Joyce Frieden

Costs Drive Foot Care Disparities

Almost 40% of African Americans with diabetes delay visits to podiatrists for financial reasons, according to an online survey sponsored by the American Podiatric Medical Association. Kelton Research conducted the survey of 200 African Americans with diabetes and 200 without, all aged 35 and older. Thirty-eight percent of respondents with diabetes put off visits to podiatrists because they couldn't afford them, they had no insurance, or the care wasn't covered by their insurance plans. Nearly half (48%) of the diabetic African Americans said they had never been to a podiatrist for a diabetic foot examination or treatment, although many indicated that they did have foot-related complications such as tingling (45%), burning (22%), and decreased sensation (18%). Of those without diabetes, 54% said that they have at least one family member with the disease. “It is vital that our nation's health care reform plan include stipulations that ensure all Americans, both those with and at risk for diabetes, can afford the necessary diabetes care and management that they require,” said Dr. Ronald D. Jensen, APMA president.

Endocrine-Disrupting Chemicals

The American Medical Association has called for more effective government oversight of endocrine-disrupting chemicals. At its mid-winter meeting, the organization adopted a resolution, introduced by the Endocrine Society, calling for most regulations on the chemicals to be handled by a single office. The exception would be for endocrine disruptors used as pharmaceuticals, which would continue to be regulated by the Food and Drug Administration. The resolution also calls for policies on the chemicals to be based on data from both low- and high-level exposures. “This new resolution marks an important step in engaging policy makers to enact policies that decrease public exposure to these potentially harmful chemicals,” said Dr. Robert Vigersky, Endocrine Society president. His group “is concerned that the public may be placed at risk because critical information about the potential health effects of endocrine-disrupting chemicals is being overlooked in the development of federal guidelines and regulations,” he said.

Families' Diabetes Costs Are High

Many households with family members suffering from diabetes find their out-of-pocket health care costs burdensome, according to a report on health insurance and diabetes from the Department of Health and Human Services. One-fourth of households that include someone with diabetes have health care costs that consume at least 10% of household income, and 8% have costs exceeding 20%. “As a result of such high costs, one in six individuals with diabetes report[s] avoiding or delaying needed medical care,” the report notes. The report, available at

www.healthreform.gov/reports/diabetes/index.html

New Surgeon General Confirmed

Family physician Regina Benjamin has been unanimously confirmed by the Senate as the U.S. Surgeon General. Dr. Benjamin, founder and CEO of the Bayou La Batre (Ala.) Rural Health Clinic, will start her work by responding to the A(H1N1) influenza pandemic, Health and Human Services Secretary Kathleen Sebelius said in a statement. The American Academy of Family Physicians praised the confirmation. “All Americans will benefit from Dr. Benjamin's medical expertise, clinical experience, and advocacy for all patients,” the academy's president, Dr. Lori Heim, said in a statement. “She is committed to ensuring that everyone has access to health care, regardless of economic status.”

Provider Fraud Most Common

Eighty percent of health care fraud involves providers systematically overcharging public or private insurers, says a report from researchers at George Washington University, Washington, and the National Academy for State Health Policy. These schemes disproportionately target demographic groups likely to be enrolled in Medicare and Medicaid. But the researchers also found that fraud information concerning the public programs is frequently confused with payment-error data. The authors recommended stronger laws governing insurance marketing, enrollment, claims payments, and antifraud procedures.

Pipeline Is Full of Treatments

Pharmaceutical and biotechnology companies have nearly 1,000 medications and vaccines in the pipeline to treat diseases that disproportionately affect women, says a report by the Pharmaceutical Research and Manufacturers of America. The 969 medicines are in clinical trials or under review by the FDA. They include 155 medications for diabetes and 114 for autoimmune diseases, which affect women at a rate three times that for men. Other treatments in the pipeline include 112 for breast cancer, 86 for obstetric/gynecologic conditions, 76 for asthma, 131 for arthritis, and 80 for Alzheimer's disease.

Costs Drive Foot Care Disparities

Almost 40% of African Americans with diabetes delay visits to podiatrists for financial reasons, according to an online survey sponsored by the American Podiatric Medical Association. Kelton Research conducted the survey of 200 African Americans with diabetes and 200 without, all aged 35 and older. Thirty-eight percent of respondents with diabetes put off visits to podiatrists because they couldn't afford them, they had no insurance, or the care wasn't covered by their insurance plans. Nearly half (48%) of the diabetic African Americans said they had never been to a podiatrist for a diabetic foot examination or treatment, although many indicated that they did have foot-related complications such as tingling (45%), burning (22%), and decreased sensation (18%). Of those without diabetes, 54% said that they have at least one family member with the disease. “It is vital that our nation's health care reform plan include stipulations that ensure all Americans, both those with and at risk for diabetes, can afford the necessary diabetes care and management that they require,” said Dr. Ronald D. Jensen, APMA president.

Endocrine-Disrupting Chemicals

The American Medical Association has called for more effective government oversight of endocrine-disrupting chemicals. At its mid-winter meeting, the organization adopted a resolution, introduced by the Endocrine Society, calling for most regulations on the chemicals to be handled by a single office. The exception would be for endocrine disruptors used as pharmaceuticals, which would continue to be regulated by the Food and Drug Administration. The resolution also calls for policies on the chemicals to be based on data from both low- and high-level exposures. “This new resolution marks an important step in engaging policy makers to enact policies that decrease public exposure to these potentially harmful chemicals,” said Dr. Robert Vigersky, Endocrine Society president. His group “is concerned that the public may be placed at risk because critical information about the potential health effects of endocrine-disrupting chemicals is being overlooked in the development of federal guidelines and regulations,” he said.

Families' Diabetes Costs Are High

Many households with family members suffering from diabetes find their out-of-pocket health care costs burdensome, according to a report on health insurance and diabetes from the Department of Health and Human Services. One-fourth of households that include someone with diabetes have health care costs that consume at least 10% of household income, and 8% have costs exceeding 20%. “As a result of such high costs, one in six individuals with diabetes report[s] avoiding or delaying needed medical care,” the report notes. The report, available at

www.healthreform.gov/reports/diabetes/index.html

New Surgeon General Confirmed

Family physician Regina Benjamin has been unanimously confirmed by the Senate as the U.S. Surgeon General. Dr. Benjamin, founder and CEO of the Bayou La Batre (Ala.) Rural Health Clinic, will start her work by responding to the A(H1N1) influenza pandemic, Health and Human Services Secretary Kathleen Sebelius said in a statement. The American Academy of Family Physicians praised the confirmation. “All Americans will benefit from Dr. Benjamin's medical expertise, clinical experience, and advocacy for all patients,” the academy's president, Dr. Lori Heim, said in a statement. “She is committed to ensuring that everyone has access to health care, regardless of economic status.”

Provider Fraud Most Common

Eighty percent of health care fraud involves providers systematically overcharging public or private insurers, says a report from researchers at George Washington University, Washington, and the National Academy for State Health Policy. These schemes disproportionately target demographic groups likely to be enrolled in Medicare and Medicaid. But the researchers also found that fraud information concerning the public programs is frequently confused with payment-error data. The authors recommended stronger laws governing insurance marketing, enrollment, claims payments, and antifraud procedures.

Pipeline Is Full of Treatments

Pharmaceutical and biotechnology companies have nearly 1,000 medications and vaccines in the pipeline to treat diseases that disproportionately affect women, says a report by the Pharmaceutical Research and Manufacturers of America. The 969 medicines are in clinical trials or under review by the FDA. They include 155 medications for diabetes and 114 for autoimmune diseases, which affect women at a rate three times that for men. Other treatments in the pipeline include 112 for breast cancer, 86 for obstetric/gynecologic conditions, 76 for asthma, 131 for arthritis, and 80 for Alzheimer's disease.

Costs Drive Foot Care Disparities

Almost 40% of African Americans with diabetes delay visits to podiatrists for financial reasons, according to an online survey sponsored by the American Podiatric Medical Association. Kelton Research conducted the survey of 200 African Americans with diabetes and 200 without, all aged 35 and older. Thirty-eight percent of respondents with diabetes put off visits to podiatrists because they couldn't afford them, they had no insurance, or the care wasn't covered by their insurance plans. Nearly half (48%) of the diabetic African Americans said they had never been to a podiatrist for a diabetic foot examination or treatment, although many indicated that they did have foot-related complications such as tingling (45%), burning (22%), and decreased sensation (18%). Of those without diabetes, 54% said that they have at least one family member with the disease. “It is vital that our nation's health care reform plan include stipulations that ensure all Americans, both those with and at risk for diabetes, can afford the necessary diabetes care and management that they require,” said Dr. Ronald D. Jensen, APMA president.

Endocrine-Disrupting Chemicals

The American Medical Association has called for more effective government oversight of endocrine-disrupting chemicals. At its mid-winter meeting, the organization adopted a resolution, introduced by the Endocrine Society, calling for most regulations on the chemicals to be handled by a single office. The exception would be for endocrine disruptors used as pharmaceuticals, which would continue to be regulated by the Food and Drug Administration. The resolution also calls for policies on the chemicals to be based on data from both low- and high-level exposures. “This new resolution marks an important step in engaging policy makers to enact policies that decrease public exposure to these potentially harmful chemicals,” said Dr. Robert Vigersky, Endocrine Society president. His group “is concerned that the public may be placed at risk because critical information about the potential health effects of endocrine-disrupting chemicals is being overlooked in the development of federal guidelines and regulations,” he said.

Families' Diabetes Costs Are High

Many households with family members suffering from diabetes find their out-of-pocket health care costs burdensome, according to a report on health insurance and diabetes from the Department of Health and Human Services. One-fourth of households that include someone with diabetes have health care costs that consume at least 10% of household income, and 8% have costs exceeding 20%. “As a result of such high costs, one in six individuals with diabetes report[s] avoiding or delaying needed medical care,” the report notes. The report, available at

www.healthreform.gov/reports/diabetes/index.html

New Surgeon General Confirmed

Family physician Regina Benjamin has been unanimously confirmed by the Senate as the U.S. Surgeon General. Dr. Benjamin, founder and CEO of the Bayou La Batre (Ala.) Rural Health Clinic, will start her work by responding to the A(H1N1) influenza pandemic, Health and Human Services Secretary Kathleen Sebelius said in a statement. The American Academy of Family Physicians praised the confirmation. “All Americans will benefit from Dr. Benjamin's medical expertise, clinical experience, and advocacy for all patients,” the academy's president, Dr. Lori Heim, said in a statement. “She is committed to ensuring that everyone has access to health care, regardless of economic status.”

Provider Fraud Most Common

Eighty percent of health care fraud involves providers systematically overcharging public or private insurers, says a report from researchers at George Washington University, Washington, and the National Academy for State Health Policy. These schemes disproportionately target demographic groups likely to be enrolled in Medicare and Medicaid. But the researchers also found that fraud information concerning the public programs is frequently confused with payment-error data. The authors recommended stronger laws governing insurance marketing, enrollment, claims payments, and antifraud procedures.

Pipeline Is Full of Treatments

Pharmaceutical and biotechnology companies have nearly 1,000 medications and vaccines in the pipeline to treat diseases that disproportionately affect women, says a report by the Pharmaceutical Research and Manufacturers of America. The 969 medicines are in clinical trials or under review by the FDA. They include 155 medications for diabetes and 114 for autoimmune diseases, which affect women at a rate three times that for men. Other treatments in the pipeline include 112 for breast cancer, 86 for obstetric/gynecologic conditions, 76 for asthma, 131 for arthritis, and 80 for Alzheimer's disease.

WASHINGTON — Despite recessionary impacts on their reimbursement, physicians continue to see Medicaid patients, several state Medicaid directors reported.

“Knock on wood; we've not seen an impact,” Charles Duarte of the Nevada Department of Health and Human Services, said at a briefing sponsored by the Kaiser Family Foundation. “We still maintain contracts with about 93% of licensed physicians in the state, and about 65% of those indicate they are still seeing new [Medicaid] recipients,” according to a survey the department performed earlier in 2009.

“We monitor very carefully,” said New York State Medicaid director Deborah Bachrach. “We have not seen an impact on access and we are working very hard with our physician community to enroll more physicians into Medicaid.”

Many states are struggling to provide services to Medicaid patients during this economic downturn, according to a 50-state Medicaid survey released by the foundation. On average, although states projected growth in Medicaid spending of 5.8% in fiscal year 2009, spending actually increased 7.9%, according to the survey. At the same time, enrollment growth, projected to grow by 3.6% for the year, was actually 5.4%.

What has allowed states to increase their Medicaid spending has been the American Recovery and Reinvestment Act, said Vernon K. Smith, Ph.D., principal at consulting firm Health Management Associates and one of the co-authors of the report.

In fiscal 2009, “States received Recovery Act funding for 9 months totaling $29 billion, of which 90% came through Medicaid” in the form of more matching dollars for the program, said Dr. Smith. “Without the federal stimulus funding, the Medicaid story in 2009 would have been dramatically different. Without any doubt we would have seen widespread cuts to eligibility and … cuts to payment rates would have been more severe.”

The Recovery Act also prevented cuts in another way: In order for the states to get the money, they were required not to make any cuts to Medicaid eligibility.

Although Medicaid spending increased overall in the last fiscal year, the portion of spending that came from states themselves—as opposed to the federal government—dropped by 6.3%, which was “simply unprecedented,” Dr. Smith noted. In addition, Medicaid spending for FY 2010 is projected to grow at a slower percentage rate than Medicaid enrollment, which also is highly unusual.

States are expecting the situation to worsen once Recovery Act funding goes away, at the end of 2012, according to Dr. Smith. At that point, more drastic cuts in benefits and payments will likely be considered, along with cuts in eligibility.

Despite the challenges, some states have expanded eligibility for certain categories of beneficiaries, and most have increased or are planning to increase their participation in electronic prescribing and electronic health records initiatives, according to the report.

The report, “The Crunch Continues: Medicaid Spending, Coverage and Policy in the Midst of a Recession,” is available online at www.kff.org

WASHINGTON — Despite recessionary impacts on their reimbursement, physicians continue to see Medicaid patients, several state Medicaid directors reported.

“Knock on wood; we've not seen an impact,” Charles Duarte of the Nevada Department of Health and Human Services, said at a briefing sponsored by the Kaiser Family Foundation. “We still maintain contracts with about 93% of licensed physicians in the state, and about 65% of those indicate they are still seeing new [Medicaid] recipients,” according to a survey the department performed earlier in 2009.

“We monitor very carefully,” said New York State Medicaid director Deborah Bachrach. “We have not seen an impact on access and we are working very hard with our physician community to enroll more physicians into Medicaid.”

Many states are struggling to provide services to Medicaid patients during this economic downturn, according to a 50-state Medicaid survey released by the foundation. On average, although states projected growth in Medicaid spending of 5.8% in fiscal year 2009, spending actually increased 7.9%, according to the survey. At the same time, enrollment growth, projected to grow by 3.6% for the year, was actually 5.4%.

What has allowed states to increase their Medicaid spending has been the American Recovery and Reinvestment Act, said Vernon K. Smith, Ph.D., principal at consulting firm Health Management Associates and one of the co-authors of the report.

In fiscal 2009, “States received Recovery Act funding for 9 months totaling $29 billion, of which 90% came through Medicaid” in the form of more matching dollars for the program, said Dr. Smith. “Without the federal stimulus funding, the Medicaid story in 2009 would have been dramatically different. Without any doubt we would have seen widespread cuts to eligibility and … cuts to payment rates would have been more severe.”

The Recovery Act also prevented cuts in another way: In order for the states to get the money, they were required not to make any cuts to Medicaid eligibility.

Although Medicaid spending increased overall in the last fiscal year, the portion of spending that came from states themselves—as opposed to the federal government—dropped by 6.3%, which was “simply unprecedented,” Dr. Smith noted. In addition, Medicaid spending for FY 2010 is projected to grow at a slower percentage rate than Medicaid enrollment, which also is highly unusual.

States are expecting the situation to worsen once Recovery Act funding goes away, at the end of 2012, according to Dr. Smith. At that point, more drastic cuts in benefits and payments will likely be considered, along with cuts in eligibility.

Despite the challenges, some states have expanded eligibility for certain categories of beneficiaries, and most have increased or are planning to increase their participation in electronic prescribing and electronic health records initiatives, according to the report.

The report, “The Crunch Continues: Medicaid Spending, Coverage and Policy in the Midst of a Recession,” is available online at www.kff.org

WASHINGTON — Despite recessionary impacts on their reimbursement, physicians continue to see Medicaid patients, several state Medicaid directors reported.

“Knock on wood; we've not seen an impact,” Charles Duarte of the Nevada Department of Health and Human Services, said at a briefing sponsored by the Kaiser Family Foundation. “We still maintain contracts with about 93% of licensed physicians in the state, and about 65% of those indicate they are still seeing new [Medicaid] recipients,” according to a survey the department performed earlier in 2009.

“We monitor very carefully,” said New York State Medicaid director Deborah Bachrach. “We have not seen an impact on access and we are working very hard with our physician community to enroll more physicians into Medicaid.”

Many states are struggling to provide services to Medicaid patients during this economic downturn, according to a 50-state Medicaid survey released by the foundation. On average, although states projected growth in Medicaid spending of 5.8% in fiscal year 2009, spending actually increased 7.9%, according to the survey. At the same time, enrollment growth, projected to grow by 3.6% for the year, was actually 5.4%.

What has allowed states to increase their Medicaid spending has been the American Recovery and Reinvestment Act, said Vernon K. Smith, Ph.D., principal at consulting firm Health Management Associates and one of the co-authors of the report.

In fiscal 2009, “States received Recovery Act funding for 9 months totaling $29 billion, of which 90% came through Medicaid” in the form of more matching dollars for the program, said Dr. Smith. “Without the federal stimulus funding, the Medicaid story in 2009 would have been dramatically different. Without any doubt we would have seen widespread cuts to eligibility and … cuts to payment rates would have been more severe.”

The Recovery Act also prevented cuts in another way: In order for the states to get the money, they were required not to make any cuts to Medicaid eligibility.

Although Medicaid spending increased overall in the last fiscal year, the portion of spending that came from states themselves—as opposed to the federal government—dropped by 6.3%, which was “simply unprecedented,” Dr. Smith noted. In addition, Medicaid spending for FY 2010 is projected to grow at a slower percentage rate than Medicaid enrollment, which also is highly unusual.

States are expecting the situation to worsen once Recovery Act funding goes away, at the end of 2012, according to Dr. Smith. At that point, more drastic cuts in benefits and payments will likely be considered, along with cuts in eligibility.

Despite the challenges, some states have expanded eligibility for certain categories of beneficiaries, and most have increased or are planning to increase their participation in electronic prescribing and electronic health records initiatives, according to the report.

The report, “The Crunch Continues: Medicaid Spending, Coverage and Policy in the Midst of a Recession,” is available online at www.kff.org

WASHINGTON — After more than a decade of steady gains, health plans are seeing some quality improvement scores plateau, according to a report from the National Committee for Quality Assurance.

“We don't seem to put our power behind what we really want,” NCQA president Margaret E. O'Kane said at a press briefing announcing the results. “The status quo is still unacceptable.”

The report included 2008 data from a record 979 plans—702 health maintenance organizations and 277 preferred provider organizations—that collectively cover 116 million Americans.

Plans did record improvement on a few measures. For example, on average, 79% of patients in commercial plans were successfully monitored while taking certain medications such as diuretics, up from 74% in 2006. And among Medicare Advantage plans, the percentage of heart attack patients who received beta-blockers at discharge and stayed on them for at least 6 months climbed 10 percentage points, to an average of 78%, during the same time period.

In addition, some areas seemed to plateau because they had reached their maximum potential: For instance, the percentage of children and adults with persistent asthma who were prescribed asthma medications stayed steady at more than 92%.

But there is room for improvement in other areas, Ms. O'Kane said. Among commercial plans, for example, 57% of measures showed no statistically significant improvement from 2006 to 2008; that figure was 64% in Medicaid plans and 86% in Medicare plans.

Specifically, among Medicare Advantage plan members, no improvement was seen on measures assessing medication use in arthritis or screening for cervical cancer. Further, the percentage of Medicare patients with poor blood sugar control did not decline as hoped.

Measures with overall plan compliance below 50% included follow-up of children on attention-deficit/hyperactivity disorder medications (34%) and initiation of alcohol/drug dependency treatment (43%).

Although the recession has taken its toll on some plans' quality budgets, Ms. O'Kane pointed out that achieving higher quality does not necessarily involve spending more money.

Some health plans achieved quality ratings in the highest quartile for care of diabetes patients even as they were in the lowest quartile for expenditures on those patients. Emulating those plans “is where the trend should be moving,” she said.

Vernon Smith, Ph.D., a former Medicaid director currently at consulting firm Health Management Associates, said part of the plateau for Medicaid plans may come from tight state budgets.

“States are in no position to undertake new quality initiatives on their own,” he said. “So the impetus really must come at the federal level, and the burden really falls to Congress and the federal agencies overseeing Medicare and Medicaid.”

Ms. O'Kane had several recommendations for moving quality improvement forward, including the creation of insurance exchanges and requiring plans to report quality and patient satisfaction data, tying payment to performance, expanding demonstrations of the patient-centered medical home and increasing payments for primary care, and introducing quality bonuses for Medicare Advantage plans.

The data in the report were incomplete because some health plans didn't submit data and because fee-for-service programs—such as Medicare—typically do not have quality tracking mechanisms, Ms. O'Kane noted.

WASHINGTON — After more than a decade of steady gains, health plans are seeing some quality improvement scores plateau, according to a report from the National Committee for Quality Assurance.

“We don't seem to put our power behind what we really want,” NCQA president Margaret E. O'Kane said at a press briefing announcing the results. “The status quo is still unacceptable.”

The report included 2008 data from a record 979 plans—702 health maintenance organizations and 277 preferred provider organizations—that collectively cover 116 million Americans.

Plans did record improvement on a few measures. For example, on average, 79% of patients in commercial plans were successfully monitored while taking certain medications such as diuretics, up from 74% in 2006. And among Medicare Advantage plans, the percentage of heart attack patients who received beta-blockers at discharge and stayed on them for at least 6 months climbed 10 percentage points, to an average of 78%, during the same time period.

In addition, some areas seemed to plateau because they had reached their maximum potential: For instance, the percentage of children and adults with persistent asthma who were prescribed asthma medications stayed steady at more than 92%.

But there is room for improvement in other areas, Ms. O'Kane said. Among commercial plans, for example, 57% of measures showed no statistically significant improvement from 2006 to 2008; that figure was 64% in Medicaid plans and 86% in Medicare plans.

Specifically, among Medicare Advantage plan members, no improvement was seen on measures assessing medication use in arthritis or screening for cervical cancer. Further, the percentage of Medicare patients with poor blood sugar control did not decline as hoped.

Measures with overall plan compliance below 50% included follow-up of children on attention-deficit/hyperactivity disorder medications (34%) and initiation of alcohol/drug dependency treatment (43%).

Although the recession has taken its toll on some plans' quality budgets, Ms. O'Kane pointed out that achieving higher quality does not necessarily involve spending more money.

Some health plans achieved quality ratings in the highest quartile for care of diabetes patients even as they were in the lowest quartile for expenditures on those patients. Emulating those plans “is where the trend should be moving,” she said.

Vernon Smith, Ph.D., a former Medicaid director currently at consulting firm Health Management Associates, said part of the plateau for Medicaid plans may come from tight state budgets.

“States are in no position to undertake new quality initiatives on their own,” he said. “So the impetus really must come at the federal level, and the burden really falls to Congress and the federal agencies overseeing Medicare and Medicaid.”

Ms. O'Kane had several recommendations for moving quality improvement forward, including the creation of insurance exchanges and requiring plans to report quality and patient satisfaction data, tying payment to performance, expanding demonstrations of the patient-centered medical home and increasing payments for primary care, and introducing quality bonuses for Medicare Advantage plans.

The data in the report were incomplete because some health plans didn't submit data and because fee-for-service programs—such as Medicare—typically do not have quality tracking mechanisms, Ms. O'Kane noted.

WASHINGTON — After more than a decade of steady gains, health plans are seeing some quality improvement scores plateau, according to a report from the National Committee for Quality Assurance.

“We don't seem to put our power behind what we really want,” NCQA president Margaret E. O'Kane said at a press briefing announcing the results. “The status quo is still unacceptable.”

The report included 2008 data from a record 979 plans—702 health maintenance organizations and 277 preferred provider organizations—that collectively cover 116 million Americans.

Plans did record improvement on a few measures. For example, on average, 79% of patients in commercial plans were successfully monitored while taking certain medications such as diuretics, up from 74% in 2006. And among Medicare Advantage plans, the percentage of heart attack patients who received beta-blockers at discharge and stayed on them for at least 6 months climbed 10 percentage points, to an average of 78%, during the same time period.

In addition, some areas seemed to plateau because they had reached their maximum potential: For instance, the percentage of children and adults with persistent asthma who were prescribed asthma medications stayed steady at more than 92%.

But there is room for improvement in other areas, Ms. O'Kane said. Among commercial plans, for example, 57% of measures showed no statistically significant improvement from 2006 to 2008; that figure was 64% in Medicaid plans and 86% in Medicare plans.

Specifically, among Medicare Advantage plan members, no improvement was seen on measures assessing medication use in arthritis or screening for cervical cancer. Further, the percentage of Medicare patients with poor blood sugar control did not decline as hoped.

Measures with overall plan compliance below 50% included follow-up of children on attention-deficit/hyperactivity disorder medications (34%) and initiation of alcohol/drug dependency treatment (43%).

Although the recession has taken its toll on some plans' quality budgets, Ms. O'Kane pointed out that achieving higher quality does not necessarily involve spending more money.

Some health plans achieved quality ratings in the highest quartile for care of diabetes patients even as they were in the lowest quartile for expenditures on those patients. Emulating those plans “is where the trend should be moving,” she said.

Vernon Smith, Ph.D., a former Medicaid director currently at consulting firm Health Management Associates, said part of the plateau for Medicaid plans may come from tight state budgets.

“States are in no position to undertake new quality initiatives on their own,” he said. “So the impetus really must come at the federal level, and the burden really falls to Congress and the federal agencies overseeing Medicare and Medicaid.”

Ms. O'Kane had several recommendations for moving quality improvement forward, including the creation of insurance exchanges and requiring plans to report quality and patient satisfaction data, tying payment to performance, expanding demonstrations of the patient-centered medical home and increasing payments for primary care, and introducing quality bonuses for Medicare Advantage plans.

The data in the report were incomplete because some health plans didn't submit data and because fee-for-service programs—such as Medicare—typically do not have quality tracking mechanisms, Ms. O'Kane noted.

WASHINGTON — After more than a decade of steady gains, health plans are seeing the plateauing of some quality improvement scores, according to a report from the National Committee for Quality Assurance.

“We feel frustrated that we don't seem to put our power behind what we really want,” NCQA president Margaret E. O'Kane said at a press briefing held to announce the results. “The status quo is still unacceptable,” she added.

The report included 2008 data from a record 979 plans (702 health maintenance organizations and 277 preferred provider organizations) that collectively cover 116 million Americans.

Plans recorded improvement on a few measures. For example, on average, 79.1% of patients in commercial plans (up from 74.4% in 2006) were successfully monitored while they took certain medications such as diuretics.

And among Medicare Advantage plans, the percentage of acute myocardial infarction patients who received beta-blockers at discharge and stayed on them for at least 6 months climbed 10.1 percentage points, to an average of 79.7%, during the same time period.

In addition, some areas of care seemed to plateau because they had reached their maximum potential. For instance, the percentage of children and adults with persistent asthma who were prescribed asthma medications stayed steady at more than 92%.

But there is room for improvement in other areas, Ms. O'Kane said. Among commercial plans, for example, 57% of measures showed no statistically significant improvement from 2006 to 2008; that figure was 64% in Medicaid plans and 86% in Medicare plans.

Among Medicare Advantage plan members, no improvement was seen on measures assessing medication use in arthritis or screening for cervical cancer. Furthermore, the percentage of Medicare patients who had poor serum glucose control did not decline as hoped.

Measures with overall plan compliance less than 50% included follow-up of children on attention-deficit/hyperactivity disorder medications (34%), initiation of alcohol/drug dependency treatment (43%), and monitoring of patients on antidepressants (46%).

Although the recession has taken its toll on some plans' quality budgets, Ms. O'Kane pointed out that achieving higher quality does not necessarily involve spending more money.

She noted that some health plans achieved quality ratings in the highest quartile for care of diabetes patients even as they were in the lowest quartile for expenditures on those patients. Emulating those plans “is where the trend should be moving,” she said.

Ms. O'Kane made the following recommendations for moving quality improvement forward:

▸ Create insurance exchanges and require plans to report quality and patient satisfaction data.

▸ Tie payment to performance.

▸ Expand demonstrations of the patient-centered medical home, and increase payments for primary care.

▸ Provide funding for developing, maintaining, and updating quality measures.

▸ Introduce quality bonuses for Medicare Advantage plans.

▸ Invest in Medicaid measure development.

The data were incomplete because some health plans didn't submit data and because fee-for-service programs, such as Medicare, typically do not have quality tracking mechanisms, which was a limitation of the report, Ms. O'Kane noted. “We lack comprehensive data for 83% of Medicare beneficiaries, 75% of Medicaid beneficiaries, and 44% of commercially insured patients,” she said.

DMARD Treatment Rates in Rheumatoid Arthritis Patients, by Payer

Source Elsevier Global Medical News

WASHINGTON — After more than a decade of steady gains, health plans are seeing the plateauing of some quality improvement scores, according to a report from the National Committee for Quality Assurance.

“We feel frustrated that we don't seem to put our power behind what we really want,” NCQA president Margaret E. O'Kane said at a press briefing held to announce the results. “The status quo is still unacceptable,” she added.

The report included 2008 data from a record 979 plans (702 health maintenance organizations and 277 preferred provider organizations) that collectively cover 116 million Americans.

Plans recorded improvement on a few measures. For example, on average, 79.1% of patients in commercial plans (up from 74.4% in 2006) were successfully monitored while they took certain medications such as diuretics.

And among Medicare Advantage plans, the percentage of acute myocardial infarction patients who received beta-blockers at discharge and stayed on them for at least 6 months climbed 10.1 percentage points, to an average of 79.7%, during the same time period.

In addition, some areas of care seemed to plateau because they had reached their maximum potential. For instance, the percentage of children and adults with persistent asthma who were prescribed asthma medications stayed steady at more than 92%.

But there is room for improvement in other areas, Ms. O'Kane said. Among commercial plans, for example, 57% of measures showed no statistically significant improvement from 2006 to 2008; that figure was 64% in Medicaid plans and 86% in Medicare plans.

Among Medicare Advantage plan members, no improvement was seen on measures assessing medication use in arthritis or screening for cervical cancer. Furthermore, the percentage of Medicare patients who had poor serum glucose control did not decline as hoped.

Measures with overall plan compliance less than 50% included follow-up of children on attention-deficit/hyperactivity disorder medications (34%), initiation of alcohol/drug dependency treatment (43%), and monitoring of patients on antidepressants (46%).

Although the recession has taken its toll on some plans' quality budgets, Ms. O'Kane pointed out that achieving higher quality does not necessarily involve spending more money.

She noted that some health plans achieved quality ratings in the highest quartile for care of diabetes patients even as they were in the lowest quartile for expenditures on those patients. Emulating those plans “is where the trend should be moving,” she said.

Ms. O'Kane made the following recommendations for moving quality improvement forward:

▸ Create insurance exchanges and require plans to report quality and patient satisfaction data.

▸ Tie payment to performance.

▸ Expand demonstrations of the patient-centered medical home, and increase payments for primary care.

▸ Provide funding for developing, maintaining, and updating quality measures.

▸ Introduce quality bonuses for Medicare Advantage plans.

▸ Invest in Medicaid measure development.

The data were incomplete because some health plans didn't submit data and because fee-for-service programs, such as Medicare, typically do not have quality tracking mechanisms, which was a limitation of the report, Ms. O'Kane noted. “We lack comprehensive data for 83% of Medicare beneficiaries, 75% of Medicaid beneficiaries, and 44% of commercially insured patients,” she said.

DMARD Treatment Rates in Rheumatoid Arthritis Patients, by Payer

Source Elsevier Global Medical News

WASHINGTON — After more than a decade of steady gains, health plans are seeing the plateauing of some quality improvement scores, according to a report from the National Committee for Quality Assurance.

“We feel frustrated that we don't seem to put our power behind what we really want,” NCQA president Margaret E. O'Kane said at a press briefing held to announce the results. “The status quo is still unacceptable,” she added.

The report included 2008 data from a record 979 plans (702 health maintenance organizations and 277 preferred provider organizations) that collectively cover 116 million Americans.

Plans recorded improvement on a few measures. For example, on average, 79.1% of patients in commercial plans (up from 74.4% in 2006) were successfully monitored while they took certain medications such as diuretics.

And among Medicare Advantage plans, the percentage of acute myocardial infarction patients who received beta-blockers at discharge and stayed on them for at least 6 months climbed 10.1 percentage points, to an average of 79.7%, during the same time period.

In addition, some areas of care seemed to plateau because they had reached their maximum potential. For instance, the percentage of children and adults with persistent asthma who were prescribed asthma medications stayed steady at more than 92%.

But there is room for improvement in other areas, Ms. O'Kane said. Among commercial plans, for example, 57% of measures showed no statistically significant improvement from 2006 to 2008; that figure was 64% in Medicaid plans and 86% in Medicare plans.

Among Medicare Advantage plan members, no improvement was seen on measures assessing medication use in arthritis or screening for cervical cancer. Furthermore, the percentage of Medicare patients who had poor serum glucose control did not decline as hoped.

Measures with overall plan compliance less than 50% included follow-up of children on attention-deficit/hyperactivity disorder medications (34%), initiation of alcohol/drug dependency treatment (43%), and monitoring of patients on antidepressants (46%).

Although the recession has taken its toll on some plans' quality budgets, Ms. O'Kane pointed out that achieving higher quality does not necessarily involve spending more money.

She noted that some health plans achieved quality ratings in the highest quartile for care of diabetes patients even as they were in the lowest quartile for expenditures on those patients. Emulating those plans “is where the trend should be moving,” she said.

Ms. O'Kane made the following recommendations for moving quality improvement forward:

▸ Create insurance exchanges and require plans to report quality and patient satisfaction data.

▸ Tie payment to performance.

▸ Expand demonstrations of the patient-centered medical home, and increase payments for primary care.

▸ Provide funding for developing, maintaining, and updating quality measures.

▸ Introduce quality bonuses for Medicare Advantage plans.

▸ Invest in Medicaid measure development.

The data were incomplete because some health plans didn't submit data and because fee-for-service programs, such as Medicare, typically do not have quality tracking mechanisms, which was a limitation of the report, Ms. O'Kane noted. “We lack comprehensive data for 83% of Medicare beneficiaries, 75% of Medicaid beneficiaries, and 44% of commercially insured patients,” she said.

DMARD Treatment Rates in Rheumatoid Arthritis Patients, by Payer

Source Elsevier Global Medical News

WASHINGTON — After more than a decade of gains, some quality improvement scores seem to have plateaued, according to a report from the National Committee for Quality Assurance.

“We feel frustrated that we don't seem to put our power behind what we really want,” NCQA president Margaret E. O'Kane said at a press briefing announcing the results. “The status quo is still unacceptable.”

The report included 2008 data from a record 979 plans—702 health maintenance organizations and 277 preferred provider organizations—that collectively cover 116 million Americans.

Plans did record improvement on a few measures. For example, on average, 79.1% of patients in commercial plans were successfully monitored while taking certain medications such as diuretics, up from 74.4% in 2006. And among Medicare Advantage plans, the percentage of heart attack patients who received beta-blockers at discharge and stayed on them for at least 6 months climbed 10.1 percentage points, to an average of 79.7%, during the same time period.

Some areas seemed to plateau because they had reached their maximum potential: For instance, the percentage of children and adults with persistent asthma who were prescribed asthma medications stayed steady at more than 92%.

But there is room for improvement in other areas, Ms. O'Kane said. Among commercial plans, for example, 57% of measures showed no statistically significant improvement from 2006 to 2008; that figure was 64% in Medicaid plans and 86% in Medicare plans.

Specifically, among Medicare Advantage plan members, no improvement was seen on measures assessing medication use in arthritis or screening for cervical cancer. Further, the percentage of Medicare patients with poor blood sugar control did not decline as hoped.

Measures with overall plan compliance below 50% included follow-up of children on attention-deficit/hyperactivity disorder medications (34%), initiation of alcohol/drug dependency treatment (43%), and monitoring of patients on antidepressants (46%).

Although the recession has taken its toll on some plans' quality budgets, Ms. O'Kane pointed out that achieving higher quality does not necessarily involve spending more money.

She noted that some health plans achieved quality ratings in the highest quartile for care of diabetes patients even as they were in the lowest quartile for expenditures on those patients. Emulating those plans “is where the trend should be moving,” she said.

Vernon Smith, Ph.D., a former Medicaid director currently at consulting firm Health Management Associates, said part of the plateau for Medicaid plans may come from tight state budgets.

“States are in no position right now to undertake new quality initiatives,” he said. “So the impetus really must come at the federal level, and the burden really falls to Congress and the federal agencies overseeing Medicare and Medicaid.”

The data were incomplete because some health plans didn't submit data and because fee-for-service programs—such as Medicare—typically do not have quality tracking mechanisms, which was a limitation of the report, Ms. O'Kane noted. “We lack comprehensive data for 83% of Medicare beneficiaries, 75% of Medicaid beneficiaries, and 44% of commercially insured patients,” she said.

Source Elsevier Global Medical News

WASHINGTON — After more than a decade of gains, some quality improvement scores seem to have plateaued, according to a report from the National Committee for Quality Assurance.

“We feel frustrated that we don't seem to put our power behind what we really want,” NCQA president Margaret E. O'Kane said at a press briefing announcing the results. “The status quo is still unacceptable.”

The report included 2008 data from a record 979 plans—702 health maintenance organizations and 277 preferred provider organizations—that collectively cover 116 million Americans.

Plans did record improvement on a few measures. For example, on average, 79.1% of patients in commercial plans were successfully monitored while taking certain medications such as diuretics, up from 74.4% in 2006. And among Medicare Advantage plans, the percentage of heart attack patients who received beta-blockers at discharge and stayed on them for at least 6 months climbed 10.1 percentage points, to an average of 79.7%, during the same time period.

Some areas seemed to plateau because they had reached their maximum potential: For instance, the percentage of children and adults with persistent asthma who were prescribed asthma medications stayed steady at more than 92%.

But there is room for improvement in other areas, Ms. O'Kane said. Among commercial plans, for example, 57% of measures showed no statistically significant improvement from 2006 to 2008; that figure was 64% in Medicaid plans and 86% in Medicare plans.

Specifically, among Medicare Advantage plan members, no improvement was seen on measures assessing medication use in arthritis or screening for cervical cancer. Further, the percentage of Medicare patients with poor blood sugar control did not decline as hoped.

Measures with overall plan compliance below 50% included follow-up of children on attention-deficit/hyperactivity disorder medications (34%), initiation of alcohol/drug dependency treatment (43%), and monitoring of patients on antidepressants (46%).

Although the recession has taken its toll on some plans' quality budgets, Ms. O'Kane pointed out that achieving higher quality does not necessarily involve spending more money.

She noted that some health plans achieved quality ratings in the highest quartile for care of diabetes patients even as they were in the lowest quartile for expenditures on those patients. Emulating those plans “is where the trend should be moving,” she said.

Vernon Smith, Ph.D., a former Medicaid director currently at consulting firm Health Management Associates, said part of the plateau for Medicaid plans may come from tight state budgets.

“States are in no position right now to undertake new quality initiatives,” he said. “So the impetus really must come at the federal level, and the burden really falls to Congress and the federal agencies overseeing Medicare and Medicaid.”

The data were incomplete because some health plans didn't submit data and because fee-for-service programs—such as Medicare—typically do not have quality tracking mechanisms, which was a limitation of the report, Ms. O'Kane noted. “We lack comprehensive data for 83% of Medicare beneficiaries, 75% of Medicaid beneficiaries, and 44% of commercially insured patients,” she said.

Source Elsevier Global Medical News

WASHINGTON — After more than a decade of gains, some quality improvement scores seem to have plateaued, according to a report from the National Committee for Quality Assurance.

“We feel frustrated that we don't seem to put our power behind what we really want,” NCQA president Margaret E. O'Kane said at a press briefing announcing the results. “The status quo is still unacceptable.”

The report included 2008 data from a record 979 plans—702 health maintenance organizations and 277 preferred provider organizations—that collectively cover 116 million Americans.

Plans did record improvement on a few measures. For example, on average, 79.1% of patients in commercial plans were successfully monitored while taking certain medications such as diuretics, up from 74.4% in 2006. And among Medicare Advantage plans, the percentage of heart attack patients who received beta-blockers at discharge and stayed on them for at least 6 months climbed 10.1 percentage points, to an average of 79.7%, during the same time period.

Some areas seemed to plateau because they had reached their maximum potential: For instance, the percentage of children and adults with persistent asthma who were prescribed asthma medications stayed steady at more than 92%.

But there is room for improvement in other areas, Ms. O'Kane said. Among commercial plans, for example, 57% of measures showed no statistically significant improvement from 2006 to 2008; that figure was 64% in Medicaid plans and 86% in Medicare plans.

Specifically, among Medicare Advantage plan members, no improvement was seen on measures assessing medication use in arthritis or screening for cervical cancer. Further, the percentage of Medicare patients with poor blood sugar control did not decline as hoped.

Measures with overall plan compliance below 50% included follow-up of children on attention-deficit/hyperactivity disorder medications (34%), initiation of alcohol/drug dependency treatment (43%), and monitoring of patients on antidepressants (46%).

Although the recession has taken its toll on some plans' quality budgets, Ms. O'Kane pointed out that achieving higher quality does not necessarily involve spending more money.

She noted that some health plans achieved quality ratings in the highest quartile for care of diabetes patients even as they were in the lowest quartile for expenditures on those patients. Emulating those plans “is where the trend should be moving,” she said.

Vernon Smith, Ph.D., a former Medicaid director currently at consulting firm Health Management Associates, said part of the plateau for Medicaid plans may come from tight state budgets.

“States are in no position right now to undertake new quality initiatives,” he said. “So the impetus really must come at the federal level, and the burden really falls to Congress and the federal agencies overseeing Medicare and Medicaid.”

The data were incomplete because some health plans didn't submit data and because fee-for-service programs—such as Medicare—typically do not have quality tracking mechanisms, which was a limitation of the report, Ms. O'Kane noted. “We lack comprehensive data for 83% of Medicare beneficiaries, 75% of Medicaid beneficiaries, and 44% of commercially insured patients,” she said.

Source Elsevier Global Medical News

Physicians and other health professionals participating in Medicare's Physician Quality Reporting Initiative received a total of $92 million in incentive payments under the program in 2008, the Centers for Medicare and Medicaid Services announced.

That figure is nearly three times the $36 million paid out in 2007, the agency noted. The number of medical professionals receiving payments also increased during the same period, from 57,000 to 85,000. The average payment in 2008 was more than $1,000, with the largest single payment at $98,000. During 2007, the reporting period lasted only 6 months for all participants, while in 2008 participants could report for a 6- or 12-month period.

“We are very pleased with the results for 2008,” acting CMS administrator Charlene Frizerra said in a statement. “More health professionals have successfully reported data, and the substantial growth in the national total for PQRI incentive payments demonstrates that Medicare can align payment with quality incentives.”

Under Medicare's PQRI program, providers receive incentive payments for reporting data on quality measures. The incentive payments currently amount to 1.5% of each provider's total estimated allowed charges under Medicare Part B. Although more than 153,000 health professionals participated in the program during 2008, only 85,000 met the requirements for satisfactory reporting and therefore received incentive payments.

To make participation easier, the CMS expanded the number of measures providers could report on, from 74 in 2007 to 119 in 2008.

Physicians and other health professionals participating in Medicare's Physician Quality Reporting Initiative received a total of $92 million in incentive payments under the program in 2008, the Centers for Medicare and Medicaid Services announced.

That figure is nearly three times the $36 million paid out in 2007, the agency noted. The number of medical professionals receiving payments also increased during the same period, from 57,000 to 85,000. The average payment in 2008 was more than $1,000, with the largest single payment at $98,000. During 2007, the reporting period lasted only 6 months for all participants, while in 2008 participants could report for a 6- or 12-month period.

“We are very pleased with the results for 2008,” acting CMS administrator Charlene Frizerra said in a statement. “More health professionals have successfully reported data, and the substantial growth in the national total for PQRI incentive payments demonstrates that Medicare can align payment with quality incentives.”

Under Medicare's PQRI program, providers receive incentive payments for reporting data on quality measures. The incentive payments currently amount to 1.5% of each provider's total estimated allowed charges under Medicare Part B. Although more than 153,000 health professionals participated in the program during 2008, only 85,000 met the requirements for satisfactory reporting and therefore received incentive payments.

To make participation easier, the CMS expanded the number of measures providers could report on, from 74 in 2007 to 119 in 2008.

Physicians and other health professionals participating in Medicare's Physician Quality Reporting Initiative received a total of $92 million in incentive payments under the program in 2008, the Centers for Medicare and Medicaid Services announced.

That figure is nearly three times the $36 million paid out in 2007, the agency noted. The number of medical professionals receiving payments also increased during the same period, from 57,000 to 85,000. The average payment in 2008 was more than $1,000, with the largest single payment at $98,000. During 2007, the reporting period lasted only 6 months for all participants, while in 2008 participants could report for a 6- or 12-month period.

“We are very pleased with the results for 2008,” acting CMS administrator Charlene Frizerra said in a statement. “More health professionals have successfully reported data, and the substantial growth in the national total for PQRI incentive payments demonstrates that Medicare can align payment with quality incentives.”

Under Medicare's PQRI program, providers receive incentive payments for reporting data on quality measures. The incentive payments currently amount to 1.5% of each provider's total estimated allowed charges under Medicare Part B. Although more than 153,000 health professionals participated in the program during 2008, only 85,000 met the requirements for satisfactory reporting and therefore received incentive payments.

To make participation easier, the CMS expanded the number of measures providers could report on, from 74 in 2007 to 119 in 2008.

WASHINGTON – Are inpatient psychiatric facilities being paid enough by Medicare? A government advisory group is trying to figure that out, but answering that question is raising other questions, too.

Dana Kelley, a staff member of the Medicare Payment Advisory Commission (MedPAC), noted at a recent commission meeting that the number of Medicare beneficiaries who were treated for mental illness decreased from 483,000 in 2004–when the new inpatient prospective payment system was implemented–to 455,000 in 2007, a drop of 5.7% .

If only beneficiaries in the fee-for-service program are included, the decrease was 2%, she added.

Several factors might be affecting the volume of patients in inpatient psychiatric facilities (IPFs), including improved access to psychotropic drugs under the Medicare drug benefit, reductions in beneficiary cost sharing for outpatient mental health services, and the use of partial hospitalization programs, Ms. Kelley said. But despite the drops in patient numbers, Medicare inpatient mental health spending increased during the same time period, from $3.5 billion to $3.8 billion.

Slightly more than half of Medicare mental health inpatients in 2007 were treated in “scatter beds” that were not part of a designated mental health unit, Ms. Kelley said.

However, the distribution of diagnoses for scatter bed patients was different from the overall inpatient distribution, with one-fourth of the scatter bed patients being treated for degenerative nervous system disorders (see chart). She also noted a change in the bed distribution in for-profit versus nonprofit mental health facilities:

The total number of beds in nonprofit facilities dropped by 11% from 2004 to 2007, compared with a 12% increase in the number of for-profit beds and a 5% increase in the number of beds in government facilities.

The change in nonprofit and for-profit facility bed capacity “makes me nervous,” said commission member Nancy Kane, of the Harvard School of Public Health, Boston. “I want to know why this is happening.”

Racial and ethnic differences, including language barriers, might affect patients' ability to seek mental health care, Ms. Kelley said. In general, “minorities who do seek treatment are more likely to receive poor quality care. They are more likely to be misdiagnosed, and less likely to receive appropriate, evidence-based treatment for their conditions.”

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON – Are inpatient psychiatric facilities being paid enough by Medicare? A government advisory group is trying to figure that out, but answering that question is raising other questions, too.

Dana Kelley, a staff member of the Medicare Payment Advisory Commission (MedPAC), noted at a recent commission meeting that the number of Medicare beneficiaries who were treated for mental illness decreased from 483,000 in 2004–when the new inpatient prospective payment system was implemented–to 455,000 in 2007, a drop of 5.7% .

If only beneficiaries in the fee-for-service program are included, the decrease was 2%, she added.

Several factors might be affecting the volume of patients in inpatient psychiatric facilities (IPFs), including improved access to psychotropic drugs under the Medicare drug benefit, reductions in beneficiary cost sharing for outpatient mental health services, and the use of partial hospitalization programs, Ms. Kelley said. But despite the drops in patient numbers, Medicare inpatient mental health spending increased during the same time period, from $3.5 billion to $3.8 billion.

Slightly more than half of Medicare mental health inpatients in 2007 were treated in “scatter beds” that were not part of a designated mental health unit, Ms. Kelley said.

However, the distribution of diagnoses for scatter bed patients was different from the overall inpatient distribution, with one-fourth of the scatter bed patients being treated for degenerative nervous system disorders (see chart). She also noted a change in the bed distribution in for-profit versus nonprofit mental health facilities:

The total number of beds in nonprofit facilities dropped by 11% from 2004 to 2007, compared with a 12% increase in the number of for-profit beds and a 5% increase in the number of beds in government facilities.

The change in nonprofit and for-profit facility bed capacity “makes me nervous,” said commission member Nancy Kane, of the Harvard School of Public Health, Boston. “I want to know why this is happening.”

Racial and ethnic differences, including language barriers, might affect patients' ability to seek mental health care, Ms. Kelley said. In general, “minorities who do seek treatment are more likely to receive poor quality care. They are more likely to be misdiagnosed, and less likely to receive appropriate, evidence-based treatment for their conditions.”

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON – Are inpatient psychiatric facilities being paid enough by Medicare? A government advisory group is trying to figure that out, but answering that question is raising other questions, too.

Dana Kelley, a staff member of the Medicare Payment Advisory Commission (MedPAC), noted at a recent commission meeting that the number of Medicare beneficiaries who were treated for mental illness decreased from 483,000 in 2004–when the new inpatient prospective payment system was implemented–to 455,000 in 2007, a drop of 5.7% .

If only beneficiaries in the fee-for-service program are included, the decrease was 2%, she added.

Several factors might be affecting the volume of patients in inpatient psychiatric facilities (IPFs), including improved access to psychotropic drugs under the Medicare drug benefit, reductions in beneficiary cost sharing for outpatient mental health services, and the use of partial hospitalization programs, Ms. Kelley said. But despite the drops in patient numbers, Medicare inpatient mental health spending increased during the same time period, from $3.5 billion to $3.8 billion.

Slightly more than half of Medicare mental health inpatients in 2007 were treated in “scatter beds” that were not part of a designated mental health unit, Ms. Kelley said.

However, the distribution of diagnoses for scatter bed patients was different from the overall inpatient distribution, with one-fourth of the scatter bed patients being treated for degenerative nervous system disorders (see chart). She also noted a change in the bed distribution in for-profit versus nonprofit mental health facilities:

The total number of beds in nonprofit facilities dropped by 11% from 2004 to 2007, compared with a 12% increase in the number of for-profit beds and a 5% increase in the number of beds in government facilities.

The change in nonprofit and for-profit facility bed capacity “makes me nervous,” said commission member Nancy Kane, of the Harvard School of Public Health, Boston. “I want to know why this is happening.”

Racial and ethnic differences, including language barriers, might affect patients' ability to seek mental health care, Ms. Kelley said. In general, “minorities who do seek treatment are more likely to receive poor quality care. They are more likely to be misdiagnosed, and less likely to receive appropriate, evidence-based treatment for their conditions.”

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON – The definition of “health disparities” should be broadened to include the conditions that caused the affected groups to have poor health in the first place, according to Dr. Camara Jones of the Centers for Disease Control and Prevention.

The usual definition of health disparities refers to differences in the quality of care patients receive within the health care system, as well as differences in access to care, including preventive and curative services, Dr. Jones said at a meeting of the federal Advisory Committee on Minority Health.

However, “differences in life opportunities, exposures, and stresses that result in differences in underlying health status” also must be taken into account. So although health is partly determined by medical care and public health conditions, “it clearly extends beyond these [factors],” she said.

Dr. Jones said the social determinants of health include individual behaviors, such as what people choose to eat; individual resources, such as education, occupation, income, and wealth; neighborhood resources, such as housing, available grocery and dining choices, public safety, transportation, parks and recreation, and political clout; hazards and toxic exposures; and opportunity structures.

Therefore, reducing health disparities requires intervention in societal structures and attention to systems of power, said Dr. Jones, who is the CDC's research director on social determinants of health and equity. “We must address the social determinants of health, including poverty but also social determinants of equity, [such as] racism, in order to achieve social justice and eliminate health disparities,” she said.

Progress in eliminating health disparities has been slow because the country has been “pruning [the problem] instead of getting to the root,” she said. For example, it could be hypothesized that racism is a fundamental cause of disparities in health. (See box.)

Dr. Jones cited a U.N. treaty–the International Convention on the Elimination of All Forms of Racial Discrimination–that the United States signed in 1966 and ratified in 1994.

The U.N. has recommended that the United States establish a mechanism to ensure compliance with the treaty against racism at the federal, state, and local levels.

Responding to this directive might focus more attention on the ramifications of racism, Dr. Jones said.

Impact of Race, Ethnicity on Health

When people think about how racism affects health, the stress of being discriminated against often comes to mind, but there's another dimension as well, according to Dr. Jones.

A 2004 survey by the federal government found that the way people are perceived racially by others affects their perceived health status. Researchers asked more than 30,000 people to list both their actual race and the race others perceived them to be. They were also asked for perceptions of their own health status.

The results showed that, for example, Hispanics who were perceived by others as Hispanic responded less often that their health was “excellent” or “very good” (40%), compared with Hispanics who were perceived as white (54%). And the latter group had a lower percentage of “excellent” or “very good” responses, compared with whites who were perceived as white (59%).

The differences were similar among American Indians/Alaska Natives (AIANs), who comprised a small subgroup of respondents (321 people). Among those who both perceived themselves to be AIANs and were perceived that way by others, 32% reported themselves in “excellent” or “very good” health, compared with 53% of AIANs who were perceived to be white.

People who are usually classified by others as being white are significantly more likely to report that they are in excellent or very good health. “We live in a society that structures opportunities and assigns value based on how you look,” she said.

WASHINGTON – The definition of “health disparities” should be broadened to include the conditions that caused the affected groups to have poor health in the first place, according to Dr. Camara Jones of the Centers for Disease Control and Prevention.

The usual definition of health disparities refers to differences in the quality of care patients receive within the health care system, as well as differences in access to care, including preventive and curative services, Dr. Jones said at a meeting of the federal Advisory Committee on Minority Health.

However, “differences in life opportunities, exposures, and stresses that result in differences in underlying health status” also must be taken into account. So although health is partly determined by medical care and public health conditions, “it clearly extends beyond these [factors],” she said.

Dr. Jones said the social determinants of health include individual behaviors, such as what people choose to eat; individual resources, such as education, occupation, income, and wealth; neighborhood resources, such as housing, available grocery and dining choices, public safety, transportation, parks and recreation, and political clout; hazards and toxic exposures; and opportunity structures.

Therefore, reducing health disparities requires intervention in societal structures and attention to systems of power, said Dr. Jones, who is the CDC's research director on social determinants of health and equity. “We must address the social determinants of health, including poverty but also social determinants of equity, [such as] racism, in order to achieve social justice and eliminate health disparities,” she said.

Progress in eliminating health disparities has been slow because the country has been “pruning [the problem] instead of getting to the root,” she said. For example, it could be hypothesized that racism is a fundamental cause of disparities in health. (See box.)

Dr. Jones cited a U.N. treaty–the International Convention on the Elimination of All Forms of Racial Discrimination–that the United States signed in 1966 and ratified in 1994.

The U.N. has recommended that the United States establish a mechanism to ensure compliance with the treaty against racism at the federal, state, and local levels.

Responding to this directive might focus more attention on the ramifications of racism, Dr. Jones said.

Impact of Race, Ethnicity on Health

When people think about how racism affects health, the stress of being discriminated against often comes to mind, but there's another dimension as well, according to Dr. Jones.

A 2004 survey by the federal government found that the way people are perceived racially by others affects their perceived health status. Researchers asked more than 30,000 people to list both their actual race and the race others perceived them to be. They were also asked for perceptions of their own health status.

The results showed that, for example, Hispanics who were perceived by others as Hispanic responded less often that their health was “excellent” or “very good” (40%), compared with Hispanics who were perceived as white (54%). And the latter group had a lower percentage of “excellent” or “very good” responses, compared with whites who were perceived as white (59%).

The differences were similar among American Indians/Alaska Natives (AIANs), who comprised a small subgroup of respondents (321 people). Among those who both perceived themselves to be AIANs and were perceived that way by others, 32% reported themselves in “excellent” or “very good” health, compared with 53% of AIANs who were perceived to be white.

People who are usually classified by others as being white are significantly more likely to report that they are in excellent or very good health. “We live in a society that structures opportunities and assigns value based on how you look,” she said.

WASHINGTON – The definition of “health disparities” should be broadened to include the conditions that caused the affected groups to have poor health in the first place, according to Dr. Camara Jones of the Centers for Disease Control and Prevention.

The usual definition of health disparities refers to differences in the quality of care patients receive within the health care system, as well as differences in access to care, including preventive and curative services, Dr. Jones said at a meeting of the federal Advisory Committee on Minority Health.

However, “differences in life opportunities, exposures, and stresses that result in differences in underlying health status” also must be taken into account. So although health is partly determined by medical care and public health conditions, “it clearly extends beyond these [factors],” she said.

Dr. Jones said the social determinants of health include individual behaviors, such as what people choose to eat; individual resources, such as education, occupation, income, and wealth; neighborhood resources, such as housing, available grocery and dining choices, public safety, transportation, parks and recreation, and political clout; hazards and toxic exposures; and opportunity structures.

Therefore, reducing health disparities requires intervention in societal structures and attention to systems of power, said Dr. Jones, who is the CDC's research director on social determinants of health and equity. “We must address the social determinants of health, including poverty but also social determinants of equity, [such as] racism, in order to achieve social justice and eliminate health disparities,” she said.

Progress in eliminating health disparities has been slow because the country has been “pruning [the problem] instead of getting to the root,” she said. For example, it could be hypothesized that racism is a fundamental cause of disparities in health. (See box.)

Dr. Jones cited a U.N. treaty–the International Convention on the Elimination of All Forms of Racial Discrimination–that the United States signed in 1966 and ratified in 1994.

The U.N. has recommended that the United States establish a mechanism to ensure compliance with the treaty against racism at the federal, state, and local levels.

Responding to this directive might focus more attention on the ramifications of racism, Dr. Jones said.

Impact of Race, Ethnicity on Health

When people think about how racism affects health, the stress of being discriminated against often comes to mind, but there's another dimension as well, according to Dr. Jones.

A 2004 survey by the federal government found that the way people are perceived racially by others affects their perceived health status. Researchers asked more than 30,000 people to list both their actual race and the race others perceived them to be. They were also asked for perceptions of their own health status.

The results showed that, for example, Hispanics who were perceived by others as Hispanic responded less often that their health was “excellent” or “very good” (40%), compared with Hispanics who were perceived as white (54%). And the latter group had a lower percentage of “excellent” or “very good” responses, compared with whites who were perceived as white (59%).

The differences were similar among American Indians/Alaska Natives (AIANs), who comprised a small subgroup of respondents (321 people). Among those who both perceived themselves to be AIANs and were perceived that way by others, 32% reported themselves in “excellent” or “very good” health, compared with 53% of AIANs who were perceived to be white.

People who are usually classified by others as being white are significantly more likely to report that they are in excellent or very good health. “We live in a society that structures opportunities and assigns value based on how you look,” she said.

WASHINGTON — After more than a decade of steady gains, health plans are seeing some quality improvement scores plateau, said a report from the National Committee for Quality Assurance.

“We feel frustrated that we don't seem to put our power behind what we really want,” NCQA president Margaret E. O'Kane said at a press briefing announcing the results. “The status quo is still unacceptable.”

The report included 2008 data from a record 979 plans—702 health maintenance organizations and 277 preferred provider organizations—that collectively cover 116 million Americans.

Plans did record improvement on a few measures. For example, on average, 79.1% of patients in commercial plans were successfully monitored while taking certain medications such as diuretics, up from 74.4% in 2006. And among Medicare Advantage plans, the percentage of heart attack patients who received beta-blockers at discharge and stayed on them for at least 6 months climbed 10.1 percentage points, to an average of 79.7%.

Some areas seemed to plateau because they had reached their maximum potential: For instance, the percentage of children and adults with persistent asthma who were prescribed asthma medications stayed steady at more than 92%.

But there is room for improvement in other areas, Ms. O'Kane said. Among commercial plans, for example, 57% of measures showed no statistically significant improvement from 2006 to 2008; that figure was 64% in Medicaid plans and 86% in Medicare plans. Specifically, among Medicare Advantage plan members, no improvement was seen on measures assessing medication use in arthritis or screening for cervical cancer. Also, the percentage of Medicare patients with poor blood sugar control did not decline.

Measures with overall plan compliance below 50% included follow-up of children on ADHD medications (34%), initiation of alcohol/drug dependency treatment (43%), and monitoring of patients on antidepressants (46%).

Although the recession has taken its toll on some plans' quality budgets, Ms. O'Kane noted that some health plans achieved quality ratings in the highest quartile for care of diabetes patients even as they were in the lowest quartile for expenditures on those patients. Emulating those plans “is where the trend should be moving,” she said.

Vernon Smith, Ph.D., a former Medicaid director currently at consulting firm Health Management Associates, said part of the plateau for Medicaid plans may come from tight state budgets.

“States are in no position right now to undertake new quality initiatives on their own,” he said. “So the impetus really must come at the federal level.”

Ms. O'Kane had several recommendations for moving quality improvement forward:

▸ Create insurance exchanges and require plans to report quality and patient satisfaction data.

▸ Tie payment to performance.

▸ Expand demonstrations of the patient-centered medical home, and increase payments for primary care.

▸ Provide funding for developing, maintaining, and updating quality measures.

▸ Introduce quality bonuses for Medicare Advantage plans.

▸ Invest in Medicaid measure development.

The data were incomplete because some health plans didn't submit data and because fee-for-service programs—such as Medicare—typically do not have quality tracking mechanisms, which was a limitation of the report, Ms. O'Kane noted. “We lack comprehensive data for 83% of Medicare beneficiaries, 75% of Medicaid beneficiaries, and 44% of commercially insured patients,” she said.

WASHINGTON — After more than a decade of steady gains, health plans are seeing some quality improvement scores plateau, said a report from the National Committee for Quality Assurance.

“We feel frustrated that we don't seem to put our power behind what we really want,” NCQA president Margaret E. O'Kane said at a press briefing announcing the results. “The status quo is still unacceptable.”

The report included 2008 data from a record 979 plans—702 health maintenance organizations and 277 preferred provider organizations—that collectively cover 116 million Americans.

Plans did record improvement on a few measures. For example, on average, 79.1% of patients in commercial plans were successfully monitored while taking certain medications such as diuretics, up from 74.4% in 2006. And among Medicare Advantage plans, the percentage of heart attack patients who received beta-blockers at discharge and stayed on them for at least 6 months climbed 10.1 percentage points, to an average of 79.7%.

Some areas seemed to plateau because they had reached their maximum potential: For instance, the percentage of children and adults with persistent asthma who were prescribed asthma medications stayed steady at more than 92%.

But there is room for improvement in other areas, Ms. O'Kane said. Among commercial plans, for example, 57% of measures showed no statistically significant improvement from 2006 to 2008; that figure was 64% in Medicaid plans and 86% in Medicare plans. Specifically, among Medicare Advantage plan members, no improvement was seen on measures assessing medication use in arthritis or screening for cervical cancer. Also, the percentage of Medicare patients with poor blood sugar control did not decline.

Measures with overall plan compliance below 50% included follow-up of children on ADHD medications (34%), initiation of alcohol/drug dependency treatment (43%), and monitoring of patients on antidepressants (46%).

Although the recession has taken its toll on some plans' quality budgets, Ms. O'Kane noted that some health plans achieved quality ratings in the highest quartile for care of diabetes patients even as they were in the lowest quartile for expenditures on those patients. Emulating those plans “is where the trend should be moving,” she said.

Vernon Smith, Ph.D., a former Medicaid director currently at consulting firm Health Management Associates, said part of the plateau for Medicaid plans may come from tight state budgets.

“States are in no position right now to undertake new quality initiatives on their own,” he said. “So the impetus really must come at the federal level.”

Ms. O'Kane had several recommendations for moving quality improvement forward:

▸ Create insurance exchanges and require plans to report quality and patient satisfaction data.

▸ Tie payment to performance.

▸ Expand demonstrations of the patient-centered medical home, and increase payments for primary care.

▸ Provide funding for developing, maintaining, and updating quality measures.

▸ Introduce quality bonuses for Medicare Advantage plans.

▸ Invest in Medicaid measure development.

The data were incomplete because some health plans didn't submit data and because fee-for-service programs—such as Medicare—typically do not have quality tracking mechanisms, which was a limitation of the report, Ms. O'Kane noted. “We lack comprehensive data for 83% of Medicare beneficiaries, 75% of Medicaid beneficiaries, and 44% of commercially insured patients,” she said.

WASHINGTON — After more than a decade of steady gains, health plans are seeing some quality improvement scores plateau, said a report from the National Committee for Quality Assurance.

“We feel frustrated that we don't seem to put our power behind what we really want,” NCQA president Margaret E. O'Kane said at a press briefing announcing the results. “The status quo is still unacceptable.”

The report included 2008 data from a record 979 plans—702 health maintenance organizations and 277 preferred provider organizations—that collectively cover 116 million Americans.

Plans did record improvement on a few measures. For example, on average, 79.1% of patients in commercial plans were successfully monitored while taking certain medications such as diuretics, up from 74.4% in 2006. And among Medicare Advantage plans, the percentage of heart attack patients who received beta-blockers at discharge and stayed on them for at least 6 months climbed 10.1 percentage points, to an average of 79.7%.

Some areas seemed to plateau because they had reached their maximum potential: For instance, the percentage of children and adults with persistent asthma who were prescribed asthma medications stayed steady at more than 92%.

But there is room for improvement in other areas, Ms. O'Kane said. Among commercial plans, for example, 57% of measures showed no statistically significant improvement from 2006 to 2008; that figure was 64% in Medicaid plans and 86% in Medicare plans. Specifically, among Medicare Advantage plan members, no improvement was seen on measures assessing medication use in arthritis or screening for cervical cancer. Also, the percentage of Medicare patients with poor blood sugar control did not decline.

Measures with overall plan compliance below 50% included follow-up of children on ADHD medications (34%), initiation of alcohol/drug dependency treatment (43%), and monitoring of patients on antidepressants (46%).

Although the recession has taken its toll on some plans' quality budgets, Ms. O'Kane noted that some health plans achieved quality ratings in the highest quartile for care of diabetes patients even as they were in the lowest quartile for expenditures on those patients. Emulating those plans “is where the trend should be moving,” she said.

Vernon Smith, Ph.D., a former Medicaid director currently at consulting firm Health Management Associates, said part of the plateau for Medicaid plans may come from tight state budgets.

“States are in no position right now to undertake new quality initiatives on their own,” he said. “So the impetus really must come at the federal level.”

Ms. O'Kane had several recommendations for moving quality improvement forward:

▸ Create insurance exchanges and require plans to report quality and patient satisfaction data.

▸ Tie payment to performance.

▸ Expand demonstrations of the patient-centered medical home, and increase payments for primary care.

▸ Provide funding for developing, maintaining, and updating quality measures.

▸ Introduce quality bonuses for Medicare Advantage plans.

▸ Invest in Medicaid measure development.

The data were incomplete because some health plans didn't submit data and because fee-for-service programs—such as Medicare—typically do not have quality tracking mechanisms, which was a limitation of the report, Ms. O'Kane noted. “We lack comprehensive data for 83% of Medicare beneficiaries, 75% of Medicaid beneficiaries, and 44% of commercially insured patients,” she said.

Physicians and other health professionals participating in Medicare's Physician Quality Reporting Initiative received a total of $92 million in incentive payments under the program in 2008, the Centers for Medicare and Medicaid Services announced.

That figure is nearly three times the $36 million paid out in 2007, the agency noted. The number of medical professionals receiving payments also increased during the same period, from 57,000 to 85,000. The average payment in 2008 was more than $1,000, with the largest single payment at $98,000. During 2007, the reporting period lasted only 6 months for all participants, while in 2008 participants could report for a 6- or 12-month period.

“More health professionals have successfully reported data, and the substantial growth in the national total for PQRI incentive payments demonstrates that Medicare can align payment with quality incentives,” acting CMS administrator Charlene Frizerra said in a statement.

Under Medicare's PQRI program, providers receive incentive payments for reporting data on quality measures. The incentive payments currently amount to 1.5% of each provider's total estimated allowed charges under Medicare Part B. Although more than 153,000 health professionals participated in the program during 2008, only 85,000 met the requirements for satisfactory reporting and therefore received incentive payments.

To make participation easier, the CMS expanded the number of reportable measures, from 74 in 2007 to 119 in 2008. The states with the highest overall provider payments were Florida ($7.5 million) and Illinois ($6 million).

Physicians and other health professionals participating in Medicare's Physician Quality Reporting Initiative received a total of $92 million in incentive payments under the program in 2008, the Centers for Medicare and Medicaid Services announced.

That figure is nearly three times the $36 million paid out in 2007, the agency noted. The number of medical professionals receiving payments also increased during the same period, from 57,000 to 85,000. The average payment in 2008 was more than $1,000, with the largest single payment at $98,000. During 2007, the reporting period lasted only 6 months for all participants, while in 2008 participants could report for a 6- or 12-month period.

“More health professionals have successfully reported data, and the substantial growth in the national total for PQRI incentive payments demonstrates that Medicare can align payment with quality incentives,” acting CMS administrator Charlene Frizerra said in a statement.

Under Medicare's PQRI program, providers receive incentive payments for reporting data on quality measures. The incentive payments currently amount to 1.5% of each provider's total estimated allowed charges under Medicare Part B. Although more than 153,000 health professionals participated in the program during 2008, only 85,000 met the requirements for satisfactory reporting and therefore received incentive payments.

To make participation easier, the CMS expanded the number of reportable measures, from 74 in 2007 to 119 in 2008. The states with the highest overall provider payments were Florida ($7.5 million) and Illinois ($6 million).

Physicians and other health professionals participating in Medicare's Physician Quality Reporting Initiative received a total of $92 million in incentive payments under the program in 2008, the Centers for Medicare and Medicaid Services announced.

That figure is nearly three times the $36 million paid out in 2007, the agency noted. The number of medical professionals receiving payments also increased during the same period, from 57,000 to 85,000. The average payment in 2008 was more than $1,000, with the largest single payment at $98,000. During 2007, the reporting period lasted only 6 months for all participants, while in 2008 participants could report for a 6- or 12-month period.

“More health professionals have successfully reported data, and the substantial growth in the national total for PQRI incentive payments demonstrates that Medicare can align payment with quality incentives,” acting CMS administrator Charlene Frizerra said in a statement.

Under Medicare's PQRI program, providers receive incentive payments for reporting data on quality measures. The incentive payments currently amount to 1.5% of each provider's total estimated allowed charges under Medicare Part B. Although more than 153,000 health professionals participated in the program during 2008, only 85,000 met the requirements for satisfactory reporting and therefore received incentive payments.

To make participation easier, the CMS expanded the number of reportable measures, from 74 in 2007 to 119 in 2008. The states with the highest overall provider payments were Florida ($7.5 million) and Illinois ($6 million).