Jane Anderson

The Department of Health and Human Services has awarded $17 million to fund research projects aimed at reducing central line–associated bloodstream infections and other hospital-acquired infections, including methicillin-resistant Staphylococcus aureus.

Nearly half of the funds will go toward financing a national expansion of the Keystone Project, which uses a checklist of evidence-based safety practices, staff training, careful measurement of infection rates, and teamwork-building tools for hospital staff to reduce the rate of central line–associated bloodstream infections (CLABSIs), according to the HHS.

The program, which has been implemented in more than 100 Michigan intensive care units, has saved more than 1,800 lives, more than $271 million in health care costs, and more than 140,700 excess hospital stay days in that state between 2004 and 2009, according to the Michigan Health and Hospital Association in Lansing.

In addition, data indicate that the CLABSI rates of hospitals participating in the Keystone program were consistently lower than the national average, the hospital association said in an October report.

Last year, the Agency for Healthcare Research and Quality (AHRQ) funded an expansion of the Keystone Project to 10 states. Now, with additional funding from the AHRQ and a private foundation, it is operating in all 50 states, the HHS said. The additional $8 million from the HHS will allow the program to expand to more hospitals, to extend to other settings in addition to intensive care units, and to broaden the focus to address other types of infections, the HHS said.

Dr. Thomas W. Barrett, a hospitalist at the Portland (Ore.) VA Medical Center, said in an interview that this type of implementation research is difficult to conduct because there are so many potentially confounding variables.

“This is a great step forward—it's very important for patient safety and patient care,” Dr. Barrett said. “It's encouraging to see AHRQ take a great step in the right direction. I hope that since AHRQ is funding this, the level of rigor in the research will continue to improve.”

To spend the remaining $9 million of the $17 million in new funding, the AHRQ said it collaborated with the Centers for Disease Control and Prevention to identify projects.

The projects chosen will focus on reducing Clostridium difficile infections through a regional hospital collaborative, reducing the overuse of antibiotics by primary care physicians treating patients in ambulatory and long-term care settings, evaluating two ways to eliminate MRSA in ICUs, and improving the measurement of the risk of infections after surgery.

Additional projects will attempt to identify rates of hospital-acquired infections, to reduce infections caused by Klebsiella pneumoniae carbapenemase-producing organisms by applying recently developed recommendations from the CDC's Healthcare Infection Control Practices Advisory Committee, to standardize antibiotic use in long-term care settings, and to implement teamwork principles for frontline health care providers, the AHRQ said.

'This is a great step forward—it's very important for patient safety and patient care.'

Source Dr. Barrett

The Department of Health and Human Services has awarded $17 million to fund research projects aimed at reducing central line–associated bloodstream infections and other hospital-acquired infections, including methicillin-resistant Staphylococcus aureus.

Nearly half of the funds will go toward financing a national expansion of the Keystone Project, which uses a checklist of evidence-based safety practices, staff training, careful measurement of infection rates, and teamwork-building tools for hospital staff to reduce the rate of central line–associated bloodstream infections (CLABSIs), according to the HHS.

The program, which has been implemented in more than 100 Michigan intensive care units, has saved more than 1,800 lives, more than $271 million in health care costs, and more than 140,700 excess hospital stay days in that state between 2004 and 2009, according to the Michigan Health and Hospital Association in Lansing.

In addition, data indicate that the CLABSI rates of hospitals participating in the Keystone program were consistently lower than the national average, the hospital association said in an October report.

Last year, the Agency for Healthcare Research and Quality (AHRQ) funded an expansion of the Keystone Project to 10 states. Now, with additional funding from the AHRQ and a private foundation, it is operating in all 50 states, the HHS said. The additional $8 million from the HHS will allow the program to expand to more hospitals, to extend to other settings in addition to intensive care units, and to broaden the focus to address other types of infections, the HHS said.

Dr. Thomas W. Barrett, a hospitalist at the Portland (Ore.) VA Medical Center, said in an interview that this type of implementation research is difficult to conduct because there are so many potentially confounding variables.

“This is a great step forward—it's very important for patient safety and patient care,” Dr. Barrett said. “It's encouraging to see AHRQ take a great step in the right direction. I hope that since AHRQ is funding this, the level of rigor in the research will continue to improve.”

To spend the remaining $9 million of the $17 million in new funding, the AHRQ said it collaborated with the Centers for Disease Control and Prevention to identify projects.

The projects chosen will focus on reducing Clostridium difficile infections through a regional hospital collaborative, reducing the overuse of antibiotics by primary care physicians treating patients in ambulatory and long-term care settings, evaluating two ways to eliminate MRSA in ICUs, and improving the measurement of the risk of infections after surgery.

Additional projects will attempt to identify rates of hospital-acquired infections, to reduce infections caused by Klebsiella pneumoniae carbapenemase-producing organisms by applying recently developed recommendations from the CDC's Healthcare Infection Control Practices Advisory Committee, to standardize antibiotic use in long-term care settings, and to implement teamwork principles for frontline health care providers, the AHRQ said.

'This is a great step forward—it's very important for patient safety and patient care.'

Source Dr. Barrett

The Department of Health and Human Services has awarded $17 million to fund research projects aimed at reducing central line–associated bloodstream infections and other hospital-acquired infections, including methicillin-resistant Staphylococcus aureus.

Nearly half of the funds will go toward financing a national expansion of the Keystone Project, which uses a checklist of evidence-based safety practices, staff training, careful measurement of infection rates, and teamwork-building tools for hospital staff to reduce the rate of central line–associated bloodstream infections (CLABSIs), according to the HHS.

The program, which has been implemented in more than 100 Michigan intensive care units, has saved more than 1,800 lives, more than $271 million in health care costs, and more than 140,700 excess hospital stay days in that state between 2004 and 2009, according to the Michigan Health and Hospital Association in Lansing.

In addition, data indicate that the CLABSI rates of hospitals participating in the Keystone program were consistently lower than the national average, the hospital association said in an October report.

Last year, the Agency for Healthcare Research and Quality (AHRQ) funded an expansion of the Keystone Project to 10 states. Now, with additional funding from the AHRQ and a private foundation, it is operating in all 50 states, the HHS said. The additional $8 million from the HHS will allow the program to expand to more hospitals, to extend to other settings in addition to intensive care units, and to broaden the focus to address other types of infections, the HHS said.

Dr. Thomas W. Barrett, a hospitalist at the Portland (Ore.) VA Medical Center, said in an interview that this type of implementation research is difficult to conduct because there are so many potentially confounding variables.

“This is a great step forward—it's very important for patient safety and patient care,” Dr. Barrett said. “It's encouraging to see AHRQ take a great step in the right direction. I hope that since AHRQ is funding this, the level of rigor in the research will continue to improve.”

To spend the remaining $9 million of the $17 million in new funding, the AHRQ said it collaborated with the Centers for Disease Control and Prevention to identify projects.

The projects chosen will focus on reducing Clostridium difficile infections through a regional hospital collaborative, reducing the overuse of antibiotics by primary care physicians treating patients in ambulatory and long-term care settings, evaluating two ways to eliminate MRSA in ICUs, and improving the measurement of the risk of infections after surgery.

Additional projects will attempt to identify rates of hospital-acquired infections, to reduce infections caused by Klebsiella pneumoniae carbapenemase-producing organisms by applying recently developed recommendations from the CDC's Healthcare Infection Control Practices Advisory Committee, to standardize antibiotic use in long-term care settings, and to implement teamwork principles for frontline health care providers, the AHRQ said.

'This is a great step forward—it's very important for patient safety and patient care.'

Source Dr. Barrett

Practice Revenues Decline

Medical practice revenues fell in 2008, possibly because of declining patient volumes and payments from people in financial hardship, according to the Medical Group Management Association. Medical practices responded by trimming overhead costs more than 1%, but that wasn't enough to offset shrinking revenues, the MGMA found in its 2009 practice cost survey. Multispecialty group practices saw a 1.9% decline in total medical revenue last year from 2008, with substantial drops in both the number of procedures and the number of patients. Bad debt in multispecialty group practices from fee-for-service charges increased 13% from 2006 to 2008. Practices trimmed their expenses mostly by cutting support-staff costs. Total worker count remained constant, suggesting that practices may have eliminated raises and bonuses or even cut pay, rather than laying off employees, the MGMA said.

Student Posts Are Unprofessional

A majority of medical schools say they have experienced incidents of students posting unprofessional content online, including material that violates patient confidentiality, researchers reported in the Journal of the American Medical Association. However, only 28 of the 78 schools surveyed said they had policies to address such postings, which typically occur on social networking sites, media-sharing sites, blogs, wikis, and podcasts, the authors said. Only six schools said they had encountered patient confidentiality violations, such as online descriptions of identifiable patients, and issues of conflict of interest were rare. But posts using profanity, discriminatory language, depictions of intoxication, and sexually suggestive material were common. Two-thirds of the schools gave students informal warnings, while three schools said they dismissed the students involved. The study authors recommended that medical schools include a digital media component in their training on professionalism.

NIH Grants Total $5 Billion

The National Institutes of Health has awarded more than 12,000 grants for $5 billion in stimulus package funds toward research in HIV, cancer, heart disease, and autism. Announced at a press conference by President Obama, the grants come from the American Recovery and Reinvestment Act passed and signed last spring. “This represents the single largest boost to biomedical research in history,” the president said. Some of the funds will be used to apply findings from the Human Genome Project to treatment and prevention of the target diseases. For example, NIH will expand the Cancer Genome Atlas so that it eventually sequences DNA from 20,000 tissue samples and 20 types of cancer. Other stimulus package funding was designated by the Department of Health and Human Services for chronic disease prevention and wellness programs as well as for information technology at large federally funded health centers. The Centers for Disease Control and Prevention will administer $373 million for the chronic disease programs and community-based approaches that increase physical activity, improve nutrition, and decrease obesity. Part of that initiative also will focus on reducing tobacco use and exposure to secondhand smoke, the HHS said. Eighteen grants totaling more than $22 million will fund new electronic health records projects and support existing EHR systems and other information technology in medicine, the department said.

Medicaid Funds More Home Care

Annual Medicaid spending for assisted living and community-based services ballooned by more than 80% in the past 7 years as states sought alternatives to costly nursing home care, a report from the National Center for Assisted Living found. Over the same period, Medicaid's nursing home spending grew only about 10%, and the number of nursing home beds dropped nearly 1.6%, the report said. The program's bills for nursing home care, at $47 billion in 2007, were still far higher than the nearly $17 billion states spent on alternative services such as home care and assisted living. But “consumer preferences for options to institutional care and the states' interest in reducing Medicaid-expenditure growth rates have created a shift in the supply and utilization of nursing homes over the past several years,” the assisted living group concluded in its report.

Resistance Cuts Antibiotic Sales

Antibacterial drugs will soon see a slump in sales, partly because of declining effectiveness and partly because of generic competition, according to the market research company Kalorama Information. The segment had sales growth of just over 3% in 2008 and 2009, but sales will rise only 1.1% in 2010 and will decline by 0.6% in 2011, Kalorama estimated in its report “Worldwide Market for Anti-Infectives (Antifungals, Antibacterials and Antivirals).” The company pegged the 2009 world market for antibacterial drugs at $24.5 billion. It forecast global sales of all classes of anti-infectives to hit $53.3 billion, up from $45.3 billion in 2006. Kalorama predicted that antiviral sales will grow vigorously, with increases of 18% in 2009, 12% in 2010, and 9% in 2011. By 2013, worldwide antiviral sales should hit $34.1 billion.

Practice Revenues Decline

Medical practice revenues fell in 2008, possibly because of declining patient volumes and payments from people in financial hardship, according to the Medical Group Management Association. Medical practices responded by trimming overhead costs more than 1%, but that wasn't enough to offset shrinking revenues, the MGMA found in its 2009 practice cost survey. Multispecialty group practices saw a 1.9% decline in total medical revenue last year from 2008, with substantial drops in both the number of procedures and the number of patients. Bad debt in multispecialty group practices from fee-for-service charges increased 13% from 2006 to 2008. Practices trimmed their expenses mostly by cutting support-staff costs. Total worker count remained constant, suggesting that practices may have eliminated raises and bonuses or even cut pay, rather than laying off employees, the MGMA said.

Student Posts Are Unprofessional

A majority of medical schools say they have experienced incidents of students posting unprofessional content online, including material that violates patient confidentiality, researchers reported in the Journal of the American Medical Association. However, only 28 of the 78 schools surveyed said they had policies to address such postings, which typically occur on social networking sites, media-sharing sites, blogs, wikis, and podcasts, the authors said. Only six schools said they had encountered patient confidentiality violations, such as online descriptions of identifiable patients, and issues of conflict of interest were rare. But posts using profanity, discriminatory language, depictions of intoxication, and sexually suggestive material were common. Two-thirds of the schools gave students informal warnings, while three schools said they dismissed the students involved. The study authors recommended that medical schools include a digital media component in their training on professionalism.

NIH Grants Total $5 Billion

The National Institutes of Health has awarded more than 12,000 grants for $5 billion in stimulus package funds toward research in HIV, cancer, heart disease, and autism. Announced at a press conference by President Obama, the grants come from the American Recovery and Reinvestment Act passed and signed last spring. “This represents the single largest boost to biomedical research in history,” the president said. Some of the funds will be used to apply findings from the Human Genome Project to treatment and prevention of the target diseases. For example, NIH will expand the Cancer Genome Atlas so that it eventually sequences DNA from 20,000 tissue samples and 20 types of cancer. Other stimulus package funding was designated by the Department of Health and Human Services for chronic disease prevention and wellness programs as well as for information technology at large federally funded health centers. The Centers for Disease Control and Prevention will administer $373 million for the chronic disease programs and community-based approaches that increase physical activity, improve nutrition, and decrease obesity. Part of that initiative also will focus on reducing tobacco use and exposure to secondhand smoke, the HHS said. Eighteen grants totaling more than $22 million will fund new electronic health records projects and support existing EHR systems and other information technology in medicine, the department said.

Medicaid Funds More Home Care

Annual Medicaid spending for assisted living and community-based services ballooned by more than 80% in the past 7 years as states sought alternatives to costly nursing home care, a report from the National Center for Assisted Living found. Over the same period, Medicaid's nursing home spending grew only about 10%, and the number of nursing home beds dropped nearly 1.6%, the report said. The program's bills for nursing home care, at $47 billion in 2007, were still far higher than the nearly $17 billion states spent on alternative services such as home care and assisted living. But “consumer preferences for options to institutional care and the states' interest in reducing Medicaid-expenditure growth rates have created a shift in the supply and utilization of nursing homes over the past several years,” the assisted living group concluded in its report.

Resistance Cuts Antibiotic Sales

Antibacterial drugs will soon see a slump in sales, partly because of declining effectiveness and partly because of generic competition, according to the market research company Kalorama Information. The segment had sales growth of just over 3% in 2008 and 2009, but sales will rise only 1.1% in 2010 and will decline by 0.6% in 2011, Kalorama estimated in its report “Worldwide Market for Anti-Infectives (Antifungals, Antibacterials and Antivirals).” The company pegged the 2009 world market for antibacterial drugs at $24.5 billion. It forecast global sales of all classes of anti-infectives to hit $53.3 billion, up from $45.3 billion in 2006. Kalorama predicted that antiviral sales will grow vigorously, with increases of 18% in 2009, 12% in 2010, and 9% in 2011. By 2013, worldwide antiviral sales should hit $34.1 billion.

Practice Revenues Decline

Medical practice revenues fell in 2008, possibly because of declining patient volumes and payments from people in financial hardship, according to the Medical Group Management Association. Medical practices responded by trimming overhead costs more than 1%, but that wasn't enough to offset shrinking revenues, the MGMA found in its 2009 practice cost survey. Multispecialty group practices saw a 1.9% decline in total medical revenue last year from 2008, with substantial drops in both the number of procedures and the number of patients. Bad debt in multispecialty group practices from fee-for-service charges increased 13% from 2006 to 2008. Practices trimmed their expenses mostly by cutting support-staff costs. Total worker count remained constant, suggesting that practices may have eliminated raises and bonuses or even cut pay, rather than laying off employees, the MGMA said.

Student Posts Are Unprofessional

A majority of medical schools say they have experienced incidents of students posting unprofessional content online, including material that violates patient confidentiality, researchers reported in the Journal of the American Medical Association. However, only 28 of the 78 schools surveyed said they had policies to address such postings, which typically occur on social networking sites, media-sharing sites, blogs, wikis, and podcasts, the authors said. Only six schools said they had encountered patient confidentiality violations, such as online descriptions of identifiable patients, and issues of conflict of interest were rare. But posts using profanity, discriminatory language, depictions of intoxication, and sexually suggestive material were common. Two-thirds of the schools gave students informal warnings, while three schools said they dismissed the students involved. The study authors recommended that medical schools include a digital media component in their training on professionalism.

NIH Grants Total $5 Billion

The National Institutes of Health has awarded more than 12,000 grants for $5 billion in stimulus package funds toward research in HIV, cancer, heart disease, and autism. Announced at a press conference by President Obama, the grants come from the American Recovery and Reinvestment Act passed and signed last spring. “This represents the single largest boost to biomedical research in history,” the president said. Some of the funds will be used to apply findings from the Human Genome Project to treatment and prevention of the target diseases. For example, NIH will expand the Cancer Genome Atlas so that it eventually sequences DNA from 20,000 tissue samples and 20 types of cancer. Other stimulus package funding was designated by the Department of Health and Human Services for chronic disease prevention and wellness programs as well as for information technology at large federally funded health centers. The Centers for Disease Control and Prevention will administer $373 million for the chronic disease programs and community-based approaches that increase physical activity, improve nutrition, and decrease obesity. Part of that initiative also will focus on reducing tobacco use and exposure to secondhand smoke, the HHS said. Eighteen grants totaling more than $22 million will fund new electronic health records projects and support existing EHR systems and other information technology in medicine, the department said.

Medicaid Funds More Home Care

Annual Medicaid spending for assisted living and community-based services ballooned by more than 80% in the past 7 years as states sought alternatives to costly nursing home care, a report from the National Center for Assisted Living found. Over the same period, Medicaid's nursing home spending grew only about 10%, and the number of nursing home beds dropped nearly 1.6%, the report said. The program's bills for nursing home care, at $47 billion in 2007, were still far higher than the nearly $17 billion states spent on alternative services such as home care and assisted living. But “consumer preferences for options to institutional care and the states' interest in reducing Medicaid-expenditure growth rates have created a shift in the supply and utilization of nursing homes over the past several years,” the assisted living group concluded in its report.

Resistance Cuts Antibiotic Sales

Antibacterial drugs will soon see a slump in sales, partly because of declining effectiveness and partly because of generic competition, according to the market research company Kalorama Information. The segment had sales growth of just over 3% in 2008 and 2009, but sales will rise only 1.1% in 2010 and will decline by 0.6% in 2011, Kalorama estimated in its report “Worldwide Market for Anti-Infectives (Antifungals, Antibacterials and Antivirals).” The company pegged the 2009 world market for antibacterial drugs at $24.5 billion. It forecast global sales of all classes of anti-infectives to hit $53.3 billion, up from $45.3 billion in 2006. Kalorama predicted that antiviral sales will grow vigorously, with increases of 18% in 2009, 12% in 2010, and 9% in 2011. By 2013, worldwide antiviral sales should hit $34.1 billion.

Contractors Get Good Marks

Physicians and other health care providers largely are satisfied with the performance of the Medicare fee-for-service contractors that process and pay the more than $300 billion in claims each year, according to an annual satisfaction survey. On a scale of 1 (low) to 6 (high), providers rated contractors at 4.54 in 2009, up very slightly from last year's average of 4.51, according to the Centers for Medicare and Medicaid Services. More than four of five providers scored contractors between 4 and 6, CMS said. The survey included more than 32,000 randomly selected providers, including physicians, suppliers, other health care practitioners, and facilities that serve Medicare beneficiaries.

OIG: Hospice Claims Fall Short

Most hospice claims for Medicare beneficiaries in nursing facilities did not meet at least one Medicare coverage requirement, according to a report from the Health and Human Services Department Office of Inspector General. Nearly two-thirds of claims did not meet plan of care requirements, while one-third failed to include hospice election statements or included inadequate election statements, the OIG report said. Meanwhile, hospices provided fewer services than outlined in plans of care in 31% of cases, and failed to meet terminal illness certification requirements in 4% of claims, the report said. The report recommended that CMS educate hospices about the coverage requirements, provide them with tools and guidance to help them meet those requirements, and strengthen hospice claim monitoring. According to CMS, Medicare hospice spending rose from $3.6 billion in 2001 to $9.2 billion in 2006.

Trial Lawyer Malpractice Ads Soar

Television commercials soliciting plaintiffs for medical malpractice lawsuits have soared 1,400% in the last 4 years, and spending by trial lawyers on those ads rose nearly as much—from $3.8 million in 2004 to $62 million last year, according to the U.S. Chamber of Commerce. This year, a total of 166,000 ads are expected to air, the report said. Media markets in New York, Boston, and Baltimore experienced the most activity in 2008, according to the report. “Lawsuits are ultimately a business driven by the plaintiffs' bar, and when you see the marketing of medical malpractice lawsuits exploding like this, it tells you that these lawsuits are a growing sector within the larger lawsuit industry,” Lisa Rickard, president of the U.S. Chamber Institute for Legal Reform, said in a statement.

Most Doctors Provide Charity Care

Almost 6 in 10 physicians reported providing charity care—defined as either free or reduced-cost care—to patients in 2008, according to the 2008 Health Tracking Physician Survey from the Center for Studying Health System Change. On average, physicians who provided charity care reported 9.5 hours of such care in the month preceding the survey. That amounts to slightly more than 4% of their time spent in all medically related activities, according to the report. The survey also found that 44% of physicians reported receiving some form of performance-adjusted salary, such as an adjustment based on their own productivity. About one-quarter said they received a fixed salary, while 20% received a share of practice revenue. Productivity factors and overall practice financial performance were the most common financial incentives affecting physician compensation, according to the survey.

Doubts on Effectiveness Research

Although comparative effectiveness research may give doctors and patients better information about what treatments work best, it's not clear that it will result in better health or less spending, according to the Rand Corporation. Its study concluded that new incentives will be needed to change the behavior of patients and providers. However, federal law prohibits using the results of federally funded comparative effectiveness research to guide payment policies. So it will be hard to develop incentives for driving down health spending, the study said. In the near term, any reduction in spending created from such research would be offset by the costs associated with generating, coordinating, and disseminating the findings. “While increasing research aimed at determining the most effective treatments for a wide array of diseases should have benefits, there is not enough evidence at this point to predict exactly what the result might be for the cost of the nation's health care system,” Elizabeth McGlynn of Rand said in a statement.

Medical Home Reduced ED Use

A pilot patient-centered medical home program at Seattle's Group Health Cooperative resulted in significantly fewer emergency department visits and hospitalizations among medical home patients when compared with results from two clinics serving as a control group, according to a study. In addition, medical home patients reported higher satisfaction in most areas, and providers and staff members working within the medical home model reported much less professional burnout. Medical home patients used more e-mail, phone, and specialist visits, but at 12 months there were no significant differences in overall costs when compared to the control group. In addition, overall care of medical home patients improved slightly more than care in the control group when composite quality measures were compared. The study was published in the American Journal of Managed Care.

Contractors Get Good Marks

Physicians and other health care providers largely are satisfied with the performance of the Medicare fee-for-service contractors that process and pay the more than $300 billion in claims each year, according to an annual satisfaction survey. On a scale of 1 (low) to 6 (high), providers rated contractors at 4.54 in 2009, up very slightly from last year's average of 4.51, according to the Centers for Medicare and Medicaid Services. More than four of five providers scored contractors between 4 and 6, CMS said. The survey included more than 32,000 randomly selected providers, including physicians, suppliers, other health care practitioners, and facilities that serve Medicare beneficiaries.

OIG: Hospice Claims Fall Short

Most hospice claims for Medicare beneficiaries in nursing facilities did not meet at least one Medicare coverage requirement, according to a report from the Health and Human Services Department Office of Inspector General. Nearly two-thirds of claims did not meet plan of care requirements, while one-third failed to include hospice election statements or included inadequate election statements, the OIG report said. Meanwhile, hospices provided fewer services than outlined in plans of care in 31% of cases, and failed to meet terminal illness certification requirements in 4% of claims, the report said. The report recommended that CMS educate hospices about the coverage requirements, provide them with tools and guidance to help them meet those requirements, and strengthen hospice claim monitoring. According to CMS, Medicare hospice spending rose from $3.6 billion in 2001 to $9.2 billion in 2006.

Trial Lawyer Malpractice Ads Soar

Television commercials soliciting plaintiffs for medical malpractice lawsuits have soared 1,400% in the last 4 years, and spending by trial lawyers on those ads rose nearly as much—from $3.8 million in 2004 to $62 million last year, according to the U.S. Chamber of Commerce. This year, a total of 166,000 ads are expected to air, the report said. Media markets in New York, Boston, and Baltimore experienced the most activity in 2008, according to the report. “Lawsuits are ultimately a business driven by the plaintiffs' bar, and when you see the marketing of medical malpractice lawsuits exploding like this, it tells you that these lawsuits are a growing sector within the larger lawsuit industry,” Lisa Rickard, president of the U.S. Chamber Institute for Legal Reform, said in a statement.

Most Doctors Provide Charity Care

Almost 6 in 10 physicians reported providing charity care—defined as either free or reduced-cost care—to patients in 2008, according to the 2008 Health Tracking Physician Survey from the Center for Studying Health System Change. On average, physicians who provided charity care reported 9.5 hours of such care in the month preceding the survey. That amounts to slightly more than 4% of their time spent in all medically related activities, according to the report. The survey also found that 44% of physicians reported receiving some form of performance-adjusted salary, such as an adjustment based on their own productivity. About one-quarter said they received a fixed salary, while 20% received a share of practice revenue. Productivity factors and overall practice financial performance were the most common financial incentives affecting physician compensation, according to the survey.

Doubts on Effectiveness Research

Although comparative effectiveness research may give doctors and patients better information about what treatments work best, it's not clear that it will result in better health or less spending, according to the Rand Corporation. Its study concluded that new incentives will be needed to change the behavior of patients and providers. However, federal law prohibits using the results of federally funded comparative effectiveness research to guide payment policies. So it will be hard to develop incentives for driving down health spending, the study said. In the near term, any reduction in spending created from such research would be offset by the costs associated with generating, coordinating, and disseminating the findings. “While increasing research aimed at determining the most effective treatments for a wide array of diseases should have benefits, there is not enough evidence at this point to predict exactly what the result might be for the cost of the nation's health care system,” Elizabeth McGlynn of Rand said in a statement.

Medical Home Reduced ED Use

A pilot patient-centered medical home program at Seattle's Group Health Cooperative resulted in significantly fewer emergency department visits and hospitalizations among medical home patients when compared with results from two clinics serving as a control group, according to a study. In addition, medical home patients reported higher satisfaction in most areas, and providers and staff members working within the medical home model reported much less professional burnout. Medical home patients used more e-mail, phone, and specialist visits, but at 12 months there were no significant differences in overall costs when compared to the control group. In addition, overall care of medical home patients improved slightly more than care in the control group when composite quality measures were compared. The study was published in the American Journal of Managed Care.

Contractors Get Good Marks

Physicians and other health care providers largely are satisfied with the performance of the Medicare fee-for-service contractors that process and pay the more than $300 billion in claims each year, according to an annual satisfaction survey. On a scale of 1 (low) to 6 (high), providers rated contractors at 4.54 in 2009, up very slightly from last year's average of 4.51, according to the Centers for Medicare and Medicaid Services. More than four of five providers scored contractors between 4 and 6, CMS said. The survey included more than 32,000 randomly selected providers, including physicians, suppliers, other health care practitioners, and facilities that serve Medicare beneficiaries.

OIG: Hospice Claims Fall Short

Most hospice claims for Medicare beneficiaries in nursing facilities did not meet at least one Medicare coverage requirement, according to a report from the Health and Human Services Department Office of Inspector General. Nearly two-thirds of claims did not meet plan of care requirements, while one-third failed to include hospice election statements or included inadequate election statements, the OIG report said. Meanwhile, hospices provided fewer services than outlined in plans of care in 31% of cases, and failed to meet terminal illness certification requirements in 4% of claims, the report said. The report recommended that CMS educate hospices about the coverage requirements, provide them with tools and guidance to help them meet those requirements, and strengthen hospice claim monitoring. According to CMS, Medicare hospice spending rose from $3.6 billion in 2001 to $9.2 billion in 2006.

Trial Lawyer Malpractice Ads Soar

Television commercials soliciting plaintiffs for medical malpractice lawsuits have soared 1,400% in the last 4 years, and spending by trial lawyers on those ads rose nearly as much—from $3.8 million in 2004 to $62 million last year, according to the U.S. Chamber of Commerce. This year, a total of 166,000 ads are expected to air, the report said. Media markets in New York, Boston, and Baltimore experienced the most activity in 2008, according to the report. “Lawsuits are ultimately a business driven by the plaintiffs' bar, and when you see the marketing of medical malpractice lawsuits exploding like this, it tells you that these lawsuits are a growing sector within the larger lawsuit industry,” Lisa Rickard, president of the U.S. Chamber Institute for Legal Reform, said in a statement.

Most Doctors Provide Charity Care

Almost 6 in 10 physicians reported providing charity care—defined as either free or reduced-cost care—to patients in 2008, according to the 2008 Health Tracking Physician Survey from the Center for Studying Health System Change. On average, physicians who provided charity care reported 9.5 hours of such care in the month preceding the survey. That amounts to slightly more than 4% of their time spent in all medically related activities, according to the report. The survey also found that 44% of physicians reported receiving some form of performance-adjusted salary, such as an adjustment based on their own productivity. About one-quarter said they received a fixed salary, while 20% received a share of practice revenue. Productivity factors and overall practice financial performance were the most common financial incentives affecting physician compensation, according to the survey.

Doubts on Effectiveness Research

Although comparative effectiveness research may give doctors and patients better information about what treatments work best, it's not clear that it will result in better health or less spending, according to the Rand Corporation. Its study concluded that new incentives will be needed to change the behavior of patients and providers. However, federal law prohibits using the results of federally funded comparative effectiveness research to guide payment policies. So it will be hard to develop incentives for driving down health spending, the study said. In the near term, any reduction in spending created from such research would be offset by the costs associated with generating, coordinating, and disseminating the findings. “While increasing research aimed at determining the most effective treatments for a wide array of diseases should have benefits, there is not enough evidence at this point to predict exactly what the result might be for the cost of the nation's health care system,” Elizabeth McGlynn of Rand said in a statement.

Medical Home Reduced ED Use

A pilot patient-centered medical home program at Seattle's Group Health Cooperative resulted in significantly fewer emergency department visits and hospitalizations among medical home patients when compared with results from two clinics serving as a control group, according to a study. In addition, medical home patients reported higher satisfaction in most areas, and providers and staff members working within the medical home model reported much less professional burnout. Medical home patients used more e-mail, phone, and specialist visits, but at 12 months there were no significant differences in overall costs when compared to the control group. In addition, overall care of medical home patients improved slightly more than care in the control group when composite quality measures were compared. The study was published in the American Journal of Managed Care.

Contractors Get Good Marks

Physicians and other health care providers largely are satisfied with the performance of the Medicare fee-for-service contractors that process and pay the more than $300 billion in claims each year, according to an annual satisfaction survey. On a scale of 1 (low) to 6 (high), 32,000 randomly selected providers rated contractors at 4.54 in 2009, up very slightly from last year's average of 4.51, according to the Centers for Medicare and Medicaid Services. More than four of five providers scored contractors between 4 and 6, the CMS said.

OIG: Hospice Claims Fall Short

Most hospice claims for Medicare beneficiaries in nursing facilities did not meet at least one Medicare coverage requirement, according to a report from the Health and Human Services Department Office of Inspector General. Nearly two-thirds of claims did not meet plan of care requirements, while one-third failed to include hospice election statements or included inadequate election statements, the OIG report said. Meanwhile, hospices provided fewer services than outlined in plans of care in 31% of cases, and failed to meet terminal illness certification requirements in 4% of claims, the report said. The report recommended that the CMS educate hospices about the coverage requirements, provide them with tools and guidance to help them meet those requirements, and strengthen hospice claim monitoring. Medicare hospice spending has risen from $3.6 billion in 2001 to $9.2 billion in 2006.

Trial Lawyer Malpractice Ads Soar

Television ads soliciting plaintiffs for medical malpractice lawsuits have soared 1,400% in the last 4 years, and trial lawyer spending on those ads rose nearly as much—from $3.8 million in 2004 to $62 million last year, according to the U.S. Chamber of Commerce. This year, a total of 166,000 ads are expected to air, the report said. Media markets in New York, Boston, and Baltimore saw the most activity in 2008, according to the report. “Lawsuits are ultimately a business driven by the plaintiffs' bar, and when you see the marketing of medical malpractice lawsuits exploding like this, it tells you that these lawsuits are a growing sector,” Lisa Rickard, president of the U.S. Chamber Institute for Legal Reform, said in a statement.

Most Doctors Provide Charity Care

Almost 6 in 10 physicians reported providing charity care—defined as either free or reduced-cost care—to patients in 2008, according to the 2008 Health Tracking Physician Survey from the Center for Studying Health System Change. On average, physicians who provided charity care reported 9.5 hours of such care in the month preceding the survey. That amounts to slightly more than 4% of their time spent in all medically related activities, according to the report. The survey also found that 44% of physicians reported receiving some form of performance-adjusted salary, such as an adjustment based on their own productivity. About one-quarter said they received a fixed salary, while 20% received a share of practice revenue.

Doubts on Effectiveness Research

Although comparative effectiveness research may give doctors and patients better information about what treatments work best, it's not clear that it will result in better health or less spending, according to the RAND Corp. Its study concluded that new incentives will be needed to change patient and provider behavior. However, because federal law prohibits using the results of federally funded comparative effectiveness research to guide payment policies, it will be hard to develop incentives for driving down health spending, the study said. In the near term, any reduction in spending created from such research would be offset by the costs associated with generating, coordinating, and disseminating the findings. “While increasing research aimed at determining the most effective treatments for a wide array of diseases should have benefits, there is not enough evidence at this point to predict exactly what the result might be for the cost of the nation's health care system,” Elizabeth McGlynn of RAND said in a statement.

Medical Home Reduced ED Use

A pilot patient-centered medical home program at Seattle's Group Health Cooperative resulted in significantly fewer emergency department visits and hospitalizations among medical home patients when compared with results from two clinics serving as controls, according to a study published in the American Journal of Managed Care. In addition, medical home patients reported higher satisfaction in most areas, and providers and staff members working within the medical home model reported much less professional burnout. Medical home patients had more e-mail, phone, and specialist visits, but at 12 months there were no significant differences in overall costs compared with controls. In addition, overall care of medical home patients improved slightly more than care in the controls on composite quality measures.

Contractors Get Good Marks

Physicians and other health care providers largely are satisfied with the performance of the Medicare fee-for-service contractors that process and pay the more than $300 billion in claims each year, according to an annual satisfaction survey. On a scale of 1 (low) to 6 (high), 32,000 randomly selected providers rated contractors at 4.54 in 2009, up very slightly from last year's average of 4.51, according to the Centers for Medicare and Medicaid Services. More than four of five providers scored contractors between 4 and 6, the CMS said.

OIG: Hospice Claims Fall Short

Most hospice claims for Medicare beneficiaries in nursing facilities did not meet at least one Medicare coverage requirement, according to a report from the Health and Human Services Department Office of Inspector General. Nearly two-thirds of claims did not meet plan of care requirements, while one-third failed to include hospice election statements or included inadequate election statements, the OIG report said. Meanwhile, hospices provided fewer services than outlined in plans of care in 31% of cases, and failed to meet terminal illness certification requirements in 4% of claims, the report said. The report recommended that the CMS educate hospices about the coverage requirements, provide them with tools and guidance to help them meet those requirements, and strengthen hospice claim monitoring. Medicare hospice spending has risen from $3.6 billion in 2001 to $9.2 billion in 2006.

Trial Lawyer Malpractice Ads Soar

Television ads soliciting plaintiffs for medical malpractice lawsuits have soared 1,400% in the last 4 years, and trial lawyer spending on those ads rose nearly as much—from $3.8 million in 2004 to $62 million last year, according to the U.S. Chamber of Commerce. This year, a total of 166,000 ads are expected to air, the report said. Media markets in New York, Boston, and Baltimore saw the most activity in 2008, according to the report. “Lawsuits are ultimately a business driven by the plaintiffs' bar, and when you see the marketing of medical malpractice lawsuits exploding like this, it tells you that these lawsuits are a growing sector,” Lisa Rickard, president of the U.S. Chamber Institute for Legal Reform, said in a statement.

Most Doctors Provide Charity Care

Almost 6 in 10 physicians reported providing charity care—defined as either free or reduced-cost care—to patients in 2008, according to the 2008 Health Tracking Physician Survey from the Center for Studying Health System Change. On average, physicians who provided charity care reported 9.5 hours of such care in the month preceding the survey. That amounts to slightly more than 4% of their time spent in all medically related activities, according to the report. The survey also found that 44% of physicians reported receiving some form of performance-adjusted salary, such as an adjustment based on their own productivity. About one-quarter said they received a fixed salary, while 20% received a share of practice revenue.

Doubts on Effectiveness Research

Although comparative effectiveness research may give doctors and patients better information about what treatments work best, it's not clear that it will result in better health or less spending, according to the RAND Corp. Its study concluded that new incentives will be needed to change patient and provider behavior. However, because federal law prohibits using the results of federally funded comparative effectiveness research to guide payment policies, it will be hard to develop incentives for driving down health spending, the study said. In the near term, any reduction in spending created from such research would be offset by the costs associated with generating, coordinating, and disseminating the findings. “While increasing research aimed at determining the most effective treatments for a wide array of diseases should have benefits, there is not enough evidence at this point to predict exactly what the result might be for the cost of the nation's health care system,” Elizabeth McGlynn of RAND said in a statement.

Medical Home Reduced ED Use

A pilot patient-centered medical home program at Seattle's Group Health Cooperative resulted in significantly fewer emergency department visits and hospitalizations among medical home patients when compared with results from two clinics serving as controls, according to a study published in the American Journal of Managed Care. In addition, medical home patients reported higher satisfaction in most areas, and providers and staff members working within the medical home model reported much less professional burnout. Medical home patients had more e-mail, phone, and specialist visits, but at 12 months there were no significant differences in overall costs compared with controls. In addition, overall care of medical home patients improved slightly more than care in the controls on composite quality measures.

Contractors Get Good Marks

Physicians and other health care providers largely are satisfied with the performance of the Medicare fee-for-service contractors that process and pay the more than $300 billion in claims each year, according to an annual satisfaction survey. On a scale of 1 (low) to 6 (high), 32,000 randomly selected providers rated contractors at 4.54 in 2009, up very slightly from last year's average of 4.51, according to the Centers for Medicare and Medicaid Services. More than four of five providers scored contractors between 4 and 6, the CMS said.

OIG: Hospice Claims Fall Short

Most hospice claims for Medicare beneficiaries in nursing facilities did not meet at least one Medicare coverage requirement, according to a report from the Health and Human Services Department Office of Inspector General. Nearly two-thirds of claims did not meet plan of care requirements, while one-third failed to include hospice election statements or included inadequate election statements, the OIG report said. Meanwhile, hospices provided fewer services than outlined in plans of care in 31% of cases, and failed to meet terminal illness certification requirements in 4% of claims, the report said. The report recommended that the CMS educate hospices about the coverage requirements, provide them with tools and guidance to help them meet those requirements, and strengthen hospice claim monitoring. Medicare hospice spending has risen from $3.6 billion in 2001 to $9.2 billion in 2006.

Trial Lawyer Malpractice Ads Soar

Television ads soliciting plaintiffs for medical malpractice lawsuits have soared 1,400% in the last 4 years, and trial lawyer spending on those ads rose nearly as much—from $3.8 million in 2004 to $62 million last year, according to the U.S. Chamber of Commerce. This year, a total of 166,000 ads are expected to air, the report said. Media markets in New York, Boston, and Baltimore saw the most activity in 2008, according to the report. “Lawsuits are ultimately a business driven by the plaintiffs' bar, and when you see the marketing of medical malpractice lawsuits exploding like this, it tells you that these lawsuits are a growing sector,” Lisa Rickard, president of the U.S. Chamber Institute for Legal Reform, said in a statement.

Most Doctors Provide Charity Care

Almost 6 in 10 physicians reported providing charity care—defined as either free or reduced-cost care—to patients in 2008, according to the 2008 Health Tracking Physician Survey from the Center for Studying Health System Change. On average, physicians who provided charity care reported 9.5 hours of such care in the month preceding the survey. That amounts to slightly more than 4% of their time spent in all medically related activities, according to the report. The survey also found that 44% of physicians reported receiving some form of performance-adjusted salary, such as an adjustment based on their own productivity. About one-quarter said they received a fixed salary, while 20% received a share of practice revenue.

Doubts on Effectiveness Research

Although comparative effectiveness research may give doctors and patients better information about what treatments work best, it's not clear that it will result in better health or less spending, according to the RAND Corp. Its study concluded that new incentives will be needed to change patient and provider behavior. However, because federal law prohibits using the results of federally funded comparative effectiveness research to guide payment policies, it will be hard to develop incentives for driving down health spending, the study said. In the near term, any reduction in spending created from such research would be offset by the costs associated with generating, coordinating, and disseminating the findings. “While increasing research aimed at determining the most effective treatments for a wide array of diseases should have benefits, there is not enough evidence at this point to predict exactly what the result might be for the cost of the nation's health care system,” Elizabeth McGlynn of RAND said in a statement.

Medical Home Reduced ED Use

A pilot patient-centered medical home program at Seattle's Group Health Cooperative resulted in significantly fewer emergency department visits and hospitalizations among medical home patients when compared with results from two clinics serving as controls, according to a study published in the American Journal of Managed Care. In addition, medical home patients reported higher satisfaction in most areas, and providers and staff members working within the medical home model reported much less professional burnout. Medical home patients had more e-mail, phone, and specialist visits, but at 12 months there were no significant differences in overall costs compared with controls. In addition, overall care of medical home patients improved slightly more than care in the controls on composite quality measures.

egmnblog.wordpress.com

Agency Calls for Fee Efficiency

Medicare should review and possibly reduce fees when physicians provide multiple services to individual patients on the same day, the Government Accountability Office recommended. To date, the Centers for Medicare and Medicaid Services hasn't done enough to “reduce excess physician payments” reflecting efficiencies that doctors achieve when delivering multiple services. The GAO said that the CMS has reduced payments for some imaging and surgical services furnished together, but even those don't reflect physician time saved. “For example, when two services are furnished together, a physician reviews a patient's medical records once, but the time for that activity is generally reflected in fees paid for both services,” according to the GAO's summary of its report. Expanding payment policies designed to reflect multiple-service efficiencies could save more than $500 million each year, the GAO said.

Tobacco Makers Challenge Law

Five tobacco manufacturers, along with a retailer, have filed suit to challenge the constitutionality of the new federal law that limits many forms of tobacco advertising. The plaintiffs chose the U.S. District Court for the Western District of Kentucky to argue that the law interferes with their First Amendment right to free speech. Lawmakers approved the Family Smoking Prevention and Tobacco Control Act last spring, setting new limits on tobacco promotion and giving the Food and Drug Administration authority to regulate tobacco products. The law prohibits most color and images in advertising, mandates larger warnings on tobacco products, and bans ad campaigns aimed at underage smokers.

Heart Group Scorns Sugar

The American Heart Association has recommended that Americans drastically cut their intake of sugar to ward off obesity and related conditions. Survey results from 2004 showed that the average American consumed about 22 teaspoons, or 355 extra calories, per day of sugar added to food during processing or preparation—mainly in sugar-sweetened drinks. But the AHA said that men should consume no more than 9 teaspoons, or 150 calories a day, of this added sugar, while women should limit themselves to 6 teaspoons, or 100 calories. One 12-ounce can of soda contains about 8 teaspoons of sugar. In a “scientific statement” published online in Circulation, the AHA noted that limited clinical trial data link sugar consumption with obesity, but observational studies associate a higher intake of soft drinks with higher body weight.

Medical Groups Post Losses

Many physician groups that are part of large, integrated provider organizations are operating at a loss, according to the American Medical Group Association's 2009 Medical Group Compensation and Financial Survey. But losses for the doctors' operations do not necessarily mean that the larger organizations are losing money overall, Tom Flatt, AMGA director of communications and publications, said in an interview. “These large, integrated systems actually have revenues coming in from other parts of the organization, so they can stay afloat,” he said. In 2008, only physician groups in the Eastern United States broke even, while losses elsewhere ranged from $120 per physician in the South to $3,254 per physician in the North. AMGA blamed declining reimbursement, competition for specialists, and the cost of new technology for the physician group losses.

Supplement Maker Fined $70 M

In a case brought by the Federal Trade Commission, a marketing group that used infomercials to tout calcium and herbal supplements as effective treatments for cancer, Parkinson's disease, heart disease, and autoimmune conditions has been ordered to pay about $70 million in consumer refunds. Last year, the U.S. District Court for the District of Massachusetts ruled that the companies and individuals involved in marketing the supplements had falsely represented their safety and efficacy. Judge George O'Toole considered potential financial penalties separately, and has now ordered the restitution in order to strip from the defendants all profits derived from the supplement sales. He also issued injunctions to prevent the defendants from making similar claims about other products.

Snapshot of Physician Patterns

Despite concerns about physicians' willingness to accept new patients from public programs, most U.S. doctors say they're doing so, according to a Center for Studying Health System Change survey. About three-quarters of physicians reported accepting new Medicare patients and more than half took new Medicaid patients. The public programs provided nearly half of physicians' practice revenue in 2008, according to the survey. Other findings from the snapshot of how physicians practice medicine: Nearly one-third work in solo or two-physician practices, and 15% are in groups of three to five physicians. The composition of the physician workforce by sex appears to be changing—while nearly three-quarters of U.S. physicians were men in 2008, about 41% of those under 40 years old were women.

egmnblog.wordpress.com

Agency Calls for Fee Efficiency

Medicare should review and possibly reduce fees when physicians provide multiple services to individual patients on the same day, the Government Accountability Office recommended. To date, the Centers for Medicare and Medicaid Services hasn't done enough to “reduce excess physician payments” reflecting efficiencies that doctors achieve when delivering multiple services. The GAO said that the CMS has reduced payments for some imaging and surgical services furnished together, but even those don't reflect physician time saved. “For example, when two services are furnished together, a physician reviews a patient's medical records once, but the time for that activity is generally reflected in fees paid for both services,” according to the GAO's summary of its report. Expanding payment policies designed to reflect multiple-service efficiencies could save more than $500 million each year, the GAO said.

Tobacco Makers Challenge Law

Five tobacco manufacturers, along with a retailer, have filed suit to challenge the constitutionality of the new federal law that limits many forms of tobacco advertising. The plaintiffs chose the U.S. District Court for the Western District of Kentucky to argue that the law interferes with their First Amendment right to free speech. Lawmakers approved the Family Smoking Prevention and Tobacco Control Act last spring, setting new limits on tobacco promotion and giving the Food and Drug Administration authority to regulate tobacco products. The law prohibits most color and images in advertising, mandates larger warnings on tobacco products, and bans ad campaigns aimed at underage smokers.

Heart Group Scorns Sugar

The American Heart Association has recommended that Americans drastically cut their intake of sugar to ward off obesity and related conditions. Survey results from 2004 showed that the average American consumed about 22 teaspoons, or 355 extra calories, per day of sugar added to food during processing or preparation—mainly in sugar-sweetened drinks. But the AHA said that men should consume no more than 9 teaspoons, or 150 calories a day, of this added sugar, while women should limit themselves to 6 teaspoons, or 100 calories. One 12-ounce can of soda contains about 8 teaspoons of sugar. In a “scientific statement” published online in Circulation, the AHA noted that limited clinical trial data link sugar consumption with obesity, but observational studies associate a higher intake of soft drinks with higher body weight.

Medical Groups Post Losses

Many physician groups that are part of large, integrated provider organizations are operating at a loss, according to the American Medical Group Association's 2009 Medical Group Compensation and Financial Survey. But losses for the doctors' operations do not necessarily mean that the larger organizations are losing money overall, Tom Flatt, AMGA director of communications and publications, said in an interview. “These large, integrated systems actually have revenues coming in from other parts of the organization, so they can stay afloat,” he said. In 2008, only physician groups in the Eastern United States broke even, while losses elsewhere ranged from $120 per physician in the South to $3,254 per physician in the North. AMGA blamed declining reimbursement, competition for specialists, and the cost of new technology for the physician group losses.

Supplement Maker Fined $70 M

In a case brought by the Federal Trade Commission, a marketing group that used infomercials to tout calcium and herbal supplements as effective treatments for cancer, Parkinson's disease, heart disease, and autoimmune conditions has been ordered to pay about $70 million in consumer refunds. Last year, the U.S. District Court for the District of Massachusetts ruled that the companies and individuals involved in marketing the supplements had falsely represented their safety and efficacy. Judge George O'Toole considered potential financial penalties separately, and has now ordered the restitution in order to strip from the defendants all profits derived from the supplement sales. He also issued injunctions to prevent the defendants from making similar claims about other products.

Snapshot of Physician Patterns

Despite concerns about physicians' willingness to accept new patients from public programs, most U.S. doctors say they're doing so, according to a Center for Studying Health System Change survey. About three-quarters of physicians reported accepting new Medicare patients and more than half took new Medicaid patients. The public programs provided nearly half of physicians' practice revenue in 2008, according to the survey. Other findings from the snapshot of how physicians practice medicine: Nearly one-third work in solo or two-physician practices, and 15% are in groups of three to five physicians. The composition of the physician workforce by sex appears to be changing—while nearly three-quarters of U.S. physicians were men in 2008, about 41% of those under 40 years old were women.

egmnblog.wordpress.com

Agency Calls for Fee Efficiency

Medicare should review and possibly reduce fees when physicians provide multiple services to individual patients on the same day, the Government Accountability Office recommended. To date, the Centers for Medicare and Medicaid Services hasn't done enough to “reduce excess physician payments” reflecting efficiencies that doctors achieve when delivering multiple services. The GAO said that the CMS has reduced payments for some imaging and surgical services furnished together, but even those don't reflect physician time saved. “For example, when two services are furnished together, a physician reviews a patient's medical records once, but the time for that activity is generally reflected in fees paid for both services,” according to the GAO's summary of its report. Expanding payment policies designed to reflect multiple-service efficiencies could save more than $500 million each year, the GAO said.

Tobacco Makers Challenge Law

Five tobacco manufacturers, along with a retailer, have filed suit to challenge the constitutionality of the new federal law that limits many forms of tobacco advertising. The plaintiffs chose the U.S. District Court for the Western District of Kentucky to argue that the law interferes with their First Amendment right to free speech. Lawmakers approved the Family Smoking Prevention and Tobacco Control Act last spring, setting new limits on tobacco promotion and giving the Food and Drug Administration authority to regulate tobacco products. The law prohibits most color and images in advertising, mandates larger warnings on tobacco products, and bans ad campaigns aimed at underage smokers.

Heart Group Scorns Sugar

The American Heart Association has recommended that Americans drastically cut their intake of sugar to ward off obesity and related conditions. Survey results from 2004 showed that the average American consumed about 22 teaspoons, or 355 extra calories, per day of sugar added to food during processing or preparation—mainly in sugar-sweetened drinks. But the AHA said that men should consume no more than 9 teaspoons, or 150 calories a day, of this added sugar, while women should limit themselves to 6 teaspoons, or 100 calories. One 12-ounce can of soda contains about 8 teaspoons of sugar. In a “scientific statement” published online in Circulation, the AHA noted that limited clinical trial data link sugar consumption with obesity, but observational studies associate a higher intake of soft drinks with higher body weight.

Medical Groups Post Losses

Many physician groups that are part of large, integrated provider organizations are operating at a loss, according to the American Medical Group Association's 2009 Medical Group Compensation and Financial Survey. But losses for the doctors' operations do not necessarily mean that the larger organizations are losing money overall, Tom Flatt, AMGA director of communications and publications, said in an interview. “These large, integrated systems actually have revenues coming in from other parts of the organization, so they can stay afloat,” he said. In 2008, only physician groups in the Eastern United States broke even, while losses elsewhere ranged from $120 per physician in the South to $3,254 per physician in the North. AMGA blamed declining reimbursement, competition for specialists, and the cost of new technology for the physician group losses.

Supplement Maker Fined $70 M

In a case brought by the Federal Trade Commission, a marketing group that used infomercials to tout calcium and herbal supplements as effective treatments for cancer, Parkinson's disease, heart disease, and autoimmune conditions has been ordered to pay about $70 million in consumer refunds. Last year, the U.S. District Court for the District of Massachusetts ruled that the companies and individuals involved in marketing the supplements had falsely represented their safety and efficacy. Judge George O'Toole considered potential financial penalties separately, and has now ordered the restitution in order to strip from the defendants all profits derived from the supplement sales. He also issued injunctions to prevent the defendants from making similar claims about other products.

Snapshot of Physician Patterns

Despite concerns about physicians' willingness to accept new patients from public programs, most U.S. doctors say they're doing so, according to a Center for Studying Health System Change survey. About three-quarters of physicians reported accepting new Medicare patients and more than half took new Medicaid patients. The public programs provided nearly half of physicians' practice revenue in 2008, according to the survey. Other findings from the snapshot of how physicians practice medicine: Nearly one-third work in solo or two-physician practices, and 15% are in groups of three to five physicians. The composition of the physician workforce by sex appears to be changing—while nearly three-quarters of U.S. physicians were men in 2008, about 41% of those under 40 years old were women.

Can't get enough Policy & Practice? Check out our new podcast each Monday. egmnblog.wordpress.com

Agency Calls for Fee Efficiency

Medicare should review and possibly reduce fees when physicians provide multiple services to individual patients on the same day, the Government Accountability Office recommended. To date, the Centers for Medicare and Medicaid Services hasn't done enough to “reduce excess physician payments” reflecting efficiencies that doctors achieve when delivering multiple services. “When two services are furnished together, a physician reviews a patient's medical records once, but the time for that activity is generally reflected in fees paid for both services,” according to the GAO. Adjusting payment policies to reflect multiple-service efficiencies could save more than $500 million a year, the GAO said.

Tobacco Makers Challenge Law

Five tobacco manufacturers, along with a retailer, have filed suit to challenge the constitutionality of the new federal law that limits many forms of tobacco advertising. The plaintiffs chose the U.S. District Court for the Western District of Kentucky to argue that the law interferes with their First Amendment right to free speech. Lawmakers approved the Family Smoking Prevention and Tobacco Control Act last spring, setting new limits on tobacco promotion and giving the Food and Drug Administration authority to regulate tobacco products. The law prohibits most color and images in advertising, mandates larger warnings on tobacco products, and bans ad campaigns aimed at underage smokers. The tobacco interests say the law hampers their ability to communicate with adult customers.

Heart Group Scorns Sugar

The American Heart Association has recommended that Americans drastically cut their intake of sugar to ward off obesity and related conditions. Survey results from 2004 showed that the average American consumed about 22 teaspoons, or 355 extra calories, per day of sugar added to food during processing—mainly in sugar-sweetened drinks. But the AHA said that men should consume no more than 9 teaspoons (150 calories) a day of this added sugar, while women should limit themselves to 6 teaspoons (100 calories). One 12-ounce can of soda contains about 8 teaspoons. In a “scientific statement” published in the Sept. 15 issue of Circulation, the AHA noted that limited clinical trial data link sugar consumption with obesity, but observational studies associate a higher intake of soft drinks with higher body weight and lower intake of nutrients.

Medical Groups Post Losses

Many physician groups that are part of large, integrated provider organizations are operating at a loss, according to the American Medical Group Association's 2009 Medical Group Compensation and Financial Survey. But losses for the doctors' operations do not necessarily mean that the larger organizations are losing money overall, Tom Flatt, AMGA director of communications and publications, said in an interview. “These large, integrated systems actually have revenues coming in from other parts of the organization, so they can stay afloat,” he said. In 2008, only physician groups in the Eastern United States broke even, while losses elsewhere ranged from $120 per physician in the South to $3,254 per physician in the North. AMGA blamed declining reimbursement, competition for specialists, and the cost of new technology.

Supplement Maker Fined $70 M

In a case brought by the Federal Trade Commission, a marketing group that used infomercials to tout calcium and herbal supplements as effective treatments for cancer, Parkinson's disease, heart disease, and autoimmune conditions has been ordered to pay about $70 million in consumer refunds. Last year, the U.S. District Court for the District of Massachusetts ruled that the companies and individuals involved in marketing the supplements had falsely represented their safety and efficacy. Judge George O'Toole considered potential financial penalties separately, and has now ordered the restitution in order to strip from the defendants all profits derived from the supplement sales. He also issued injunctions to prevent the defendants from making similar claims about other products.

Snapshot Shows Practice Patterns

Despite concerns about physicians' willingness to accept new patients from public programs, most U.S. doctors say they're doing so, according to a Center for Studying Health System Change survey. About three-quarters of physicians reported accepting new Medicare patients and more than half took new Medicaid patients. The public programs provided nearly half of physicians' practice revenue in 2008, according to the survey. Other findings from the snapshot of how physicians practice medicine: Nearly one-third work in solo or two-physician practices, and 15% are in groups of three to five physicians. The composition of the physician workforce by sex appears to be changing—while nearly three-quarters of U.S. physicians were men in 2008, about 41% of those under 40 years old were women. The center predicted that a gender shift in the profession will continue in coming decades.

Can't get enough Policy & Practice? Check out our new podcast each Monday. egmnblog.wordpress.com

Agency Calls for Fee Efficiency

Medicare should review and possibly reduce fees when physicians provide multiple services to individual patients on the same day, the Government Accountability Office recommended. To date, the Centers for Medicare and Medicaid Services hasn't done enough to “reduce excess physician payments” reflecting efficiencies that doctors achieve when delivering multiple services. “When two services are furnished together, a physician reviews a patient's medical records once, but the time for that activity is generally reflected in fees paid for both services,” according to the GAO. Adjusting payment policies to reflect multiple-service efficiencies could save more than $500 million a year, the GAO said.

Tobacco Makers Challenge Law

Five tobacco manufacturers, along with a retailer, have filed suit to challenge the constitutionality of the new federal law that limits many forms of tobacco advertising. The plaintiffs chose the U.S. District Court for the Western District of Kentucky to argue that the law interferes with their First Amendment right to free speech. Lawmakers approved the Family Smoking Prevention and Tobacco Control Act last spring, setting new limits on tobacco promotion and giving the Food and Drug Administration authority to regulate tobacco products. The law prohibits most color and images in advertising, mandates larger warnings on tobacco products, and bans ad campaigns aimed at underage smokers. The tobacco interests say the law hampers their ability to communicate with adult customers.

Heart Group Scorns Sugar

The American Heart Association has recommended that Americans drastically cut their intake of sugar to ward off obesity and related conditions. Survey results from 2004 showed that the average American consumed about 22 teaspoons, or 355 extra calories, per day of sugar added to food during processing—mainly in sugar-sweetened drinks. But the AHA said that men should consume no more than 9 teaspoons (150 calories) a day of this added sugar, while women should limit themselves to 6 teaspoons (100 calories). One 12-ounce can of soda contains about 8 teaspoons. In a “scientific statement” published in the Sept. 15 issue of Circulation, the AHA noted that limited clinical trial data link sugar consumption with obesity, but observational studies associate a higher intake of soft drinks with higher body weight and lower intake of nutrients.

Medical Groups Post Losses

Many physician groups that are part of large, integrated provider organizations are operating at a loss, according to the American Medical Group Association's 2009 Medical Group Compensation and Financial Survey. But losses for the doctors' operations do not necessarily mean that the larger organizations are losing money overall, Tom Flatt, AMGA director of communications and publications, said in an interview. “These large, integrated systems actually have revenues coming in from other parts of the organization, so they can stay afloat,” he said. In 2008, only physician groups in the Eastern United States broke even, while losses elsewhere ranged from $120 per physician in the South to $3,254 per physician in the North. AMGA blamed declining reimbursement, competition for specialists, and the cost of new technology.

Supplement Maker Fined $70 M

In a case brought by the Federal Trade Commission, a marketing group that used infomercials to tout calcium and herbal supplements as effective treatments for cancer, Parkinson's disease, heart disease, and autoimmune conditions has been ordered to pay about $70 million in consumer refunds. Last year, the U.S. District Court for the District of Massachusetts ruled that the companies and individuals involved in marketing the supplements had falsely represented their safety and efficacy. Judge George O'Toole considered potential financial penalties separately, and has now ordered the restitution in order to strip from the defendants all profits derived from the supplement sales. He also issued injunctions to prevent the defendants from making similar claims about other products.

Snapshot Shows Practice Patterns

Despite concerns about physicians' willingness to accept new patients from public programs, most U.S. doctors say they're doing so, according to a Center for Studying Health System Change survey. About three-quarters of physicians reported accepting new Medicare patients and more than half took new Medicaid patients. The public programs provided nearly half of physicians' practice revenue in 2008, according to the survey. Other findings from the snapshot of how physicians practice medicine: Nearly one-third work in solo or two-physician practices, and 15% are in groups of three to five physicians. The composition of the physician workforce by sex appears to be changing—while nearly three-quarters of U.S. physicians were men in 2008, about 41% of those under 40 years old were women. The center predicted that a gender shift in the profession will continue in coming decades.

Can't get enough Policy & Practice? Check out our new podcast each Monday. egmnblog.wordpress.com

Agency Calls for Fee Efficiency

Medicare should review and possibly reduce fees when physicians provide multiple services to individual patients on the same day, the Government Accountability Office recommended. To date, the Centers for Medicare and Medicaid Services hasn't done enough to “reduce excess physician payments” reflecting efficiencies that doctors achieve when delivering multiple services. “When two services are furnished together, a physician reviews a patient's medical records once, but the time for that activity is generally reflected in fees paid for both services,” according to the GAO. Adjusting payment policies to reflect multiple-service efficiencies could save more than $500 million a year, the GAO said.

Tobacco Makers Challenge Law

Five tobacco manufacturers, along with a retailer, have filed suit to challenge the constitutionality of the new federal law that limits many forms of tobacco advertising. The plaintiffs chose the U.S. District Court for the Western District of Kentucky to argue that the law interferes with their First Amendment right to free speech. Lawmakers approved the Family Smoking Prevention and Tobacco Control Act last spring, setting new limits on tobacco promotion and giving the Food and Drug Administration authority to regulate tobacco products. The law prohibits most color and images in advertising, mandates larger warnings on tobacco products, and bans ad campaigns aimed at underage smokers. The tobacco interests say the law hampers their ability to communicate with adult customers.

Heart Group Scorns Sugar

The American Heart Association has recommended that Americans drastically cut their intake of sugar to ward off obesity and related conditions. Survey results from 2004 showed that the average American consumed about 22 teaspoons, or 355 extra calories, per day of sugar added to food during processing—mainly in sugar-sweetened drinks. But the AHA said that men should consume no more than 9 teaspoons (150 calories) a day of this added sugar, while women should limit themselves to 6 teaspoons (100 calories). One 12-ounce can of soda contains about 8 teaspoons. In a “scientific statement” published in the Sept. 15 issue of Circulation, the AHA noted that limited clinical trial data link sugar consumption with obesity, but observational studies associate a higher intake of soft drinks with higher body weight and lower intake of nutrients.

Medical Groups Post Losses

Many physician groups that are part of large, integrated provider organizations are operating at a loss, according to the American Medical Group Association's 2009 Medical Group Compensation and Financial Survey. But losses for the doctors' operations do not necessarily mean that the larger organizations are losing money overall, Tom Flatt, AMGA director of communications and publications, said in an interview. “These large, integrated systems actually have revenues coming in from other parts of the organization, so they can stay afloat,” he said. In 2008, only physician groups in the Eastern United States broke even, while losses elsewhere ranged from $120 per physician in the South to $3,254 per physician in the North. AMGA blamed declining reimbursement, competition for specialists, and the cost of new technology.

Supplement Maker Fined $70 M

In a case brought by the Federal Trade Commission, a marketing group that used infomercials to tout calcium and herbal supplements as effective treatments for cancer, Parkinson's disease, heart disease, and autoimmune conditions has been ordered to pay about $70 million in consumer refunds. Last year, the U.S. District Court for the District of Massachusetts ruled that the companies and individuals involved in marketing the supplements had falsely represented their safety and efficacy. Judge George O'Toole considered potential financial penalties separately, and has now ordered the restitution in order to strip from the defendants all profits derived from the supplement sales. He also issued injunctions to prevent the defendants from making similar claims about other products.

Snapshot Shows Practice Patterns

Despite concerns about physicians' willingness to accept new patients from public programs, most U.S. doctors say they're doing so, according to a Center for Studying Health System Change survey. About three-quarters of physicians reported accepting new Medicare patients and more than half took new Medicaid patients. The public programs provided nearly half of physicians' practice revenue in 2008, according to the survey. Other findings from the snapshot of how physicians practice medicine: Nearly one-third work in solo or two-physician practices, and 15% are in groups of three to five physicians. The composition of the physician workforce by sex appears to be changing—while nearly three-quarters of U.S. physicians were men in 2008, about 41% of those under 40 years old were women. The center predicted that a gender shift in the profession will continue in coming decades.

More HIPAA Goes to Rights Office

The Health and Human Services' Office for Civil Rights will now enforce the confidentiality of electronic health information as well as other patient records, HHS Secretary Kathleen Sebelius announced. The office already had responsibility for enforcing the HIPAA's “privacy” rule, which guards nonelectronic personal health information. But enforcement of HIPAA's “security” rule for electronic health information had been delegated to the Centers for Medicare and Medicaid Services. Legislation approved as part of the Recovery Act of 2009 mandated better enforcement of both rules. Ms. Sebelius noted in a statement that electronic and nonelectronic health information increasingly overlaps. “Combining the enforcement authority [for both rules] in one agency within HHS will facilitate improvements by eliminating duplication and increasing efficiency,” she said. CMS will continue to have authority for the administration and enforcement of other HIPAA regulations.

HHS Issues Privacy Breach Rules

The federal government is requiring physicians and other HIPAA-covered entities to notify individuals when their protected health information has been breached. The interim final rule, issued in August, goes into effect this month. Under the rule, physicians have up to 60 calendar days from when they detect unauthorized access of protected health information to notify the patient. If the breach involves more than 500 individuals, the HHS secretary and a major media outlet in their area must be notified. “This new federal law ensures that covered entities and business associates are accountable to [HHS] and to individuals for proper safeguarding of the private information entrusted to their care,” said Robinsue Frohboese, acting director of the Office of Civil Rights at HHS. There are exceptions: Notifications are not necessary if the information that was disclosed is unlikely to be retained. For example, if a nurse gives a patient the wrong discharge papers but quickly takes them back, it's reasonable to assume that the patient could not have retained that protected information, according to HHS. More information about the regulation is available at

www.hhs.gov/ocr/privacy

Public Is Biggest ED Payer

More than 40% of the 120 million visits that Americans made to hospital emergency departments in 2006 were billed to Medicare and Medicaid, according to the Agency for Healthcare Research and Quality. In all, 34% of visits were billed to private insurance companies, 18% weren't covered at all, and the rest were billed to workers' compensation, Tricare, and other payers. However, uninsured people were 1.2 times as likely to visit the ED than were people with public or private insurance, AHRQ said. The uninsured also were the most likely to be treated and released. About 38% of the 24.2 million visits billed to Medicare ended with the patients being admitted, compared with 11% of the 41.5 million visits billed to private insurers, fewer than 10% of the 26 million visits billed to Medicaid, and 7% of the 21.2 million visits by the uninsured, the report found.

Obesity Medicine Exam to Come

Ten professional societies are jointly developing an Obesity Medicine Physician Certification Examination to credential physicians who care for obese adults and children. Last year, the group began assembling the body of knowledge that physicians need to be experts in obesity. The societies have now begun writing questions for the exam, which is scheduled to be completed by March 2010, according to the Obesity Society. The 10 groups are the Obesity Society, the American Academy of Pediatrics, the American Association of Clinical Endocrinologists, the American Diabetes Association, the American Gastroenterological Association, the American Heart Association, the American Society for Parenteral and Enteral Nutrition, the American Society for Metabolic and Bariatric Surgery, the American Society for Nutrition, and the Endocrine Society.

Bill Seeks Pay for Performance

A small bipartisan group of senators has cosponsored legislation that would pay a physician for work under part of Medicare only if a patient's health status improves. Sen. Ron Wyden (D-Ore.), Sen. John Cornyn (R-Tex.), and Sen. Tom Harkin (D-Iowa) offered the Take Back Your Health Act of 2009 (S. 1640) to create a new Medicare program based on “comprehensive lifestyle programs.” Such treatment plans would be designed by physicians specifically for each patient in the program. The plans can include nutritional therapy, exercise, medication management, care coordination, and tobacco-use cessation. Physicians wouldn't be paid if a patient were rehospitalized for a chronic illness accounted for in his or her plan. Sen. Wyden said in a statement that several trials of such a system, including those at Mutual of Omaha Insurance Co. and Highmark Blue Cross Blue Shield, have shown that comprehensive lifestyle programs can result in up to 50% reductions in medical costs.

More HIPAA Goes to Rights Office

The Health and Human Services' Office for Civil Rights will now enforce the confidentiality of electronic health information as well as other patient records, HHS Secretary Kathleen Sebelius announced. The office already had responsibility for enforcing the HIPAA's “privacy” rule, which guards nonelectronic personal health information. But enforcement of HIPAA's “security” rule for electronic health information had been delegated to the Centers for Medicare and Medicaid Services. Legislation approved as part of the Recovery Act of 2009 mandated better enforcement of both rules. Ms. Sebelius noted in a statement that electronic and nonelectronic health information increasingly overlaps. “Combining the enforcement authority [for both rules] in one agency within HHS will facilitate improvements by eliminating duplication and increasing efficiency,” she said. CMS will continue to have authority for the administration and enforcement of other HIPAA regulations.

HHS Issues Privacy Breach Rules

The federal government is requiring physicians and other HIPAA-covered entities to notify individuals when their protected health information has been breached. The interim final rule, issued in August, goes into effect this month. Under the rule, physicians have up to 60 calendar days from when they detect unauthorized access of protected health information to notify the patient. If the breach involves more than 500 individuals, the HHS secretary and a major media outlet in their area must be notified. “This new federal law ensures that covered entities and business associates are accountable to [HHS] and to individuals for proper safeguarding of the private information entrusted to their care,” said Robinsue Frohboese, acting director of the Office of Civil Rights at HHS. There are exceptions: Notifications are not necessary if the information that was disclosed is unlikely to be retained. For example, if a nurse gives a patient the wrong discharge papers but quickly takes them back, it's reasonable to assume that the patient could not have retained that protected information, according to HHS. More information about the regulation is available at

www.hhs.gov/ocr/privacy

Public Is Biggest ED Payer

More than 40% of the 120 million visits that Americans made to hospital emergency departments in 2006 were billed to Medicare and Medicaid, according to the Agency for Healthcare Research and Quality. In all, 34% of visits were billed to private insurance companies, 18% weren't covered at all, and the rest were billed to workers' compensation, Tricare, and other payers. However, uninsured people were 1.2 times as likely to visit the ED than were people with public or private insurance, AHRQ said. The uninsured also were the most likely to be treated and released. About 38% of the 24.2 million visits billed to Medicare ended with the patients being admitted, compared with 11% of the 41.5 million visits billed to private insurers, fewer than 10% of the 26 million visits billed to Medicaid, and 7% of the 21.2 million visits by the uninsured, the report found.

Obesity Medicine Exam to Come

Ten professional societies are jointly developing an Obesity Medicine Physician Certification Examination to credential physicians who care for obese adults and children. Last year, the group began assembling the body of knowledge that physicians need to be experts in obesity. The societies have now begun writing questions for the exam, which is scheduled to be completed by March 2010, according to the Obesity Society. The 10 groups are the Obesity Society, the American Academy of Pediatrics, the American Association of Clinical Endocrinologists, the American Diabetes Association, the American Gastroenterological Association, the American Heart Association, the American Society for Parenteral and Enteral Nutrition, the American Society for Metabolic and Bariatric Surgery, the American Society for Nutrition, and the Endocrine Society.

Bill Seeks Pay for Performance

A small bipartisan group of senators has cosponsored legislation that would pay a physician for work under part of Medicare only if a patient's health status improves. Sen. Ron Wyden (D-Ore.), Sen. John Cornyn (R-Tex.), and Sen. Tom Harkin (D-Iowa) offered the Take Back Your Health Act of 2009 (S. 1640) to create a new Medicare program based on “comprehensive lifestyle programs.” Such treatment plans would be designed by physicians specifically for each patient in the program. The plans can include nutritional therapy, exercise, medication management, care coordination, and tobacco-use cessation. Physicians wouldn't be paid if a patient were rehospitalized for a chronic illness accounted for in his or her plan. Sen. Wyden said in a statement that several trials of such a system, including those at Mutual of Omaha Insurance Co. and Highmark Blue Cross Blue Shield, have shown that comprehensive lifestyle programs can result in up to 50% reductions in medical costs.

More HIPAA Goes to Rights Office

The Health and Human Services' Office for Civil Rights will now enforce the confidentiality of electronic health information as well as other patient records, HHS Secretary Kathleen Sebelius announced. The office already had responsibility for enforcing the HIPAA's “privacy” rule, which guards nonelectronic personal health information. But enforcement of HIPAA's “security” rule for electronic health information had been delegated to the Centers for Medicare and Medicaid Services. Legislation approved as part of the Recovery Act of 2009 mandated better enforcement of both rules. Ms. Sebelius noted in a statement that electronic and nonelectronic health information increasingly overlaps. “Combining the enforcement authority [for both rules] in one agency within HHS will facilitate improvements by eliminating duplication and increasing efficiency,” she said. CMS will continue to have authority for the administration and enforcement of other HIPAA regulations.

HHS Issues Privacy Breach Rules

The federal government is requiring physicians and other HIPAA-covered entities to notify individuals when their protected health information has been breached. The interim final rule, issued in August, goes into effect this month. Under the rule, physicians have up to 60 calendar days from when they detect unauthorized access of protected health information to notify the patient. If the breach involves more than 500 individuals, the HHS secretary and a major media outlet in their area must be notified. “This new federal law ensures that covered entities and business associates are accountable to [HHS] and to individuals for proper safeguarding of the private information entrusted to their care,” said Robinsue Frohboese, acting director of the Office of Civil Rights at HHS. There are exceptions: Notifications are not necessary if the information that was disclosed is unlikely to be retained. For example, if a nurse gives a patient the wrong discharge papers but quickly takes them back, it's reasonable to assume that the patient could not have retained that protected information, according to HHS. More information about the regulation is available at

www.hhs.gov/ocr/privacy

Public Is Biggest ED Payer

More than 40% of the 120 million visits that Americans made to hospital emergency departments in 2006 were billed to Medicare and Medicaid, according to the Agency for Healthcare Research and Quality. In all, 34% of visits were billed to private insurance companies, 18% weren't covered at all, and the rest were billed to workers' compensation, Tricare, and other payers. However, uninsured people were 1.2 times as likely to visit the ED than were people with public or private insurance, AHRQ said. The uninsured also were the most likely to be treated and released. About 38% of the 24.2 million visits billed to Medicare ended with the patients being admitted, compared with 11% of the 41.5 million visits billed to private insurers, fewer than 10% of the 26 million visits billed to Medicaid, and 7% of the 21.2 million visits by the uninsured, the report found.

Obesity Medicine Exam to Come

Ten professional societies are jointly developing an Obesity Medicine Physician Certification Examination to credential physicians who care for obese adults and children. Last year, the group began assembling the body of knowledge that physicians need to be experts in obesity. The societies have now begun writing questions for the exam, which is scheduled to be completed by March 2010, according to the Obesity Society. The 10 groups are the Obesity Society, the American Academy of Pediatrics, the American Association of Clinical Endocrinologists, the American Diabetes Association, the American Gastroenterological Association, the American Heart Association, the American Society for Parenteral and Enteral Nutrition, the American Society for Metabolic and Bariatric Surgery, the American Society for Nutrition, and the Endocrine Society.

Bill Seeks Pay for Performance

A small bipartisan group of senators has cosponsored legislation that would pay a physician for work under part of Medicare only if a patient's health status improves. Sen. Ron Wyden (D-Ore.), Sen. John Cornyn (R-Tex.), and Sen. Tom Harkin (D-Iowa) offered the Take Back Your Health Act of 2009 (S. 1640) to create a new Medicare program based on “comprehensive lifestyle programs.” Such treatment plans would be designed by physicians specifically for each patient in the program. The plans can include nutritional therapy, exercise, medication management, care coordination, and tobacco-use cessation. Physicians wouldn't be paid if a patient were rehospitalized for a chronic illness accounted for in his or her plan. Sen. Wyden said in a statement that several trials of such a system, including those at Mutual of Omaha Insurance Co. and Highmark Blue Cross Blue Shield, have shown that comprehensive lifestyle programs can result in up to 50% reductions in medical costs.

HHS Issues Privacy-Breach Rules

The federal government is requiring physicians and other HIPAA-covered entities to notify individuals when their protected health information has been breached. The interim final rule, issued in August, goes into effect this month. Under the rule, physicians have up to 60 calendar days from when they detect unauthorized access of protected health information to notify the patient. If the breach involves more than 500 individuals, the HHS secretary and a major media outlet in their area must be notified. “This new federal law ensures that covered entities and business associates are accountable to [HHS] and to individuals for proper safeguarding of the private information entrusted to their care,” said Robinsue Frohboese, acting director of the Office of Civil Rights at HHS. “These protections will be a cornerstone of maintaining consumer trust as we move forward with meaningful use of electronic health records and electronic exchange of health information.” There are exceptions: Notifications are not necessary if the information that was disclosed is unlikely to be retained. For example, if a nurse gives a patient the wrong discharge papers but quickly takes them back, it's reasonable to assume that the patient could not have retained that protected information, according to HHS. More information about the regulation is available at

www.hhs.gov/ocr/privacy

More HIPAA Goes to Rights Office

The Health and Human Services' Office for Civil Rights will now enforce the confidentiality of electronic health information as well as other patient records, HHS Secretary Kathleen Sebelius announced. The office already had responsibility for enforcing the HIPAA's “privacy” rule, which guards nonelectronic personal health information. But enforcement of HIPAA's “security” rule for electronic health information had been delegated to the Centers for Medicare and Medicaid Services. Legislation approved as part of the Recovery Act of 2009 mandated better enforcement of both rules. Ms. Sebelius noted in a statement that electronic and nonelectronic health information increasingly overlaps. “Combining the enforcement authority [for both rules] in one agency within HHS will facilitate improvements by eliminating duplication and increasing efficiency,” she said. The CMS will continue to have authority for the administration and enforcement of other HIPAA regulations.

Public Is Biggest ED Payer

More than 40% of the 120 million visits that Americans made to hospital emergency departments in 2006 were billed to Medicare and Medicaid, according to the Agency for Healthcare Research and Quality. In all, 34% of visits were billed to private insurance companies, 18% weren't covered at all, and the rest were billed to workers' compensation, Tricare, and other payers. However, uninsured people were 1.2 times as likely to visit the ED than were people with public or private insurance, the AHRQ said. The uninsured also were the most likely to be treated and released. About 38% of the 24.2 million visits billed to Medicare ended with the patients being admitted, compared with 11% of the 41.5 million visits billed to private insurers, fewer than 10% of the 26 million visits billed to Medicaid, and 7% of the 21.2 million visits by the uninsured, the report found.

Obesity Medicine Exam to Come

Ten professional societies are jointly developing an Obesity Medicine Physician Certification Examination to credential physicians who care for obese adults and children. Last year, the group began assembling the body of knowledge that physicians need to be experts in obesity. The societies have now begun writing questions for the exam, which is scheduled to be completed by March 2010, according to the Obesity Society. Among the 10 groups are the Obesity Society, the American Association of Clinical Endocrinologists, the American Diabetes Association, the American Gastroenterological Association, the American Heart Association, the American Society for Metabolic and Bariatric Surgery, the American Society for Nutrition, and the Endocrine Society.

Bill Seeks Pay for Performance

A small bipartisan group of senators has cosponsored legislation that would pay a physician for work under part of Medicare only if a patient's health status improves. Sen. Ron Wyden (D-Ore.), Sen. John Cornyn (R-Tex.), and Sen. Tom Harkin (D-Iowa) offered the Take Back Your Health Act of 2009 (S. 1640) to create a new Medicare program based on “comprehensive lifestyle programs.” Such treatment plans would be designed by physicians specifically for each patient in the program. The plans can include nutritional therapy, exercise, medication management, care coordination, and tobacco-use cessation. Physicians wouldn't be paid if a patient were rehospitalized for a chronic illness accounted for in his or her plan. Sen. Wyden said in a statement that several trials of such a system, including those at Mutual of Omaha Insurance Co. and Highmark Blue Cross Blue Shield, have shown that comprehensive lifestyle programs can result in up to 50% reductions in medical costs.

HHS Issues Privacy-Breach Rules

The federal government is requiring physicians and other HIPAA-covered entities to notify individuals when their protected health information has been breached. The interim final rule, issued in August, goes into effect this month. Under the rule, physicians have up to 60 calendar days from when they detect unauthorized access of protected health information to notify the patient. If the breach involves more than 500 individuals, the HHS secretary and a major media outlet in their area must be notified. “This new federal law ensures that covered entities and business associates are accountable to [HHS] and to individuals for proper safeguarding of the private information entrusted to their care,” said Robinsue Frohboese, acting director of the Office of Civil Rights at HHS. “These protections will be a cornerstone of maintaining consumer trust as we move forward with meaningful use of electronic health records and electronic exchange of health information.” There are exceptions: Notifications are not necessary if the information that was disclosed is unlikely to be retained. For example, if a nurse gives a patient the wrong discharge papers but quickly takes them back, it's reasonable to assume that the patient could not have retained that protected information, according to HHS. More information about the regulation is available at

www.hhs.gov/ocr/privacy

More HIPAA Goes to Rights Office

The Health and Human Services' Office for Civil Rights will now enforce the confidentiality of electronic health information as well as other patient records, HHS Secretary Kathleen Sebelius announced. The office already had responsibility for enforcing the HIPAA's “privacy” rule, which guards nonelectronic personal health information. But enforcement of HIPAA's “security” rule for electronic health information had been delegated to the Centers for Medicare and Medicaid Services. Legislation approved as part of the Recovery Act of 2009 mandated better enforcement of both rules. Ms. Sebelius noted in a statement that electronic and nonelectronic health information increasingly overlaps. “Combining the enforcement authority [for both rules] in one agency within HHS will facilitate improvements by eliminating duplication and increasing efficiency,” she said. The CMS will continue to have authority for the administration and enforcement of other HIPAA regulations.

Public Is Biggest ED Payer

More than 40% of the 120 million visits that Americans made to hospital emergency departments in 2006 were billed to Medicare and Medicaid, according to the Agency for Healthcare Research and Quality. In all, 34% of visits were billed to private insurance companies, 18% weren't covered at all, and the rest were billed to workers' compensation, Tricare, and other payers. However, uninsured people were 1.2 times as likely to visit the ED than were people with public or private insurance, the AHRQ said. The uninsured also were the most likely to be treated and released. About 38% of the 24.2 million visits billed to Medicare ended with the patients being admitted, compared with 11% of the 41.5 million visits billed to private insurers, fewer than 10% of the 26 million visits billed to Medicaid, and 7% of the 21.2 million visits by the uninsured, the report found.

Obesity Medicine Exam to Come

Ten professional societies are jointly developing an Obesity Medicine Physician Certification Examination to credential physicians who care for obese adults and children. Last year, the group began assembling the body of knowledge that physicians need to be experts in obesity. The societies have now begun writing questions for the exam, which is scheduled to be completed by March 2010, according to the Obesity Society. Among the 10 groups are the Obesity Society, the American Association of Clinical Endocrinologists, the American Diabetes Association, the American Gastroenterological Association, the American Heart Association, the American Society for Metabolic and Bariatric Surgery, the American Society for Nutrition, and the Endocrine Society.

Bill Seeks Pay for Performance

A small bipartisan group of senators has cosponsored legislation that would pay a physician for work under part of Medicare only if a patient's health status improves. Sen. Ron Wyden (D-Ore.), Sen. John Cornyn (R-Tex.), and Sen. Tom Harkin (D-Iowa) offered the Take Back Your Health Act of 2009 (S. 1640) to create a new Medicare program based on “comprehensive lifestyle programs.” Such treatment plans would be designed by physicians specifically for each patient in the program. The plans can include nutritional therapy, exercise, medication management, care coordination, and tobacco-use cessation. Physicians wouldn't be paid if a patient were rehospitalized for a chronic illness accounted for in his or her plan. Sen. Wyden said in a statement that several trials of such a system, including those at Mutual of Omaha Insurance Co. and Highmark Blue Cross Blue Shield, have shown that comprehensive lifestyle programs can result in up to 50% reductions in medical costs.

HHS Issues Privacy-Breach Rules

The federal government is requiring physicians and other HIPAA-covered entities to notify individuals when their protected health information has been breached. The interim final rule, issued in August, goes into effect this month. Under the rule, physicians have up to 60 calendar days from when they detect unauthorized access of protected health information to notify the patient. If the breach involves more than 500 individuals, the HHS secretary and a major media outlet in their area must be notified. “This new federal law ensures that covered entities and business associates are accountable to [HHS] and to individuals for proper safeguarding of the private information entrusted to their care,” said Robinsue Frohboese, acting director of the Office of Civil Rights at HHS. “These protections will be a cornerstone of maintaining consumer trust as we move forward with meaningful use of electronic health records and electronic exchange of health information.” There are exceptions: Notifications are not necessary if the information that was disclosed is unlikely to be retained. For example, if a nurse gives a patient the wrong discharge papers but quickly takes them back, it's reasonable to assume that the patient could not have retained that protected information, according to HHS. More information about the regulation is available at

www.hhs.gov/ocr/privacy

More HIPAA Goes to Rights Office

The Health and Human Services' Office for Civil Rights will now enforce the confidentiality of electronic health information as well as other patient records, HHS Secretary Kathleen Sebelius announced. The office already had responsibility for enforcing the HIPAA's “privacy” rule, which guards nonelectronic personal health information. But enforcement of HIPAA's “security” rule for electronic health information had been delegated to the Centers for Medicare and Medicaid Services. Legislation approved as part of the Recovery Act of 2009 mandated better enforcement of both rules. Ms. Sebelius noted in a statement that electronic and nonelectronic health information increasingly overlaps. “Combining the enforcement authority [for both rules] in one agency within HHS will facilitate improvements by eliminating duplication and increasing efficiency,” she said. The CMS will continue to have authority for the administration and enforcement of other HIPAA regulations.

Public Is Biggest ED Payer

More than 40% of the 120 million visits that Americans made to hospital emergency departments in 2006 were billed to Medicare and Medicaid, according to the Agency for Healthcare Research and Quality. In all, 34% of visits were billed to private insurance companies, 18% weren't covered at all, and the rest were billed to workers' compensation, Tricare, and other payers. However, uninsured people were 1.2 times as likely to visit the ED than were people with public or private insurance, the AHRQ said. The uninsured also were the most likely to be treated and released. About 38% of the 24.2 million visits billed to Medicare ended with the patients being admitted, compared with 11% of the 41.5 million visits billed to private insurers, fewer than 10% of the 26 million visits billed to Medicaid, and 7% of the 21.2 million visits by the uninsured, the report found.

Obesity Medicine Exam to Come

Ten professional societies are jointly developing an Obesity Medicine Physician Certification Examination to credential physicians who care for obese adults and children. Last year, the group began assembling the body of knowledge that physicians need to be experts in obesity. The societies have now begun writing questions for the exam, which is scheduled to be completed by March 2010, according to the Obesity Society. Among the 10 groups are the Obesity Society, the American Association of Clinical Endocrinologists, the American Diabetes Association, the American Gastroenterological Association, the American Heart Association, the American Society for Metabolic and Bariatric Surgery, the American Society for Nutrition, and the Endocrine Society.

Bill Seeks Pay for Performance

A small bipartisan group of senators has cosponsored legislation that would pay a physician for work under part of Medicare only if a patient's health status improves. Sen. Ron Wyden (D-Ore.), Sen. John Cornyn (R-Tex.), and Sen. Tom Harkin (D-Iowa) offered the Take Back Your Health Act of 2009 (S. 1640) to create a new Medicare program based on “comprehensive lifestyle programs.” Such treatment plans would be designed by physicians specifically for each patient in the program. The plans can include nutritional therapy, exercise, medication management, care coordination, and tobacco-use cessation. Physicians wouldn't be paid if a patient were rehospitalized for a chronic illness accounted for in his or her plan. Sen. Wyden said in a statement that several trials of such a system, including those at Mutual of Omaha Insurance Co. and Highmark Blue Cross Blue Shield, have shown that comprehensive lifestyle programs can result in up to 50% reductions in medical costs.

Barriers to Care in New Orleans

Four years after Hurricane Katrina, children in New Orleans are still at risk for mental health problems and yet continue encountering barriers to care, according to a report by the Government Accountability Office. The GAO estimated that 187,000 children were living in the four parishes that make up the metro area, and that a “substantial number of these children may need referrals for mental health services.” Lack of providers and lack of funding continuity were cited as barriers to providing services, along with transportation problems, competing family priorities, and concerns about stigma. Federal grants have helped, but aren't enough, the report said. Sen. Joseph Lieberman (I-Conn.) and Sen. Mary Landrieu (D-La.) requested the study.

Obesity Concern Is Rising

Public concern about childhood obesity in the United States, already high, continues to increase, according to a poll conducted by the University of Michigan C.S. Mott Children's Hospital. The National Poll on Children's Health found that the proportion of adults who believe childhood obesity is a big problem has increased from 35% in 2008 to 42% in 2009. Blacks and Hispanics now rate childhood obesity as their biggest childhood health concern. Before, blacks' chief concern for children was teen pregnancy and Hispanics' was smoking, according to the study. Drug abuse was ranked second overall in the poll: 36% of adults rated drug abuse as a big problem for children. Smoking, which had been ranked No. 1 in 2007, now holds the No. 3 position, with 32% of adults saying it's a big problem. Bullying, Internet safety, and child abuse and neglect rounded out the top six concerns.

Lunch Eats Up School Budgets

Most school food-service directors say that rising expenses and limited funding are the most pressing issues facing school cafeteria programs nationwide, according to a poll from the School Nutrition Association. Nearly 60% of districts increased school lunch prices this year to keep up with the costs, the survey found. The median increase, 25 cents, was significantly larger than the 15-cent median increase reported in 2007, the last time the survey was conducted. Also, at every grade level, more children were participating in free and reduced-price meal programs. On the plus side, school nutrition programs increasingly are offering healthy options, with peak gains seen in vegetarian offerings and low-fat prepared and packaged foods. In addition, locally grown fruits and vegetables were available on more than one-third of school menus, and an additional 21% of districts were considering such offerings.

Hyponatremia Danger in Children

Spurred by the deaths of two children from hyponatremia after surgery, the Institute for Safe Medication Practices has warned health care practitioners to become better educated about the causes, signs, and symptoms of the condition. The institute cautioned that postoperative children are at high risk for developing hyponatremia, which is the most common electrolyte disorder among hospitalized patients. It can be caused by administration of intravenous fluids containing too little sodium and, if untreated, can result in severe brain swelling and death. The institute said that one of the children who died had undergone an outpatient tonsillectomy, while the other had had vascular surgery. The organization recommended that standards of practice be established for intravenous hydration of patients, particularly children. Protocols should establish how to identify and treat patients with hyponatremia and related conditions, and all physicians, nurses, and pharmacists should gain a thorough understanding of the condition in children, the group said.

Youth Tobacco Sales Drop More

Sales of tobacco to children have reached historic lows, the Substance Abuse and Mental Health Services Administration said. SAMHSA credited the Synar Amendment program, which requires states to prohibit the sale and distribution of tobacco to people under age 18. All 50 states and the District of Columbia have, for the third year running, achieved better than 80% compliance among tobacco product retailers, SAMHSA said. “Continued state vigilance will build on our track record of success in protecting children from the public health menace of tobacco,” said SAMHSA acting administrator Eric Broderick, D.D.S., in a statement.

Congress Weighs 'Safe Babies Act'

A bipartisan group led by Sen. Tom Harkin (D-Iowa) has introduced legislation known as the Safe Babies Act of 2009 in the Senate (S. 1554) that would create local court teams to protect maltreated children, screen them for developmental and health issues, and counsel parents. Rep. Rosa L. DeLauro (D-Conn.) introduced a companion bill in the House (H.R. 3474). The teams would be led by a judge with jurisdiction over children in foster care and would include pediatricians and other child welfare professionals. These groups would review cases monthly and guide medical, developmental, mental health, and substance abuse interventions for maltreated children and their families. Five cosponsors joined Sen. Harkin in the Senate, and three joined Rep. DeLauro in the House.

Barriers to Care in New Orleans

Four years after Hurricane Katrina, children in New Orleans are still at risk for mental health problems and yet continue encountering barriers to care, according to a report by the Government Accountability Office. The GAO estimated that 187,000 children were living in the four parishes that make up the metro area, and that a “substantial number of these children may need referrals for mental health services.” Lack of providers and lack of funding continuity were cited as barriers to providing services, along with transportation problems, competing family priorities, and concerns about stigma. Federal grants have helped, but aren't enough, the report said. Sen. Joseph Lieberman (I-Conn.) and Sen. Mary Landrieu (D-La.) requested the study.

Obesity Concern Is Rising

Public concern about childhood obesity in the United States, already high, continues to increase, according to a poll conducted by the University of Michigan C.S. Mott Children's Hospital. The National Poll on Children's Health found that the proportion of adults who believe childhood obesity is a big problem has increased from 35% in 2008 to 42% in 2009. Blacks and Hispanics now rate childhood obesity as their biggest childhood health concern. Before, blacks' chief concern for children was teen pregnancy and Hispanics' was smoking, according to the study. Drug abuse was ranked second overall in the poll: 36% of adults rated drug abuse as a big problem for children. Smoking, which had been ranked No. 1 in 2007, now holds the No. 3 position, with 32% of adults saying it's a big problem. Bullying, Internet safety, and child abuse and neglect rounded out the top six concerns.

Lunch Eats Up School Budgets

Most school food-service directors say that rising expenses and limited funding are the most pressing issues facing school cafeteria programs nationwide, according to a poll from the School Nutrition Association. Nearly 60% of districts increased school lunch prices this year to keep up with the costs, the survey found. The median increase, 25 cents, was significantly larger than the 15-cent median increase reported in 2007, the last time the survey was conducted. Also, at every grade level, more children were participating in free and reduced-price meal programs. On the plus side, school nutrition programs increasingly are offering healthy options, with peak gains seen in vegetarian offerings and low-fat prepared and packaged foods. In addition, locally grown fruits and vegetables were available on more than one-third of school menus, and an additional 21% of districts were considering such offerings.

Hyponatremia Danger in Children

Spurred by the deaths of two children from hyponatremia after surgery, the Institute for Safe Medication Practices has warned health care practitioners to become better educated about the causes, signs, and symptoms of the condition. The institute cautioned that postoperative children are at high risk for developing hyponatremia, which is the most common electrolyte disorder among hospitalized patients. It can be caused by administration of intravenous fluids containing too little sodium and, if untreated, can result in severe brain swelling and death. The institute said that one of the children who died had undergone an outpatient tonsillectomy, while the other had had vascular surgery. The organization recommended that standards of practice be established for intravenous hydration of patients, particularly children. Protocols should establish how to identify and treat patients with hyponatremia and related conditions, and all physicians, nurses, and pharmacists should gain a thorough understanding of the condition in children, the group said.

Youth Tobacco Sales Drop More

Sales of tobacco to children have reached historic lows, the Substance Abuse and Mental Health Services Administration said. SAMHSA credited the Synar Amendment program, which requires states to prohibit the sale and distribution of tobacco to people under age 18. All 50 states and the District of Columbia have, for the third year running, achieved better than 80% compliance among tobacco product retailers, SAMHSA said. “Continued state vigilance will build on our track record of success in protecting children from the public health menace of tobacco,” said SAMHSA acting administrator Eric Broderick, D.D.S., in a statement.

Congress Weighs 'Safe Babies Act'

A bipartisan group led by Sen. Tom Harkin (D-Iowa) has introduced legislation known as the Safe Babies Act of 2009 in the Senate (S. 1554) that would create local court teams to protect maltreated children, screen them for developmental and health issues, and counsel parents. Rep. Rosa L. DeLauro (D-Conn.) introduced a companion bill in the House (H.R. 3474). The teams would be led by a judge with jurisdiction over children in foster care and would include pediatricians and other child welfare professionals. These groups would review cases monthly and guide medical, developmental, mental health, and substance abuse interventions for maltreated children and their families. Five cosponsors joined Sen. Harkin in the Senate, and three joined Rep. DeLauro in the House.

Barriers to Care in New Orleans

Four years after Hurricane Katrina, children in New Orleans are still at risk for mental health problems and yet continue encountering barriers to care, according to a report by the Government Accountability Office. The GAO estimated that 187,000 children were living in the four parishes that make up the metro area, and that a “substantial number of these children may need referrals for mental health services.” Lack of providers and lack of funding continuity were cited as barriers to providing services, along with transportation problems, competing family priorities, and concerns about stigma. Federal grants have helped, but aren't enough, the report said. Sen. Joseph Lieberman (I-Conn.) and Sen. Mary Landrieu (D-La.) requested the study.

Obesity Concern Is Rising

Public concern about childhood obesity in the United States, already high, continues to increase, according to a poll conducted by the University of Michigan C.S. Mott Children's Hospital. The National Poll on Children's Health found that the proportion of adults who believe childhood obesity is a big problem has increased from 35% in 2008 to 42% in 2009. Blacks and Hispanics now rate childhood obesity as their biggest childhood health concern. Before, blacks' chief concern for children was teen pregnancy and Hispanics' was smoking, according to the study. Drug abuse was ranked second overall in the poll: 36% of adults rated drug abuse as a big problem for children. Smoking, which had been ranked No. 1 in 2007, now holds the No. 3 position, with 32% of adults saying it's a big problem. Bullying, Internet safety, and child abuse and neglect rounded out the top six concerns.

Lunch Eats Up School Budgets

Most school food-service directors say that rising expenses and limited funding are the most pressing issues facing school cafeteria programs nationwide, according to a poll from the School Nutrition Association. Nearly 60% of districts increased school lunch prices this year to keep up with the costs, the survey found. The median increase, 25 cents, was significantly larger than the 15-cent median increase reported in 2007, the last time the survey was conducted. Also, at every grade level, more children were participating in free and reduced-price meal programs. On the plus side, school nutrition programs increasingly are offering healthy options, with peak gains seen in vegetarian offerings and low-fat prepared and packaged foods. In addition, locally grown fruits and vegetables were available on more than one-third of school menus, and an additional 21% of districts were considering such offerings.

Hyponatremia Danger in Children

Spurred by the deaths of two children from hyponatremia after surgery, the Institute for Safe Medication Practices has warned health care practitioners to become better educated about the causes, signs, and symptoms of the condition. The institute cautioned that postoperative children are at high risk for developing hyponatremia, which is the most common electrolyte disorder among hospitalized patients. It can be caused by administration of intravenous fluids containing too little sodium and, if untreated, can result in severe brain swelling and death. The institute said that one of the children who died had undergone an outpatient tonsillectomy, while the other had had vascular surgery. The organization recommended that standards of practice be established for intravenous hydration of patients, particularly children. Protocols should establish how to identify and treat patients with hyponatremia and related conditions, and all physicians, nurses, and pharmacists should gain a thorough understanding of the condition in children, the group said.

Youth Tobacco Sales Drop More

Sales of tobacco to children have reached historic lows, the Substance Abuse and Mental Health Services Administration said. SAMHSA credited the Synar Amendment program, which requires states to prohibit the sale and distribution of tobacco to people under age 18. All 50 states and the District of Columbia have, for the third year running, achieved better than 80% compliance among tobacco product retailers, SAMHSA said. “Continued state vigilance will build on our track record of success in protecting children from the public health menace of tobacco,” said SAMHSA acting administrator Eric Broderick, D.D.S., in a statement.

Congress Weighs 'Safe Babies Act'

A bipartisan group led by Sen. Tom Harkin (D-Iowa) has introduced legislation known as the Safe Babies Act of 2009 in the Senate (S. 1554) that would create local court teams to protect maltreated children, screen them for developmental and health issues, and counsel parents. Rep. Rosa L. DeLauro (D-Conn.) introduced a companion bill in the House (H.R. 3474). The teams would be led by a judge with jurisdiction over children in foster care and would include pediatricians and other child welfare professionals. These groups would review cases monthly and guide medical, developmental, mental health, and substance abuse interventions for maltreated children and their families. Five cosponsors joined Sen. Harkin in the Senate, and three joined Rep. DeLauro in the House.