costs, physicians believe burden of responsibility lies primarily with plaintiffs attorneys, followed by insurers, hospitals, drug and device makers, patients, and, lastly, themselves. Those conclusions are based on 2,438 responses from some 3,900 physicians randomly surveyed in 2012. Dr. Jon C. Tilburt of the Mayo Clinic, Rochester, Minn., and his colleagues reported their findings.
When asked whether individual physicians should have a major responsibility in reducing health costs, 36% of respondents said yes. Sixty percent said that trial lawyers bore the major burden, with health insurers coming in a close second.
More than half said that drug and device companies, hospitals and health systems, and patients also should have major responsibility for cost containment. A total of 44% said the government had that responsibility (JAMA 2013;310:380-8).
Physicians also were asked about their enthusiasm for various cost-control strategies and to examine their own role in cost containment by assessing their knowledge of prices of procedures and tests and their desire to personally curb costs in their practice. The authors asked about and analyzed potential barriers to physicians becoming more cost conscious, as well.
Doctors were very enthusiastic about improving the quality and efficiency of care, primarily through promoting continuity of care and going after fraud and abuse. Expanding access to preventive care was also warmly received. Physicians were also enthusiastic about limiting access to expensive treatments that had shown little benefit, using cost-effectiveness data to choose a therapy, and promoting head-to-head trials of competing therapies.
Just over half of respondents said that cutting pay for the highest-paid specialists should be embraced.
Eliminating fee for service altogether was rejected by 70% of respondents. Ninety percent said that they weren’t enthusiastic about letting the Medicare Sustainable Growth Rate cuts take effect. Two-thirds said that bundled pay and penalties for readmissions – both cost-control keystones advanced by the Obama administration – were not attractive.
Not surprisingly, increasing use of electronic health records also got a strong negative response, with 29% saying they were "not enthusiastic."
When it came to their own practice, 76% said they were aware of the costs of treatments or tests they recommended, and 84% said that cost is important whether a patient pays out of pocket or not.
When it comes to individual physicians’ responsibility for reducing health costs, the responses were very mixed. The survey participants largely agreed that "trying to contain costs is the responsibility of every physician" (85%) and that physicians should take a more prominent role in eliminating unnecessary tests (89%). But by almost the same percentages, physicians also said that they should be devoted to their individual patients, even if a test or therapy was expensive, and that they should not deny services to their patients because someone else might need it more.
"This apparent inconsistency may reflect inherent tensions in professional roles to serve patients individually and society as a whole," Dr. Tilburt and colleagues wrote.
Finally, physicians overwhelmingly said that fear of malpractice had substantially decreased their enjoyment of practicing medicine. The authors rated that fear as a barrier to cost-conscious practice.
They also found that 43% of physicians admitted they ordered more tests when they did not know the patient as well. Half said that being more cost conscious was the right thing to do, but large numbers said that it might not make a difference or could make things worse. A total of 40% said it would not limit unreasonable patient demands, and 28% said it could erode patients’ trust.
Dr. Tilburt and his colleagues pointed out that the findings should be viewed with caution in part because it could not fully reflect the opinions of all American physicians. Further, opinions could be in flux, given how much things are changing.
The study was funded by the Greenwall Foundation and the Mayo Clinic. The authors reported having no financial conflicts.
Almost 2 million try to quit smoking in wake of CDC campaign
Almost 2 million Americans tried to quit smoking in the wake of a 2012 government educational campaign, and at least 100,000 of them have quit permanently.
That’s according to an analysis of the Centers for Disease Control and Prevention’s (CDC’s) Tips From Former Smokers campaign that was published online in the Lancet on Sept. 9 (doi: 10.1016/S0140-6736(13)61686-4). The analysis by CDC officials estimates that 1.6 million Americans tried to quit after the campaign’s launch in March 2012. By June 2012, when it ended, at least 100,000 of them could be defined as having permanently quit.
"These are really minimal estimates," said Dr. Thomas Frieden, director of the CDC, in a briefing with reporters. "We think the actual impact may have been even larger than this."
The Tips From Former Smokers campaign was made possible by a $54 million grant from the Affordable Care Act’s Public Health and Prevention Fund. Print ads featured graphic photos of former smokers with stomas, or scars from open heart surgery. Former smokers also described tobacco’s toll on their health in broadcast and radio ads and videos posted to the CDC website. The TV ads directed viewers to the 1-800-QUIT-NOW quit line or to the National Cancer Institute’s quit assistance website, www.smokefree.gov.
A testimonial from former smoker Terrie Hall has been the most-visited page on the entire CDC site, receiving 2.5 million hits so far, Dr. Frieden said. In it, Ms. Hall tells smokers: "Record your voice for loved ones while you still can." Ms. Hall was diagnosed with throat cancer, had her larynx removed, and now speaks with the aid of an artificial voice box.
Overall, the tips campaign was seen by four out of five smokers, the Lancet report estimated.
To assess how well the campaign worked, the CDC used a nationally representative online survey. Current smokers – those who had smoked at least 100 cigarettes in their lifetime and now smoked every day or some days – and nonsmokers (all others) were compared. There was a baseline survey before the campaign started and another immediately after the campaign ended.
Of the invited smokers, 70% (4,108) responded, and 58% (3,000) of the invited nonsmokers responded to the baseline survey. After the campaign ended, 74% (3,058) of the smokers and 74% (2,220) of the nonsmokers responded. About 75% of the smokers and nonsmokers said they recalled seeing at least one tips ad.
The prevalence of smokers who tried to quit in the past 3 months increased from 31% before the tips campaign to 35% after the campaign. At the end of the 12-week campaign, 13% of smokers who tried to quit said they had not smoked again.
After stratifying the results of the overall response to the campaign, the CDC researchers found that there were more quit attempts among younger smokers, lighter smokers, African American smokers, and smokers with less education.
Calls to the 1-800-QUIT-NOW line increased 132% during the 12-week campaign, 200,000 more calls than during the same period the previous year. There were also 500,000 unique visitors to the www.smokefree.gov website.
The analysis showed that the campaign spurred a large number of nonsmokers to talk to their friends or family about the dangers of smoking and quitting. Applying the findings to the U.S. population, the researchers reported that almost 5 million nonsmokers recommended a smoking cessation service to a friend or family member, and 6 million discussed the dangers of smoking.
Lisha Hancock was one of those smokers who heard from a family member about quitting, but she also said that she was influenced greatly by Terrie Hall’s story. Ms. Hancock told reporters that she smoked for 17 years, starting at age 21. Family and peer pressure did not motivate her to quit. But her 5-year-old son’s questions and response to Ms. Hall’s ads, along with her own impressions from Ms. Hall’s testimonial, moved her. "You can see the regret and sadness in her eyes," said Ms. Hancock, in a conference call.
After seeing the ads and online testimonials, Ms. Hancock decided to make a plan, made some diet and exercise changes, and used nicotine lozenges to help her quit. She has gone about 6 months without smoking, she said.
The CDC report found that thanks to more people quitting, the campaign may have added 500,000 quality-adjusted life-years to the U.S. population, which suggests a cost per life-year saved of less than $200. That ranks the campaign "among the most cost-effective preventive interventions," said the CDC authors.
Meanwhile, the $54 million spent on the campaign is less than what the tobacco industry spends for 3 days of marketing, according to the report. The industry’s $8 billion in annual spending far outweighs the federal government’s capabilities, but Dr. Frieden said he was optimistic. "We’re going to win that David and Goliath battle," he told reporters.
Dr. Frieden said that the study results validated a large, national educational antismoking campaign. The CDC will continue to find ways to alert the public to the dangers of smoking, he said. The agency ran additional Tips From Former Smokers ads between March and June this year. That campaign included exhortations for smokers to talk to their physicians about quitting.
The authors reported having no financial disclosures.
On Twitter @aliciaault
Almost 2 million Americans tried to quit smoking in the wake of a 2012 government educational campaign, and at least 100,000 of them have quit permanently.
That’s according to an analysis of the Centers for Disease Control and Prevention’s (CDC’s) Tips From Former Smokers campaign that was published online in the Lancet on Sept. 9 (doi: 10.1016/S0140-6736(13)61686-4). The analysis by CDC officials estimates that 1.6 million Americans tried to quit after the campaign’s launch in March 2012. By June 2012, when it ended, at least 100,000 of them could be defined as having permanently quit.
"These are really minimal estimates," said Dr. Thomas Frieden, director of the CDC, in a briefing with reporters. "We think the actual impact may have been even larger than this."
The Tips From Former Smokers campaign was made possible by a $54 million grant from the Affordable Care Act’s Public Health and Prevention Fund. Print ads featured graphic photos of former smokers with stomas, or scars from open heart surgery. Former smokers also described tobacco’s toll on their health in broadcast and radio ads and videos posted to the CDC website. The TV ads directed viewers to the 1-800-QUIT-NOW quit line or to the National Cancer Institute’s quit assistance website, www.smokefree.gov.
A testimonial from former smoker Terrie Hall has been the most-visited page on the entire CDC site, receiving 2.5 million hits so far, Dr. Frieden said. In it, Ms. Hall tells smokers: "Record your voice for loved ones while you still can." Ms. Hall was diagnosed with throat cancer, had her larynx removed, and now speaks with the aid of an artificial voice box.
Overall, the tips campaign was seen by four out of five smokers, the Lancet report estimated.
To assess how well the campaign worked, the CDC used a nationally representative online survey. Current smokers – those who had smoked at least 100 cigarettes in their lifetime and now smoked every day or some days – and nonsmokers (all others) were compared. There was a baseline survey before the campaign started and another immediately after the campaign ended.
Of the invited smokers, 70% (4,108) responded, and 58% (3,000) of the invited nonsmokers responded to the baseline survey. After the campaign ended, 74% (3,058) of the smokers and 74% (2,220) of the nonsmokers responded. About 75% of the smokers and nonsmokers said they recalled seeing at least one tips ad.
The prevalence of smokers who tried to quit in the past 3 months increased from 31% before the tips campaign to 35% after the campaign. At the end of the 12-week campaign, 13% of smokers who tried to quit said they had not smoked again.
After stratifying the results of the overall response to the campaign, the CDC researchers found that there were more quit attempts among younger smokers, lighter smokers, African American smokers, and smokers with less education.
Calls to the 1-800-QUIT-NOW line increased 132% during the 12-week campaign, 200,000 more calls than during the same period the previous year. There were also 500,000 unique visitors to the www.smokefree.gov website.
The analysis showed that the campaign spurred a large number of nonsmokers to talk to their friends or family about the dangers of smoking and quitting. Applying the findings to the U.S. population, the researchers reported that almost 5 million nonsmokers recommended a smoking cessation service to a friend or family member, and 6 million discussed the dangers of smoking.
Lisha Hancock was one of those smokers who heard from a family member about quitting, but she also said that she was influenced greatly by Terrie Hall’s story. Ms. Hancock told reporters that she smoked for 17 years, starting at age 21. Family and peer pressure did not motivate her to quit. But her 5-year-old son’s questions and response to Ms. Hall’s ads, along with her own impressions from Ms. Hall’s testimonial, moved her. "You can see the regret and sadness in her eyes," said Ms. Hancock, in a conference call.
After seeing the ads and online testimonials, Ms. Hancock decided to make a plan, made some diet and exercise changes, and used nicotine lozenges to help her quit. She has gone about 6 months without smoking, she said.
The CDC report found that thanks to more people quitting, the campaign may have added 500,000 quality-adjusted life-years to the U.S. population, which suggests a cost per life-year saved of less than $200. That ranks the campaign "among the most cost-effective preventive interventions," said the CDC authors.
Meanwhile, the $54 million spent on the campaign is less than what the tobacco industry spends for 3 days of marketing, according to the report. The industry’s $8 billion in annual spending far outweighs the federal government’s capabilities, but Dr. Frieden said he was optimistic. "We’re going to win that David and Goliath battle," he told reporters.
Dr. Frieden said that the study results validated a large, national educational antismoking campaign. The CDC will continue to find ways to alert the public to the dangers of smoking, he said. The agency ran additional Tips From Former Smokers ads between March and June this year. That campaign included exhortations for smokers to talk to their physicians about quitting.
The authors reported having no financial disclosures.
On Twitter @aliciaault
Almost 2 million Americans tried to quit smoking in the wake of a 2012 government educational campaign, and at least 100,000 of them have quit permanently.
That’s according to an analysis of the Centers for Disease Control and Prevention’s (CDC’s) Tips From Former Smokers campaign that was published online in the Lancet on Sept. 9 (doi: 10.1016/S0140-6736(13)61686-4). The analysis by CDC officials estimates that 1.6 million Americans tried to quit after the campaign’s launch in March 2012. By June 2012, when it ended, at least 100,000 of them could be defined as having permanently quit.
"These are really minimal estimates," said Dr. Thomas Frieden, director of the CDC, in a briefing with reporters. "We think the actual impact may have been even larger than this."
The Tips From Former Smokers campaign was made possible by a $54 million grant from the Affordable Care Act’s Public Health and Prevention Fund. Print ads featured graphic photos of former smokers with stomas, or scars from open heart surgery. Former smokers also described tobacco’s toll on their health in broadcast and radio ads and videos posted to the CDC website. The TV ads directed viewers to the 1-800-QUIT-NOW quit line or to the National Cancer Institute’s quit assistance website, www.smokefree.gov.
A testimonial from former smoker Terrie Hall has been the most-visited page on the entire CDC site, receiving 2.5 million hits so far, Dr. Frieden said. In it, Ms. Hall tells smokers: "Record your voice for loved ones while you still can." Ms. Hall was diagnosed with throat cancer, had her larynx removed, and now speaks with the aid of an artificial voice box.
Overall, the tips campaign was seen by four out of five smokers, the Lancet report estimated.
To assess how well the campaign worked, the CDC used a nationally representative online survey. Current smokers – those who had smoked at least 100 cigarettes in their lifetime and now smoked every day or some days – and nonsmokers (all others) were compared. There was a baseline survey before the campaign started and another immediately after the campaign ended.
Of the invited smokers, 70% (4,108) responded, and 58% (3,000) of the invited nonsmokers responded to the baseline survey. After the campaign ended, 74% (3,058) of the smokers and 74% (2,220) of the nonsmokers responded. About 75% of the smokers and nonsmokers said they recalled seeing at least one tips ad.
The prevalence of smokers who tried to quit in the past 3 months increased from 31% before the tips campaign to 35% after the campaign. At the end of the 12-week campaign, 13% of smokers who tried to quit said they had not smoked again.
After stratifying the results of the overall response to the campaign, the CDC researchers found that there were more quit attempts among younger smokers, lighter smokers, African American smokers, and smokers with less education.
Calls to the 1-800-QUIT-NOW line increased 132% during the 12-week campaign, 200,000 more calls than during the same period the previous year. There were also 500,000 unique visitors to the www.smokefree.gov website.
The analysis showed that the campaign spurred a large number of nonsmokers to talk to their friends or family about the dangers of smoking and quitting. Applying the findings to the U.S. population, the researchers reported that almost 5 million nonsmokers recommended a smoking cessation service to a friend or family member, and 6 million discussed the dangers of smoking.
Lisha Hancock was one of those smokers who heard from a family member about quitting, but she also said that she was influenced greatly by Terrie Hall’s story. Ms. Hancock told reporters that she smoked for 17 years, starting at age 21. Family and peer pressure did not motivate her to quit. But her 5-year-old son’s questions and response to Ms. Hall’s ads, along with her own impressions from Ms. Hall’s testimonial, moved her. "You can see the regret and sadness in her eyes," said Ms. Hancock, in a conference call.
After seeing the ads and online testimonials, Ms. Hancock decided to make a plan, made some diet and exercise changes, and used nicotine lozenges to help her quit. She has gone about 6 months without smoking, she said.
The CDC report found that thanks to more people quitting, the campaign may have added 500,000 quality-adjusted life-years to the U.S. population, which suggests a cost per life-year saved of less than $200. That ranks the campaign "among the most cost-effective preventive interventions," said the CDC authors.
Meanwhile, the $54 million spent on the campaign is less than what the tobacco industry spends for 3 days of marketing, according to the report. The industry’s $8 billion in annual spending far outweighs the federal government’s capabilities, but Dr. Frieden said he was optimistic. "We’re going to win that David and Goliath battle," he told reporters.
Dr. Frieden said that the study results validated a large, national educational antismoking campaign. The CDC will continue to find ways to alert the public to the dangers of smoking, he said. The agency ran additional Tips From Former Smokers ads between March and June this year. That campaign included exhortations for smokers to talk to their physicians about quitting.
The authors reported having no financial disclosures.
On Twitter @aliciaault
FROM THE LANCET
Major finding: About 2 million Americans tried to quit in March 2012, and by June 2012 at least 100,000 remained abstinent following a public education campaign.
Data source: Data compiled from a baseline and follow-up survey of nationally representative samples of adult smokers and nonsmokers.
Disclosures: The authors reported having no financial disclosures.
Teen drug and alcohol use decline, but more adults using marijuana
Teens are drinking less, seem to be responding to messages to stay away from nonmedical use of prescription drugs, and are slightly curbing marijuana use. For adults, however, the story is slightly different. Marijuana use is increasing, especially in those aged 18 to 25, and overall illicit drug use is growing in the 50- to 64-year-old segment.
That’s according to the latest data from the annual National Survey on Drug Use and Health (NSDUH), which is sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), and tracks the illicit use of substances in the U.S. population. The 2012 NSDUH report screened almost 70,000 people aged 12 and over between January through December 2012.
"These findings show that while we have made progress in preventing some aspects of substance abuse, we must redouble our efforts to reduce and eliminate all forms of it throughout our nation," said SAMHSA Administrator Pamela S. Hyde, in a statement.
Marijuana is by far the most popular illicit drug in America. Overall, 7% of survey respondents were current marijuana users in 2012. Past-month use rose in almost every age group from 2007 to 2012. A quarter of 18- to-20-year-olds and 17% of 21- to-25-year-olds were past-month users, and a third of each group had used in the past year.
Rates declined very slightly for 12- to-17-year olds, from 7.9% in 2011 to 7.2% in 2012. But the proportion who said smoking marijuana once or twice a week was risky decreased from 55% in 2007 to 44% in 2012. A similar slight decline in use, but a larger decline in perception of risk also was seen in the Monitoring the Future survey released in December, which is sponsored by the National Institute on Drug Abuse.
The decreased perception of harm is particularly dangerous, because it can lead to higher usage rates, said Dr. Sharon Levy, director of the Adolescent Substance Abuse Program at Children’s Hospital, Boston, in an interview. The edging up of marijuana use among older adolescents is likely attributable to an ever-present and growing national conversation that marijuana is safe, said Dr. Levy, who also serves as chair of the American Academy of Pediatrics’ Committee on Substance Abuse.
She said that while cannabinoids might end up being useful from a medical standpoint, marijuana itself is associated with harms in children and adolescents, including an increase in mental health disorders and decline in motivation, and potentially, a higher risk of cognitive decline.
The AAP’s most-recent statement on substance abuse intervention and treatment (Pediatrics 2011;128:e1330) recommends that clinicians start screening children for substance abuse at age 12 years. By that time, it’s likely that they’ve heard of marijuana, Dr. Levy said. Children expect health advice from their pediatrician; the aim is to keep the information both medically and personally relevant as much as possible, she said. Athletes can be told that smoking will affect their lungs, for instance.
More positively, the SAMHSA data showed a stabilization of nonmedical use of prescription drugs, such as narcotics, among young adults aged 18-25 years. In 2012, 5% of that age cohort admitted to past-month use, which was similar to rates in 2010 and 2011, but lower than the 6.4% reported in 2009.
Past-month drinking, binge drinking, and heavy drinking among adolescents aged 12-17 years also stabilized, and rates were lower than previous high points of 2002 and 2009.
About half of Americans over the age of 12 years say they are current drinkers. About a quarter in 2012 identified as binge drinkers, which is five or more drinks on one occasion at least 1 day in the past month. That’s the same rate as in 2011. Heavy drinking stayed the same also, for all age groups.
The declines in alcohol, tobacco, and nonmedical prescription drug use among children were encouraging, and indicate that government and physician-led efforts "are having an impact," Dr. Levy said.
"We’re never going to eliminate all use, but we can continue to push it down," Dr. Levy said.
R. Gil Kerlikowske, director of the Office of National Drug Control Policy, agreed that campaigns focusing on prescription drug use had had some effect. "For the first time in a decade, we are seeing real and significant reductions in the abuse of prescription drugs in America, proving that a more comprehensive response to our drug problem can make a real difference in making our nation healthier and safer," he said in a statement.
One area of concern: an upward trend in heroin use. In 2012, 669,000 Americans said they’d used heroin in the past year, compared with 373,000 in 2007. There’s been a small uptick in heroin users aged 18-25 years. And there’s been a big increase over the last decade in the number of Americans who would be classified under the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as having heroin dependence, according to the report. In 2012, 467,000 people would be labeled dependent, compared with 214,000 in 2002. Last year, 450,000 Americans received treatment for heroin abuse.
Overall, 4 million Americans over the age of 12 (1.5% of the population) received alcohol or illicit drug use treatment. That number and percentage have basically stayed the same since 2002. In 2012, the largest number of those who received treatment – 2.4 million – reported receiving treatment for alcohol use. Next came treatment for pain relievers (973,000), and third was marijuana use (957,000).
An estimated 23 million Americans (8% of the nation) needed treatment; 2.5 million received care in a specialized facility. Of the 21 million who did not get care, only 1 million said they felt that they actually needed treatment, according to SAMHSA. In that group, some 31% said they’d made an effort but could not get into a program. The primary reason was "a lack of insurance coverage and inability to pay the cost," said the SAMHSA report.
"Expanding prevention, treatment, and support for people in recovery for substance use disorders will be our guide as we work to address other emerging challenges, including the recent uptick in heroin use shown in this survey," Mr. Kerlikowske said.
On Twitter @aliciaault
Teens are drinking less, seem to be responding to messages to stay away from nonmedical use of prescription drugs, and are slightly curbing marijuana use. For adults, however, the story is slightly different. Marijuana use is increasing, especially in those aged 18 to 25, and overall illicit drug use is growing in the 50- to 64-year-old segment.
That’s according to the latest data from the annual National Survey on Drug Use and Health (NSDUH), which is sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), and tracks the illicit use of substances in the U.S. population. The 2012 NSDUH report screened almost 70,000 people aged 12 and over between January through December 2012.
"These findings show that while we have made progress in preventing some aspects of substance abuse, we must redouble our efforts to reduce and eliminate all forms of it throughout our nation," said SAMHSA Administrator Pamela S. Hyde, in a statement.
Marijuana is by far the most popular illicit drug in America. Overall, 7% of survey respondents were current marijuana users in 2012. Past-month use rose in almost every age group from 2007 to 2012. A quarter of 18- to-20-year-olds and 17% of 21- to-25-year-olds were past-month users, and a third of each group had used in the past year.
Rates declined very slightly for 12- to-17-year olds, from 7.9% in 2011 to 7.2% in 2012. But the proportion who said smoking marijuana once or twice a week was risky decreased from 55% in 2007 to 44% in 2012. A similar slight decline in use, but a larger decline in perception of risk also was seen in the Monitoring the Future survey released in December, which is sponsored by the National Institute on Drug Abuse.
The decreased perception of harm is particularly dangerous, because it can lead to higher usage rates, said Dr. Sharon Levy, director of the Adolescent Substance Abuse Program at Children’s Hospital, Boston, in an interview. The edging up of marijuana use among older adolescents is likely attributable to an ever-present and growing national conversation that marijuana is safe, said Dr. Levy, who also serves as chair of the American Academy of Pediatrics’ Committee on Substance Abuse.
She said that while cannabinoids might end up being useful from a medical standpoint, marijuana itself is associated with harms in children and adolescents, including an increase in mental health disorders and decline in motivation, and potentially, a higher risk of cognitive decline.
The AAP’s most-recent statement on substance abuse intervention and treatment (Pediatrics 2011;128:e1330) recommends that clinicians start screening children for substance abuse at age 12 years. By that time, it’s likely that they’ve heard of marijuana, Dr. Levy said. Children expect health advice from their pediatrician; the aim is to keep the information both medically and personally relevant as much as possible, she said. Athletes can be told that smoking will affect their lungs, for instance.
More positively, the SAMHSA data showed a stabilization of nonmedical use of prescription drugs, such as narcotics, among young adults aged 18-25 years. In 2012, 5% of that age cohort admitted to past-month use, which was similar to rates in 2010 and 2011, but lower than the 6.4% reported in 2009.
Past-month drinking, binge drinking, and heavy drinking among adolescents aged 12-17 years also stabilized, and rates were lower than previous high points of 2002 and 2009.
About half of Americans over the age of 12 years say they are current drinkers. About a quarter in 2012 identified as binge drinkers, which is five or more drinks on one occasion at least 1 day in the past month. That’s the same rate as in 2011. Heavy drinking stayed the same also, for all age groups.
The declines in alcohol, tobacco, and nonmedical prescription drug use among children were encouraging, and indicate that government and physician-led efforts "are having an impact," Dr. Levy said.
"We’re never going to eliminate all use, but we can continue to push it down," Dr. Levy said.
R. Gil Kerlikowske, director of the Office of National Drug Control Policy, agreed that campaigns focusing on prescription drug use had had some effect. "For the first time in a decade, we are seeing real and significant reductions in the abuse of prescription drugs in America, proving that a more comprehensive response to our drug problem can make a real difference in making our nation healthier and safer," he said in a statement.
One area of concern: an upward trend in heroin use. In 2012, 669,000 Americans said they’d used heroin in the past year, compared with 373,000 in 2007. There’s been a small uptick in heroin users aged 18-25 years. And there’s been a big increase over the last decade in the number of Americans who would be classified under the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as having heroin dependence, according to the report. In 2012, 467,000 people would be labeled dependent, compared with 214,000 in 2002. Last year, 450,000 Americans received treatment for heroin abuse.
Overall, 4 million Americans over the age of 12 (1.5% of the population) received alcohol or illicit drug use treatment. That number and percentage have basically stayed the same since 2002. In 2012, the largest number of those who received treatment – 2.4 million – reported receiving treatment for alcohol use. Next came treatment for pain relievers (973,000), and third was marijuana use (957,000).
An estimated 23 million Americans (8% of the nation) needed treatment; 2.5 million received care in a specialized facility. Of the 21 million who did not get care, only 1 million said they felt that they actually needed treatment, according to SAMHSA. In that group, some 31% said they’d made an effort but could not get into a program. The primary reason was "a lack of insurance coverage and inability to pay the cost," said the SAMHSA report.
"Expanding prevention, treatment, and support for people in recovery for substance use disorders will be our guide as we work to address other emerging challenges, including the recent uptick in heroin use shown in this survey," Mr. Kerlikowske said.
On Twitter @aliciaault
Teens are drinking less, seem to be responding to messages to stay away from nonmedical use of prescription drugs, and are slightly curbing marijuana use. For adults, however, the story is slightly different. Marijuana use is increasing, especially in those aged 18 to 25, and overall illicit drug use is growing in the 50- to 64-year-old segment.
That’s according to the latest data from the annual National Survey on Drug Use and Health (NSDUH), which is sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), and tracks the illicit use of substances in the U.S. population. The 2012 NSDUH report screened almost 70,000 people aged 12 and over between January through December 2012.
"These findings show that while we have made progress in preventing some aspects of substance abuse, we must redouble our efforts to reduce and eliminate all forms of it throughout our nation," said SAMHSA Administrator Pamela S. Hyde, in a statement.
Marijuana is by far the most popular illicit drug in America. Overall, 7% of survey respondents were current marijuana users in 2012. Past-month use rose in almost every age group from 2007 to 2012. A quarter of 18- to-20-year-olds and 17% of 21- to-25-year-olds were past-month users, and a third of each group had used in the past year.
Rates declined very slightly for 12- to-17-year olds, from 7.9% in 2011 to 7.2% in 2012. But the proportion who said smoking marijuana once or twice a week was risky decreased from 55% in 2007 to 44% in 2012. A similar slight decline in use, but a larger decline in perception of risk also was seen in the Monitoring the Future survey released in December, which is sponsored by the National Institute on Drug Abuse.
The decreased perception of harm is particularly dangerous, because it can lead to higher usage rates, said Dr. Sharon Levy, director of the Adolescent Substance Abuse Program at Children’s Hospital, Boston, in an interview. The edging up of marijuana use among older adolescents is likely attributable to an ever-present and growing national conversation that marijuana is safe, said Dr. Levy, who also serves as chair of the American Academy of Pediatrics’ Committee on Substance Abuse.
She said that while cannabinoids might end up being useful from a medical standpoint, marijuana itself is associated with harms in children and adolescents, including an increase in mental health disorders and decline in motivation, and potentially, a higher risk of cognitive decline.
The AAP’s most-recent statement on substance abuse intervention and treatment (Pediatrics 2011;128:e1330) recommends that clinicians start screening children for substance abuse at age 12 years. By that time, it’s likely that they’ve heard of marijuana, Dr. Levy said. Children expect health advice from their pediatrician; the aim is to keep the information both medically and personally relevant as much as possible, she said. Athletes can be told that smoking will affect their lungs, for instance.
More positively, the SAMHSA data showed a stabilization of nonmedical use of prescription drugs, such as narcotics, among young adults aged 18-25 years. In 2012, 5% of that age cohort admitted to past-month use, which was similar to rates in 2010 and 2011, but lower than the 6.4% reported in 2009.
Past-month drinking, binge drinking, and heavy drinking among adolescents aged 12-17 years also stabilized, and rates were lower than previous high points of 2002 and 2009.
About half of Americans over the age of 12 years say they are current drinkers. About a quarter in 2012 identified as binge drinkers, which is five or more drinks on one occasion at least 1 day in the past month. That’s the same rate as in 2011. Heavy drinking stayed the same also, for all age groups.
The declines in alcohol, tobacco, and nonmedical prescription drug use among children were encouraging, and indicate that government and physician-led efforts "are having an impact," Dr. Levy said.
"We’re never going to eliminate all use, but we can continue to push it down," Dr. Levy said.
R. Gil Kerlikowske, director of the Office of National Drug Control Policy, agreed that campaigns focusing on prescription drug use had had some effect. "For the first time in a decade, we are seeing real and significant reductions in the abuse of prescription drugs in America, proving that a more comprehensive response to our drug problem can make a real difference in making our nation healthier and safer," he said in a statement.
One area of concern: an upward trend in heroin use. In 2012, 669,000 Americans said they’d used heroin in the past year, compared with 373,000 in 2007. There’s been a small uptick in heroin users aged 18-25 years. And there’s been a big increase over the last decade in the number of Americans who would be classified under the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as having heroin dependence, according to the report. In 2012, 467,000 people would be labeled dependent, compared with 214,000 in 2002. Last year, 450,000 Americans received treatment for heroin abuse.
Overall, 4 million Americans over the age of 12 (1.5% of the population) received alcohol or illicit drug use treatment. That number and percentage have basically stayed the same since 2002. In 2012, the largest number of those who received treatment – 2.4 million – reported receiving treatment for alcohol use. Next came treatment for pain relievers (973,000), and third was marijuana use (957,000).
An estimated 23 million Americans (8% of the nation) needed treatment; 2.5 million received care in a specialized facility. Of the 21 million who did not get care, only 1 million said they felt that they actually needed treatment, according to SAMHSA. In that group, some 31% said they’d made an effort but could not get into a program. The primary reason was "a lack of insurance coverage and inability to pay the cost," said the SAMHSA report.
"Expanding prevention, treatment, and support for people in recovery for substance use disorders will be our guide as we work to address other emerging challenges, including the recent uptick in heroin use shown in this survey," Mr. Kerlikowske said.
On Twitter @aliciaault
AGA shines light on gut microbiome on Capitol Hill
Scientific advisers from the AGA’s Center for Gut Microbiome Research and Education went to Capitol Hill in late July to make a pitch for increased research funding, including for the National Institutes of Health’s Human Microbiome Project.
The advisers – Rob Knight, Ph.D., Dr. Martin J. Blaser, and Dr. Gary D. Wu – along with AGA President Loren A. Laine, briefed congressional staff on the science of the gut microbiome and the importance of delving further into its workings.
"There’s no question that understanding and manipulating the gut microbiome will be very important in attacking diseases, and how we take care of patients’ diseases in the future," said Dr. Laine.
Dr. Knight, an associate professor of chemistry at the University of Colorado, Boulder, and a career scientist with the Howard Hughes Medical Institute, gave an overview of the field, focusing on what’s been collected so far by the Human Microbiome Project. The HMP, begun in 2007, aims to characterize the healthy human microbiome by sampling 300 subjects (from 15 body sites on men and 18 sites on women).
So far, the HMP data have shown that humans have unique microbiome "fingerprints." We are 90% different, with microbes differing according to age, sex, and geographic area – and possibly by other parameters, as well. Getting the genomic fingerprint of the microbiome is important because microbes can help determine, for instance, whether certain drugs might cause liver toxicity or make a person more attractive to mosquitoes, said Mr. Knight. The HMP, however, is limited to studying healthy Western adults.
Dr. Knight is a collaborator on the American Gut Project, which is using crowd-sourced samples to further examine the makeup of the gut microbiome. So far, several thousand people from around the world have participated. It is funded by $99 "donations," from each participant, which cover the cost of the sampling kit. The donations go to the Biofrontiers Institute at the University of Colorado, Boulder, and the Earth Microbiome Project.
There is a need for faster DNA sequencing, databases of normal and abnormal microbiomes to provide a baseline, and research into how the microbiome affects health, including longitudinal studies to predict and monitor health changes, and animal models to help establish causality, said Dr. Knight.
Dr. Blaser, professor of microbiology and director of the Human Microbiome Program at the New York University Langone Medical Center, said findings so far had stimulated interest in researching the identity of various microbes, their activities, how the human host responds to microbes, the forces that maintain equilibrium in the host, and the unique characteristics of each individual’s microbiome. He and others have been looking into how antibiotic use in childhood might be affecting obesity. Studies have shown a correlation between heavy antibiotic use in certain areas of the country and greater rates of obesity in those same areas, said Dr. Blaser.
Antibiotic use may also be leading to less diversity in the guts of American adults, he said. There is a need for more research on the consequences of antibiotic use, and to help produce better diagnostics and therapies that are more narrowly targeted, he said. It would also be useful to examine the potential for both prebiotic and probiotic therapies, Dr. Blaser said.
Dr. Wu, professor of medicine at the University of Pennsylvania, Philadelphia, briefed the attendees on the success of fecal transplants to treat Clostridium difficile. So far, the procedure has offered proof of principle that human microbiota can be modified to treat disease, said Dr. Wu. It also has provided a window into the biology of the gut microbiome.
But "we must be very cautious," said Dr. Wu, noting that there are no data on short-term or long-term consequences of fecal transplant. The gut includes bacteria, fungi, and viruses, many of which have not been fully characterized yet, and is a "dynamic and living consortium that can change over time in ways that scientists cannot fully predict," said Dr. Wu.
He noted that clinicians had accidentally infected a generation of patients with hepatitis C through blood transfusions, because hepatitis C virus had not been discovered yet.
In the future, the aim is to standardize the process – both in creating the material to be transplanted and the conditions under which it is given, said Dr. Wu. There is also a need for functional studies in humans, to determine how the transplants work. Finally, he said, "it’s of tremendous importance that there be a register so people can be tracked for short- and long-term safety."
With potentially thousands of people getting fecal transplants in the near future, education of the lay public and clinicians is also crucial, said Dr. Wu.
The AGA’s Center for Gut Microbiome Research and Education will help fulfill that role. Started in March, its mission is to advance research and education. The advisory board will make recommendations to the AGA Governing Board on policy and research strategies.
Danone Inc. is a founding supporter of the center.
On Twitter @aliciaault
Scientific advisers from the AGA’s Center for Gut Microbiome Research and Education went to Capitol Hill in late July to make a pitch for increased research funding, including for the National Institutes of Health’s Human Microbiome Project.
The advisers – Rob Knight, Ph.D., Dr. Martin J. Blaser, and Dr. Gary D. Wu – along with AGA President Loren A. Laine, briefed congressional staff on the science of the gut microbiome and the importance of delving further into its workings.
"There’s no question that understanding and manipulating the gut microbiome will be very important in attacking diseases, and how we take care of patients’ diseases in the future," said Dr. Laine.
Dr. Knight, an associate professor of chemistry at the University of Colorado, Boulder, and a career scientist with the Howard Hughes Medical Institute, gave an overview of the field, focusing on what’s been collected so far by the Human Microbiome Project. The HMP, begun in 2007, aims to characterize the healthy human microbiome by sampling 300 subjects (from 15 body sites on men and 18 sites on women).
So far, the HMP data have shown that humans have unique microbiome "fingerprints." We are 90% different, with microbes differing according to age, sex, and geographic area – and possibly by other parameters, as well. Getting the genomic fingerprint of the microbiome is important because microbes can help determine, for instance, whether certain drugs might cause liver toxicity or make a person more attractive to mosquitoes, said Mr. Knight. The HMP, however, is limited to studying healthy Western adults.
Dr. Knight is a collaborator on the American Gut Project, which is using crowd-sourced samples to further examine the makeup of the gut microbiome. So far, several thousand people from around the world have participated. It is funded by $99 "donations," from each participant, which cover the cost of the sampling kit. The donations go to the Biofrontiers Institute at the University of Colorado, Boulder, and the Earth Microbiome Project.
There is a need for faster DNA sequencing, databases of normal and abnormal microbiomes to provide a baseline, and research into how the microbiome affects health, including longitudinal studies to predict and monitor health changes, and animal models to help establish causality, said Dr. Knight.
Dr. Blaser, professor of microbiology and director of the Human Microbiome Program at the New York University Langone Medical Center, said findings so far had stimulated interest in researching the identity of various microbes, their activities, how the human host responds to microbes, the forces that maintain equilibrium in the host, and the unique characteristics of each individual’s microbiome. He and others have been looking into how antibiotic use in childhood might be affecting obesity. Studies have shown a correlation between heavy antibiotic use in certain areas of the country and greater rates of obesity in those same areas, said Dr. Blaser.
Antibiotic use may also be leading to less diversity in the guts of American adults, he said. There is a need for more research on the consequences of antibiotic use, and to help produce better diagnostics and therapies that are more narrowly targeted, he said. It would also be useful to examine the potential for both prebiotic and probiotic therapies, Dr. Blaser said.
Dr. Wu, professor of medicine at the University of Pennsylvania, Philadelphia, briefed the attendees on the success of fecal transplants to treat Clostridium difficile. So far, the procedure has offered proof of principle that human microbiota can be modified to treat disease, said Dr. Wu. It also has provided a window into the biology of the gut microbiome.
But "we must be very cautious," said Dr. Wu, noting that there are no data on short-term or long-term consequences of fecal transplant. The gut includes bacteria, fungi, and viruses, many of which have not been fully characterized yet, and is a "dynamic and living consortium that can change over time in ways that scientists cannot fully predict," said Dr. Wu.
He noted that clinicians had accidentally infected a generation of patients with hepatitis C through blood transfusions, because hepatitis C virus had not been discovered yet.
In the future, the aim is to standardize the process – both in creating the material to be transplanted and the conditions under which it is given, said Dr. Wu. There is also a need for functional studies in humans, to determine how the transplants work. Finally, he said, "it’s of tremendous importance that there be a register so people can be tracked for short- and long-term safety."
With potentially thousands of people getting fecal transplants in the near future, education of the lay public and clinicians is also crucial, said Dr. Wu.
The AGA’s Center for Gut Microbiome Research and Education will help fulfill that role. Started in March, its mission is to advance research and education. The advisory board will make recommendations to the AGA Governing Board on policy and research strategies.
Danone Inc. is a founding supporter of the center.
On Twitter @aliciaault
Scientific advisers from the AGA’s Center for Gut Microbiome Research and Education went to Capitol Hill in late July to make a pitch for increased research funding, including for the National Institutes of Health’s Human Microbiome Project.
The advisers – Rob Knight, Ph.D., Dr. Martin J. Blaser, and Dr. Gary D. Wu – along with AGA President Loren A. Laine, briefed congressional staff on the science of the gut microbiome and the importance of delving further into its workings.
"There’s no question that understanding and manipulating the gut microbiome will be very important in attacking diseases, and how we take care of patients’ diseases in the future," said Dr. Laine.
Dr. Knight, an associate professor of chemistry at the University of Colorado, Boulder, and a career scientist with the Howard Hughes Medical Institute, gave an overview of the field, focusing on what’s been collected so far by the Human Microbiome Project. The HMP, begun in 2007, aims to characterize the healthy human microbiome by sampling 300 subjects (from 15 body sites on men and 18 sites on women).
So far, the HMP data have shown that humans have unique microbiome "fingerprints." We are 90% different, with microbes differing according to age, sex, and geographic area – and possibly by other parameters, as well. Getting the genomic fingerprint of the microbiome is important because microbes can help determine, for instance, whether certain drugs might cause liver toxicity or make a person more attractive to mosquitoes, said Mr. Knight. The HMP, however, is limited to studying healthy Western adults.
Dr. Knight is a collaborator on the American Gut Project, which is using crowd-sourced samples to further examine the makeup of the gut microbiome. So far, several thousand people from around the world have participated. It is funded by $99 "donations," from each participant, which cover the cost of the sampling kit. The donations go to the Biofrontiers Institute at the University of Colorado, Boulder, and the Earth Microbiome Project.
There is a need for faster DNA sequencing, databases of normal and abnormal microbiomes to provide a baseline, and research into how the microbiome affects health, including longitudinal studies to predict and monitor health changes, and animal models to help establish causality, said Dr. Knight.
Dr. Blaser, professor of microbiology and director of the Human Microbiome Program at the New York University Langone Medical Center, said findings so far had stimulated interest in researching the identity of various microbes, their activities, how the human host responds to microbes, the forces that maintain equilibrium in the host, and the unique characteristics of each individual’s microbiome. He and others have been looking into how antibiotic use in childhood might be affecting obesity. Studies have shown a correlation between heavy antibiotic use in certain areas of the country and greater rates of obesity in those same areas, said Dr. Blaser.
Antibiotic use may also be leading to less diversity in the guts of American adults, he said. There is a need for more research on the consequences of antibiotic use, and to help produce better diagnostics and therapies that are more narrowly targeted, he said. It would also be useful to examine the potential for both prebiotic and probiotic therapies, Dr. Blaser said.
Dr. Wu, professor of medicine at the University of Pennsylvania, Philadelphia, briefed the attendees on the success of fecal transplants to treat Clostridium difficile. So far, the procedure has offered proof of principle that human microbiota can be modified to treat disease, said Dr. Wu. It also has provided a window into the biology of the gut microbiome.
But "we must be very cautious," said Dr. Wu, noting that there are no data on short-term or long-term consequences of fecal transplant. The gut includes bacteria, fungi, and viruses, many of which have not been fully characterized yet, and is a "dynamic and living consortium that can change over time in ways that scientists cannot fully predict," said Dr. Wu.
He noted that clinicians had accidentally infected a generation of patients with hepatitis C through blood transfusions, because hepatitis C virus had not been discovered yet.
In the future, the aim is to standardize the process – both in creating the material to be transplanted and the conditions under which it is given, said Dr. Wu. There is also a need for functional studies in humans, to determine how the transplants work. Finally, he said, "it’s of tremendous importance that there be a register so people can be tracked for short- and long-term safety."
With potentially thousands of people getting fecal transplants in the near future, education of the lay public and clinicians is also crucial, said Dr. Wu.
The AGA’s Center for Gut Microbiome Research and Education will help fulfill that role. Started in March, its mission is to advance research and education. The advisory board will make recommendations to the AGA Governing Board on policy and research strategies.
Danone Inc. is a founding supporter of the center.
On Twitter @aliciaault
ACO spillover effect: Lower spending for all
Implementing the requirements of an accountable care organization for one group of patients may lower costs and improve care for every patient seen in a physician’s practice, according to a study published online Aug. 27 in JAMA.
Dr. J. Michael McWilliams of Harvard Medical School, Boston, and his colleagues looked at whether the Blue Cross Blue Shield of Massachusetts’ Alternative Quality Contract (ACQ), a successful ACO started in 2009, was associated with changes in spending or quality of care for Medicare beneficiaries who were not part of the ACO.
In the AQC, physicians and other providers assumed financial risk if they spent more than a global budget, but shared savings with the insurer if spending was under budget. Physicians could also receive bonuses for meeting quality targets.
The investigators compared total quarterly medical spending per beneficiary between two groups: beneficiaries who received care through the AQC in 2009 or 2010 (1.7 million person-years) and controls who received care from other providers (JAMA 2013;310:829-836).
Quarterly spending per beneficiary in 2007 and 2008 (prior to the AQC contracts) was $150 higher for the AQC group than the control group. Two years after the ACQ contracts went into effect, the difference was $51 per quarter. The biggest reduction in spending was for beneficiaries with five or more conditions, and in spending on outpatient care. Spending was significantly reduced for office visits, emergency department visits, minor procedures, imaging, and lab tests.
Some improvement was seen on quality measures. The number of beneficiaries tested for low-density lipoprotein levels increased. Prior to the AQC, LDL testing rates for diabetic beneficiaries in the AQC group were 2.2% higher than for controls. By the second year, the testing rate was 5.2% higher for those in the AQC. LDL testing rates also improved for cardiovascular disease patients in the AQC.
No improvement was seen on other quality measures, including hospitalization for an ambulatory care–sensitive condition related to cardiovascular disease or diabetes; readmission within 30 days of discharge; screening mammography for women aged 65-69 years; LDL testing for beneficiaries with a history of ischemic heart disease, myocardial infarction, or stroke; and hemoglobin A1c testing and retinal exams for beneficiaries with diabetes.
"These findings suggest that global payment incentives in the AQC elicited responses from participating organizations that extended beyond targeted case management of BCBS enrollees," the authors wrote.
Overall, the study "suggests that organizations in Massachusetts willing to assume greater financial risk were capable of achieving modest reductions in spending for Medicare beneficiaries without compromising quality of care," wrote Dr. McWilliams and his colleagues.
The study also showed that physicians and provider organizations who see spillover effects from one ACO contract might be willing "to enter similar contracts with additional insurers."
But there is a potential downside to the spillover effect, according to the authors: Because cost and quality may be improved overall, "competing insurers with similar provider networks could offer lower premiums without incurring the costs of managing an ACO."
The study was supported by grants from the National Institute on Aging, the American Federation for Aging Research, the Doris Duke Charitable Foundation, and the Commonwealth Fund. The investigators reported no relevant conflicts of interest.
On Twitter @aliciaault
Implementing the requirements of an accountable care organization for one group of patients may lower costs and improve care for every patient seen in a physician’s practice, according to a study published online Aug. 27 in JAMA.
Dr. J. Michael McWilliams of Harvard Medical School, Boston, and his colleagues looked at whether the Blue Cross Blue Shield of Massachusetts’ Alternative Quality Contract (ACQ), a successful ACO started in 2009, was associated with changes in spending or quality of care for Medicare beneficiaries who were not part of the ACO.
In the AQC, physicians and other providers assumed financial risk if they spent more than a global budget, but shared savings with the insurer if spending was under budget. Physicians could also receive bonuses for meeting quality targets.
The investigators compared total quarterly medical spending per beneficiary between two groups: beneficiaries who received care through the AQC in 2009 or 2010 (1.7 million person-years) and controls who received care from other providers (JAMA 2013;310:829-836).
Quarterly spending per beneficiary in 2007 and 2008 (prior to the AQC contracts) was $150 higher for the AQC group than the control group. Two years after the ACQ contracts went into effect, the difference was $51 per quarter. The biggest reduction in spending was for beneficiaries with five or more conditions, and in spending on outpatient care. Spending was significantly reduced for office visits, emergency department visits, minor procedures, imaging, and lab tests.
Some improvement was seen on quality measures. The number of beneficiaries tested for low-density lipoprotein levels increased. Prior to the AQC, LDL testing rates for diabetic beneficiaries in the AQC group were 2.2% higher than for controls. By the second year, the testing rate was 5.2% higher for those in the AQC. LDL testing rates also improved for cardiovascular disease patients in the AQC.
No improvement was seen on other quality measures, including hospitalization for an ambulatory care–sensitive condition related to cardiovascular disease or diabetes; readmission within 30 days of discharge; screening mammography for women aged 65-69 years; LDL testing for beneficiaries with a history of ischemic heart disease, myocardial infarction, or stroke; and hemoglobin A1c testing and retinal exams for beneficiaries with diabetes.
"These findings suggest that global payment incentives in the AQC elicited responses from participating organizations that extended beyond targeted case management of BCBS enrollees," the authors wrote.
Overall, the study "suggests that organizations in Massachusetts willing to assume greater financial risk were capable of achieving modest reductions in spending for Medicare beneficiaries without compromising quality of care," wrote Dr. McWilliams and his colleagues.
The study also showed that physicians and provider organizations who see spillover effects from one ACO contract might be willing "to enter similar contracts with additional insurers."
But there is a potential downside to the spillover effect, according to the authors: Because cost and quality may be improved overall, "competing insurers with similar provider networks could offer lower premiums without incurring the costs of managing an ACO."
The study was supported by grants from the National Institute on Aging, the American Federation for Aging Research, the Doris Duke Charitable Foundation, and the Commonwealth Fund. The investigators reported no relevant conflicts of interest.
On Twitter @aliciaault
Implementing the requirements of an accountable care organization for one group of patients may lower costs and improve care for every patient seen in a physician’s practice, according to a study published online Aug. 27 in JAMA.
Dr. J. Michael McWilliams of Harvard Medical School, Boston, and his colleagues looked at whether the Blue Cross Blue Shield of Massachusetts’ Alternative Quality Contract (ACQ), a successful ACO started in 2009, was associated with changes in spending or quality of care for Medicare beneficiaries who were not part of the ACO.
In the AQC, physicians and other providers assumed financial risk if they spent more than a global budget, but shared savings with the insurer if spending was under budget. Physicians could also receive bonuses for meeting quality targets.
The investigators compared total quarterly medical spending per beneficiary between two groups: beneficiaries who received care through the AQC in 2009 or 2010 (1.7 million person-years) and controls who received care from other providers (JAMA 2013;310:829-836).
Quarterly spending per beneficiary in 2007 and 2008 (prior to the AQC contracts) was $150 higher for the AQC group than the control group. Two years after the ACQ contracts went into effect, the difference was $51 per quarter. The biggest reduction in spending was for beneficiaries with five or more conditions, and in spending on outpatient care. Spending was significantly reduced for office visits, emergency department visits, minor procedures, imaging, and lab tests.
Some improvement was seen on quality measures. The number of beneficiaries tested for low-density lipoprotein levels increased. Prior to the AQC, LDL testing rates for diabetic beneficiaries in the AQC group were 2.2% higher than for controls. By the second year, the testing rate was 5.2% higher for those in the AQC. LDL testing rates also improved for cardiovascular disease patients in the AQC.
No improvement was seen on other quality measures, including hospitalization for an ambulatory care–sensitive condition related to cardiovascular disease or diabetes; readmission within 30 days of discharge; screening mammography for women aged 65-69 years; LDL testing for beneficiaries with a history of ischemic heart disease, myocardial infarction, or stroke; and hemoglobin A1c testing and retinal exams for beneficiaries with diabetes.
"These findings suggest that global payment incentives in the AQC elicited responses from participating organizations that extended beyond targeted case management of BCBS enrollees," the authors wrote.
Overall, the study "suggests that organizations in Massachusetts willing to assume greater financial risk were capable of achieving modest reductions in spending for Medicare beneficiaries without compromising quality of care," wrote Dr. McWilliams and his colleagues.
The study also showed that physicians and provider organizations who see spillover effects from one ACO contract might be willing "to enter similar contracts with additional insurers."
But there is a potential downside to the spillover effect, according to the authors: Because cost and quality may be improved overall, "competing insurers with similar provider networks could offer lower premiums without incurring the costs of managing an ACO."
The study was supported by grants from the National Institute on Aging, the American Federation for Aging Research, the Doris Duke Charitable Foundation, and the Commonwealth Fund. The investigators reported no relevant conflicts of interest.
On Twitter @aliciaault
FROM JAMA
Major finding: Quarterly spending per Medicare beneficiary was reduced by about $100 for those who were receiving care in a practice that had a contract with Blues Cross Blue Shield of Massachusetts’ Alternative Quality Contract.
Data source: Quasi-experimental comparisons from 2007-2010 of Medicare beneficiaries served by 11 provider organizations who entered the AQC in 2009 or 2010, compared to those served by other providers.
Disclosures: The study was supported by grants from the National Institute on Aging, the American Federation for Aging Research, the Doris Duke Charitable Foundation, and the Commonwealth Fund. The investigators reported no relevant conflicts of interest.
Bipartisan support is one key to getting SGR fixed, AMA president says
WASHINGTON – Congress appears to be on the brink of reforming the Medicare Sustainable Growth Rate formula after many years of temporary payment updates that physicians say undermine the stability of their practices and of the federal health program, as well.
Dr. Ardis Dee Hoven, president of the American Medical Association, discusses why Congress is so much closer to solving the Medicare physician payment puzzle this year. She also weighs in on prospects for action in the House and Senate when lawmakers return from their summer recess in September and what the practice world might look like after the SGR disappears.
On Twitter @aliciaault
WASHINGTON – Congress appears to be on the brink of reforming the Medicare Sustainable Growth Rate formula after many years of temporary payment updates that physicians say undermine the stability of their practices and of the federal health program, as well.
Dr. Ardis Dee Hoven, president of the American Medical Association, discusses why Congress is so much closer to solving the Medicare physician payment puzzle this year. She also weighs in on prospects for action in the House and Senate when lawmakers return from their summer recess in September and what the practice world might look like after the SGR disappears.
On Twitter @aliciaault
WASHINGTON – Congress appears to be on the brink of reforming the Medicare Sustainable Growth Rate formula after many years of temporary payment updates that physicians say undermine the stability of their practices and of the federal health program, as well.
Dr. Ardis Dee Hoven, president of the American Medical Association, discusses why Congress is so much closer to solving the Medicare physician payment puzzle this year. She also weighs in on prospects for action in the House and Senate when lawmakers return from their summer recess in September and what the practice world might look like after the SGR disappears.
On Twitter @aliciaault
Doctors seek halt on meaningful use stage 2 penalties
The Medical Group Management Association wants an indefinite hold on penalties to be levied on physicians who cannot move on to the next stage of meaningful use of electronic health records.
In an Aug. 21 letter to the Health and Human Services (HHS) department, Dr. Susan Turney, MGMA president and chief executive officer, said that physicians who have already met requirements for stage 1 meaningful use should not be penalized if they can’t meet the requirements for stage 2.
Physicians have been receiving incentive payments to become meaningful users of EHRs under the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009. Those payments continue through 2014. But stage 2 starts in 2014, and physicians will be penalized in 2015 if they can’t meet the goals.
Dr. Turney noted that while there are 2,200 products and 1,400 complete EHRs that are certified by the government for stage 1, so far, there are only 75 products and 21 complete EHRs that are certified for stage 2.
That dearth of certified technology does not give physicians enough time to upgrade their systems or acquire new technology to allow them to be ready to participate in stage 2, Dr. Turney said.
Physicians not only are waiting on vendors to upgrade their products, but have to consider whether they can afford to invest in new technology. And, if they do, staff will have to be trained, which can take a year or more, she noted.
In addition to indefinitely delaying penalties on physicians who have achieved stage 1 but not stage 2, the MGMA recommended that HHS also extend the reporting period for stage 2 for at least a year. "This extra year would provide additional time for vendors to upgrade their software, certify for the stage 2 criteria, and install the products," Dr. Turney wrote.
HHS also should extend the reporting period for stage 1 so that providers who have attested for stage 1 and whose EHR has not been recertified by January 2015 can continue to report on stage 1 during 2014.
The MGMA is also concerned about the stage 2 criteria that would require physicians to give at least 5% of their patients the ability to view, download, and transmit their health information online within 4 days of it being posted. That requirement should be closely monitored and potentially adjusted, according to the MGMA letter.
The MGMA represents 22,500 leaders at 13,200 organizations that in turn employ or are affiliated with 280,000 physicians.
[email protected]
On Twitter @aliciaault
The Medical Group Management Association wants an indefinite hold on penalties to be levied on physicians who cannot move on to the next stage of meaningful use of electronic health records.
In an Aug. 21 letter to the Health and Human Services (HHS) department, Dr. Susan Turney, MGMA president and chief executive officer, said that physicians who have already met requirements for stage 1 meaningful use should not be penalized if they can’t meet the requirements for stage 2.
Physicians have been receiving incentive payments to become meaningful users of EHRs under the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009. Those payments continue through 2014. But stage 2 starts in 2014, and physicians will be penalized in 2015 if they can’t meet the goals.
Dr. Turney noted that while there are 2,200 products and 1,400 complete EHRs that are certified by the government for stage 1, so far, there are only 75 products and 21 complete EHRs that are certified for stage 2.
That dearth of certified technology does not give physicians enough time to upgrade their systems or acquire new technology to allow them to be ready to participate in stage 2, Dr. Turney said.
Physicians not only are waiting on vendors to upgrade their products, but have to consider whether they can afford to invest in new technology. And, if they do, staff will have to be trained, which can take a year or more, she noted.
In addition to indefinitely delaying penalties on physicians who have achieved stage 1 but not stage 2, the MGMA recommended that HHS also extend the reporting period for stage 2 for at least a year. "This extra year would provide additional time for vendors to upgrade their software, certify for the stage 2 criteria, and install the products," Dr. Turney wrote.
HHS also should extend the reporting period for stage 1 so that providers who have attested for stage 1 and whose EHR has not been recertified by January 2015 can continue to report on stage 1 during 2014.
The MGMA is also concerned about the stage 2 criteria that would require physicians to give at least 5% of their patients the ability to view, download, and transmit their health information online within 4 days of it being posted. That requirement should be closely monitored and potentially adjusted, according to the MGMA letter.
The MGMA represents 22,500 leaders at 13,200 organizations that in turn employ or are affiliated with 280,000 physicians.
[email protected]
On Twitter @aliciaault
The Medical Group Management Association wants an indefinite hold on penalties to be levied on physicians who cannot move on to the next stage of meaningful use of electronic health records.
In an Aug. 21 letter to the Health and Human Services (HHS) department, Dr. Susan Turney, MGMA president and chief executive officer, said that physicians who have already met requirements for stage 1 meaningful use should not be penalized if they can’t meet the requirements for stage 2.
Physicians have been receiving incentive payments to become meaningful users of EHRs under the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009. Those payments continue through 2014. But stage 2 starts in 2014, and physicians will be penalized in 2015 if they can’t meet the goals.
Dr. Turney noted that while there are 2,200 products and 1,400 complete EHRs that are certified by the government for stage 1, so far, there are only 75 products and 21 complete EHRs that are certified for stage 2.
That dearth of certified technology does not give physicians enough time to upgrade their systems or acquire new technology to allow them to be ready to participate in stage 2, Dr. Turney said.
Physicians not only are waiting on vendors to upgrade their products, but have to consider whether they can afford to invest in new technology. And, if they do, staff will have to be trained, which can take a year or more, she noted.
In addition to indefinitely delaying penalties on physicians who have achieved stage 1 but not stage 2, the MGMA recommended that HHS also extend the reporting period for stage 2 for at least a year. "This extra year would provide additional time for vendors to upgrade their software, certify for the stage 2 criteria, and install the products," Dr. Turney wrote.
HHS also should extend the reporting period for stage 1 so that providers who have attested for stage 1 and whose EHR has not been recertified by January 2015 can continue to report on stage 1 during 2014.
The MGMA is also concerned about the stage 2 criteria that would require physicians to give at least 5% of their patients the ability to view, download, and transmit their health information online within 4 days of it being posted. That requirement should be closely monitored and potentially adjusted, according to the MGMA letter.
The MGMA represents 22,500 leaders at 13,200 organizations that in turn employ or are affiliated with 280,000 physicians.
[email protected]
On Twitter @aliciaault
