Frances Correa

The number of hospital palliative care teams has soared over the past decade, including a 138% increase at institutions with more than 50 beds, according to the Center to Advance Palliative Care (CAPC).

The center looked at data from the American Hospital Association’s Annual Survey and the National Palliative Care Registry from 2000 to 2009. Of the 2,489 hospitals studied, 1,568 (63%) reported having a palliative care team.

Uptake was greater at large hospitals. Among the 699 hospitals with more then 300 beds, 85% had teams, compared with 54% for those with 50-299 beds.

Among the 1,500 hospitals with fewer than 50 beds, only 22% reported having a team, but these smaller institutions were excluded from further analysis.

The rate was lowest in the South, with only 51% of hospitals reporting a team, compared with 73% in the Northeast. In addition, 72% of hospitals in the Midwest, and 68% of hospitals in the West said they had a team.

Palliative care has been a topic of controversy since the implementation of the Affordable Care Act, which contains a provision in Medicare that would reimburse doctors for counseling elderly patients on end-of-life issues and palliative care. Opponents to the provision argued that it would encourage doctors to withhold care from elderly patients.

At a policy summit in March, health experts voiced support for increasing palliative care, arguing that it improved the quality of life for elderly patients.

"The quality of a patient’s life goes up. The quality of the family’s life goes up. More patients die at home, which is where 80% of Americans say they’d like to die," said Dr. Allen S. Lichter, a panelist at the summit. "Now, when you do the cost analysis, it happens to save money. That’s the sprinkles on the icing on the top of the cake – that’s not the cake."

Dr. Lichter, chief executive officer of the American Society of Clinical Oncology,* added that physicians should focus on making patients comfortable in their last days, instead of offering "false hope for a cure."

"Palliative care teams are transforming the care of serious illness in this country because they address the fragmentation of the health care system and put control and choice back in the hands of the patient and family," said CAPC director Dr. Diane E. Meier in a statement. "Hospitals today recognize that palliative care is the key to delivering better quality, coordinated care to our sickest and most vulnerable patients."

Regardless of the controversy among the experts, a CAPC poll showed that 70% of Americans don’t know what palliative care is. The center conducted the poll through a combination of one-on-one interviews with caregivers, Internet focus groups, and a telephone survey of 800 adults aged 25 years and older. Currently, 90 million Americans are living with chronic conditions and that number will only increase as the baby boomers age, CAPC said.

*Correction, 8/18/2011: An earlier version of this story incorrectly identified Dr. Lichter's affiliation.

The number of hospital palliative care teams has soared over the past decade, including a 138% increase at institutions with more than 50 beds, according to the Center to Advance Palliative Care (CAPC).

The center looked at data from the American Hospital Association’s Annual Survey and the National Palliative Care Registry from 2000 to 2009. Of the 2,489 hospitals studied, 1,568 (63%) reported having a palliative care team.

Uptake was greater at large hospitals. Among the 699 hospitals with more then 300 beds, 85% had teams, compared with 54% for those with 50-299 beds.

Among the 1,500 hospitals with fewer than 50 beds, only 22% reported having a team, but these smaller institutions were excluded from further analysis.

The rate was lowest in the South, with only 51% of hospitals reporting a team, compared with 73% in the Northeast. In addition, 72% of hospitals in the Midwest, and 68% of hospitals in the West said they had a team.

Palliative care has been a topic of controversy since the implementation of the Affordable Care Act, which contains a provision in Medicare that would reimburse doctors for counseling elderly patients on end-of-life issues and palliative care. Opponents to the provision argued that it would encourage doctors to withhold care from elderly patients.

At a policy summit in March, health experts voiced support for increasing palliative care, arguing that it improved the quality of life for elderly patients.

"The quality of a patient’s life goes up. The quality of the family’s life goes up. More patients die at home, which is where 80% of Americans say they’d like to die," said Dr. Allen S. Lichter, a panelist at the summit. "Now, when you do the cost analysis, it happens to save money. That’s the sprinkles on the icing on the top of the cake – that’s not the cake."

Dr. Lichter, chief executive officer of the American Society of Clinical Oncology,* added that physicians should focus on making patients comfortable in their last days, instead of offering "false hope for a cure."

"Palliative care teams are transforming the care of serious illness in this country because they address the fragmentation of the health care system and put control and choice back in the hands of the patient and family," said CAPC director Dr. Diane E. Meier in a statement. "Hospitals today recognize that palliative care is the key to delivering better quality, coordinated care to our sickest and most vulnerable patients."

Regardless of the controversy among the experts, a CAPC poll showed that 70% of Americans don’t know what palliative care is. The center conducted the poll through a combination of one-on-one interviews with caregivers, Internet focus groups, and a telephone survey of 800 adults aged 25 years and older. Currently, 90 million Americans are living with chronic conditions and that number will only increase as the baby boomers age, CAPC said.

*Correction, 8/18/2011: An earlier version of this story incorrectly identified Dr. Lichter's affiliation.

The number of hospital palliative care teams has soared over the past decade, including a 138% increase at institutions with more than 50 beds, according to the Center to Advance Palliative Care (CAPC).

The center looked at data from the American Hospital Association’s Annual Survey and the National Palliative Care Registry from 2000 to 2009. Of the 2,489 hospitals studied, 1,568 (63%) reported having a palliative care team.

Uptake was greater at large hospitals. Among the 699 hospitals with more then 300 beds, 85% had teams, compared with 54% for those with 50-299 beds.

Among the 1,500 hospitals with fewer than 50 beds, only 22% reported having a team, but these smaller institutions were excluded from further analysis.

The rate was lowest in the South, with only 51% of hospitals reporting a team, compared with 73% in the Northeast. In addition, 72% of hospitals in the Midwest, and 68% of hospitals in the West said they had a team.

Palliative care has been a topic of controversy since the implementation of the Affordable Care Act, which contains a provision in Medicare that would reimburse doctors for counseling elderly patients on end-of-life issues and palliative care. Opponents to the provision argued that it would encourage doctors to withhold care from elderly patients.

At a policy summit in March, health experts voiced support for increasing palliative care, arguing that it improved the quality of life for elderly patients.

"The quality of a patient’s life goes up. The quality of the family’s life goes up. More patients die at home, which is where 80% of Americans say they’d like to die," said Dr. Allen S. Lichter, a panelist at the summit. "Now, when you do the cost analysis, it happens to save money. That’s the sprinkles on the icing on the top of the cake – that’s not the cake."

Dr. Lichter, chief executive officer of the American Society of Clinical Oncology,* added that physicians should focus on making patients comfortable in their last days, instead of offering "false hope for a cure."

"Palliative care teams are transforming the care of serious illness in this country because they address the fragmentation of the health care system and put control and choice back in the hands of the patient and family," said CAPC director Dr. Diane E. Meier in a statement. "Hospitals today recognize that palliative care is the key to delivering better quality, coordinated care to our sickest and most vulnerable patients."

Regardless of the controversy among the experts, a CAPC poll showed that 70% of Americans don’t know what palliative care is. The center conducted the poll through a combination of one-on-one interviews with caregivers, Internet focus groups, and a telephone survey of 800 adults aged 25 years and older. Currently, 90 million Americans are living with chronic conditions and that number will only increase as the baby boomers age, CAPC said.

*Correction, 8/18/2011: An earlier version of this story incorrectly identified Dr. Lichter's affiliation.

At a time when hospitals are looking for ways to optimize their performance, a recent study suggests an association between physician-led hospitals and high performance ratings.

Among 1,859 hospitals that were analyzed in the specialties of cancer, digestive disorders, and heart surgery, physician-led hospitals scored more than 25% higher than did those with nonphysicians managers, averaging 8-9 points more in their hospital quality ratings, according to Amanda Goodall, Ph.D., a senior research fellow at the Institute for the Study of Labor, Bonn, Germany. She analyzed data from performance ratings for the top 100 hospitals as ranked by U.S. News & World Report in 2009.

Hospital quality points were awarded based on quality measurements including mortality rates, nurse staffing, physician decision making, the number of discharges, and availability of necessary technologies.

The fact that the number of physician-led hospitals has declined by 90% (from 35% in 1935 to 4% today) has contributed to the ailing U.S. health care system, according to Dr. Richard Gunderman of Indiana University, Indianapolis, who has written about physicians as hospital leaders (Acad. Med.2009;84:1348-51). One of the reasons our health care system "is in such sorry shape" is the fact that many of the chief executives of our hospitals and health care corporations see the hospital primarily as a business whose product happens to be health care, Dr. Gunderman said.

He added that the qualities of a good doctor and a good manager are closely linked. "Studying structure and function and using it to improve coordination and performance is second nature to physicians. We need to provide physicians opportunities to better understand the structure and function of hospitals and [other health care organizations], so that they can use that understanding to help hospitals perform better."

The change, Dr. Gunderman said, needs to come from within the medical school curriculum.

"The organizational dimension of medicine (as opposed to the molecular, cellular, and other dimensions) has been crowded out of the curricula of medical schools and residency programs," he said.

Although the idea of doctors as hospital chiefs may have support within the medical community, Dr. Goodall said, further analysis is necessary to assess the tangible effects of physician CEOs vs. a business manager.

At a time when hospitals are looking for ways to optimize their performance, a recent study suggests an association between physician-led hospitals and high performance ratings.

Among 1,859 hospitals that were analyzed in the specialties of cancer, digestive disorders, and heart surgery, physician-led hospitals scored more than 25% higher than did those with nonphysicians managers, averaging 8-9 points more in their hospital quality ratings, according to Amanda Goodall, Ph.D., a senior research fellow at the Institute for the Study of Labor, Bonn, Germany. She analyzed data from performance ratings for the top 100 hospitals as ranked by U.S. News & World Report in 2009.

Hospital quality points were awarded based on quality measurements including mortality rates, nurse staffing, physician decision making, the number of discharges, and availability of necessary technologies.

The fact that the number of physician-led hospitals has declined by 90% (from 35% in 1935 to 4% today) has contributed to the ailing U.S. health care system, according to Dr. Richard Gunderman of Indiana University, Indianapolis, who has written about physicians as hospital leaders (Acad. Med.2009;84:1348-51). One of the reasons our health care system "is in such sorry shape" is the fact that many of the chief executives of our hospitals and health care corporations see the hospital primarily as a business whose product happens to be health care, Dr. Gunderman said.

He added that the qualities of a good doctor and a good manager are closely linked. "Studying structure and function and using it to improve coordination and performance is second nature to physicians. We need to provide physicians opportunities to better understand the structure and function of hospitals and [other health care organizations], so that they can use that understanding to help hospitals perform better."

The change, Dr. Gunderman said, needs to come from within the medical school curriculum.

"The organizational dimension of medicine (as opposed to the molecular, cellular, and other dimensions) has been crowded out of the curricula of medical schools and residency programs," he said.

Although the idea of doctors as hospital chiefs may have support within the medical community, Dr. Goodall said, further analysis is necessary to assess the tangible effects of physician CEOs vs. a business manager.

At a time when hospitals are looking for ways to optimize their performance, a recent study suggests an association between physician-led hospitals and high performance ratings.

Among 1,859 hospitals that were analyzed in the specialties of cancer, digestive disorders, and heart surgery, physician-led hospitals scored more than 25% higher than did those with nonphysicians managers, averaging 8-9 points more in their hospital quality ratings, according to Amanda Goodall, Ph.D., a senior research fellow at the Institute for the Study of Labor, Bonn, Germany. She analyzed data from performance ratings for the top 100 hospitals as ranked by U.S. News & World Report in 2009.

Hospital quality points were awarded based on quality measurements including mortality rates, nurse staffing, physician decision making, the number of discharges, and availability of necessary technologies.

The fact that the number of physician-led hospitals has declined by 90% (from 35% in 1935 to 4% today) has contributed to the ailing U.S. health care system, according to Dr. Richard Gunderman of Indiana University, Indianapolis, who has written about physicians as hospital leaders (Acad. Med.2009;84:1348-51). One of the reasons our health care system "is in such sorry shape" is the fact that many of the chief executives of our hospitals and health care corporations see the hospital primarily as a business whose product happens to be health care, Dr. Gunderman said.

He added that the qualities of a good doctor and a good manager are closely linked. "Studying structure and function and using it to improve coordination and performance is second nature to physicians. We need to provide physicians opportunities to better understand the structure and function of hospitals and [other health care organizations], so that they can use that understanding to help hospitals perform better."

The change, Dr. Gunderman said, needs to come from within the medical school curriculum.

"The organizational dimension of medicine (as opposed to the molecular, cellular, and other dimensions) has been crowded out of the curricula of medical schools and residency programs," he said.

Although the idea of doctors as hospital chiefs may have support within the medical community, Dr. Goodall said, further analysis is necessary to assess the tangible effects of physician CEOs vs. a business manager.

Consumer Operated and Oriented Plans insurers will provide more health plan options for individuals and small businesses, officials from the Centers for Medicare and Medicaid Services said July 18.

The new insurers "will provide consumers more choices, greater plan accountability, and help ensure a more competitive insurance market," Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at CMS, said during a press briefing to announce the proposed rule on CO-OPs. He added that he hopes CO-OPs will provide affordable options for small businesses that often pay up to 18% more in health care costs than large businesses.

While health insurance plans created under the CO-OP program will have requirements similar to those of plans offered through state exchanges, CO-OP plans will be required to use any profits they make to lower premiums, improve the quality of care, or improve benefits available to consumers.

In addition, CO-OP plans will be governed by a board composed chiefly of plan members elected by their peers, and enrollees will have the opportunity to help decide the direction of health plans. CO-OPs will also be required to tailor two-thirds of their plans to serve either individuals or small businesses.

CMS will be issuing $3.8 billion in start-up and capital loans for CO-OP insurers. They will also be evaluating potential insurers for their potential financial viability, to ensure that they will be able to turn a profit.

Despite opportunity for consumer benefits, CMS is also bracing for potential costs, including default on the loans. According to the proposed rule, CMS estimates that 35% of solvency loans and 40% of start-up loans may not be repaid. The rule also states that the CMS estimates spending $600 million for start-up loans and $3.2 million for solvency loans. Start-up loans must be repaid in 5 years, and capital, or solvency, loans must be paid in 15 years. However, Mr. Larsen said those estimates are "conservative," and the actual expectation is a much lower rate of default.

"Our role in terms of due diligence and oversight and evaluation of the business plan is to make sure that the money goes out to entities that create sound business plans," Mr. Larsen said.

He added that the agency will be pushing to have a CO-OP available in every state. So far, the agency estimates 57 entities will participate in the program. Rhode Island and Texas have announced that they plan to have a CO-OP available. Existing health CO-OPs include Puget Sound Health CO-OP in Washington and the Health Partners CO-OP that operates in Wisconsin and Minnesota.

CMS will accept comments on the proposed rule for 60 days after it is officially published in the Federal Register.

Consumer Operated and Oriented Plans insurers will provide more health plan options for individuals and small businesses, officials from the Centers for Medicare and Medicaid Services said July 18.

The new insurers "will provide consumers more choices, greater plan accountability, and help ensure a more competitive insurance market," Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at CMS, said during a press briefing to announce the proposed rule on CO-OPs. He added that he hopes CO-OPs will provide affordable options for small businesses that often pay up to 18% more in health care costs than large businesses.

While health insurance plans created under the CO-OP program will have requirements similar to those of plans offered through state exchanges, CO-OP plans will be required to use any profits they make to lower premiums, improve the quality of care, or improve benefits available to consumers.

In addition, CO-OP plans will be governed by a board composed chiefly of plan members elected by their peers, and enrollees will have the opportunity to help decide the direction of health plans. CO-OPs will also be required to tailor two-thirds of their plans to serve either individuals or small businesses.

CMS will be issuing $3.8 billion in start-up and capital loans for CO-OP insurers. They will also be evaluating potential insurers for their potential financial viability, to ensure that they will be able to turn a profit.

Despite opportunity for consumer benefits, CMS is also bracing for potential costs, including default on the loans. According to the proposed rule, CMS estimates that 35% of solvency loans and 40% of start-up loans may not be repaid. The rule also states that the CMS estimates spending $600 million for start-up loans and $3.2 million for solvency loans. Start-up loans must be repaid in 5 years, and capital, or solvency, loans must be paid in 15 years. However, Mr. Larsen said those estimates are "conservative," and the actual expectation is a much lower rate of default.

"Our role in terms of due diligence and oversight and evaluation of the business plan is to make sure that the money goes out to entities that create sound business plans," Mr. Larsen said.

He added that the agency will be pushing to have a CO-OP available in every state. So far, the agency estimates 57 entities will participate in the program. Rhode Island and Texas have announced that they plan to have a CO-OP available. Existing health CO-OPs include Puget Sound Health CO-OP in Washington and the Health Partners CO-OP that operates in Wisconsin and Minnesota.

CMS will accept comments on the proposed rule for 60 days after it is officially published in the Federal Register.

Consumer Operated and Oriented Plans insurers will provide more health plan options for individuals and small businesses, officials from the Centers for Medicare and Medicaid Services said July 18.

The new insurers "will provide consumers more choices, greater plan accountability, and help ensure a more competitive insurance market," Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at CMS, said during a press briefing to announce the proposed rule on CO-OPs. He added that he hopes CO-OPs will provide affordable options for small businesses that often pay up to 18% more in health care costs than large businesses.

While health insurance plans created under the CO-OP program will have requirements similar to those of plans offered through state exchanges, CO-OP plans will be required to use any profits they make to lower premiums, improve the quality of care, or improve benefits available to consumers.

In addition, CO-OP plans will be governed by a board composed chiefly of plan members elected by their peers, and enrollees will have the opportunity to help decide the direction of health plans. CO-OPs will also be required to tailor two-thirds of their plans to serve either individuals or small businesses.

CMS will be issuing $3.8 billion in start-up and capital loans for CO-OP insurers. They will also be evaluating potential insurers for their potential financial viability, to ensure that they will be able to turn a profit.

Despite opportunity for consumer benefits, CMS is also bracing for potential costs, including default on the loans. According to the proposed rule, CMS estimates that 35% of solvency loans and 40% of start-up loans may not be repaid. The rule also states that the CMS estimates spending $600 million for start-up loans and $3.2 million for solvency loans. Start-up loans must be repaid in 5 years, and capital, or solvency, loans must be paid in 15 years. However, Mr. Larsen said those estimates are "conservative," and the actual expectation is a much lower rate of default.

"Our role in terms of due diligence and oversight and evaluation of the business plan is to make sure that the money goes out to entities that create sound business plans," Mr. Larsen said.

He added that the agency will be pushing to have a CO-OP available in every state. So far, the agency estimates 57 entities will participate in the program. Rhode Island and Texas have announced that they plan to have a CO-OP available. Existing health CO-OPs include Puget Sound Health CO-OP in Washington and the Health Partners CO-OP that operates in Wisconsin and Minnesota.

CMS will accept comments on the proposed rule for 60 days after it is officially published in the Federal Register.

WASHINGTON – Partisan squabbling from both sides of the aisle was the highlight of 2 days of House committee hearings on the Independent Payment Advisory Board.

“The Affordable Care Act ends the Medicare guarantee; it ends Medicare as we know it,” chairman Paul Ryan (R-Wisc.) said during a July 12 hearing before the House Budget Committee. “Nobody is arguing against capping spending around here. The only difference is, this law empowers the [Independent Payment Advisory Board] with the unilateral power to decide how to live underneath that cap.”

Rep. Henry Waxman (D-Calif.) and Rep. Frank Pallone (D-N.J.) defended the health reform law and its capacity to improve Medicare.

“Republicans just assert [that the Affordable Care Act] doesn’t control costs and then they attack the new law’s comprehensive approach it takes to control costs,” Mr. Waxman said during a July 13 hearing of the House Energy and Commerce Committee’s Subcommittee on Health. He argued that Republicans also ignore Congressional Budget Office estimates that the Republican budget proposal could double costs for Medicare beneficiaries once the law is fully enacted in 2022.

The IPAB is a board created by the Affordable Care Act. Slated to start in 2014, the board will consist of 15 members appointed by the president, plus three ex-officio members from the Executive Branch. The IPAB will make yearly recommendation to Congress on how to stay within Medicare budget targets; if Congress does not reject the recommendations by a two-thirds majority or come up with equivalent savings of their own, the recommendations will become law automatically.

During rounds of questioning before both committees, Health and Human Services Secretary Kathleen Sebelius drove home the point that the IPAB recommendations would keep Congress in the “driver’s seat,” requiring its approval. Ms. Sebelius also argued in favor of the board’s potential to improve the health care system, and added that the Republican budget plan would do the opposite.

“I think [the IPAB] could look at a lot of the underlying rising costs, and recommend payment strategies that much more closely align what doctors tell me they really want to do,” Ms. Sebelius testified. “I would suggest that the House Republican plan just shifts costs onto seniors and those with disabilities, and does not addresses the underlying costs at all.”

IPAB opponents disagree with the requirement that the House and Senate approve IPAB recommendation by a two-thirds vote. They said that this cedes to the board powers that the Constitution gives to Congress, making the IPAB fundamentally unconstitutional.

Although the board is charged with devising recommendations to reduce costs within Medicare, it lacks the ability to increase revenue or change existing benefits. This is one of the reasons opponents argue against the board’s potential to enact further cuts in provider payments and, in their view, decrease access to care.

Rep. Tom Price (R-Ga.), who is also an orthopedic surgeon, spoke before the committee. “If I’m told by the federal government that I will not be paid for a service, what happens in my presentation of the options to that patient?

“As that treating physician, I may be coerced by the federal government into not even presenting that option to the patient,” Rep. Price said.

WASHINGTON – Partisan squabbling from both sides of the aisle was the highlight of 2 days of House committee hearings on the Independent Payment Advisory Board.

“The Affordable Care Act ends the Medicare guarantee; it ends Medicare as we know it,” chairman Paul Ryan (R-Wisc.) said during a July 12 hearing before the House Budget Committee. “Nobody is arguing against capping spending around here. The only difference is, this law empowers the [Independent Payment Advisory Board] with the unilateral power to decide how to live underneath that cap.”

Rep. Henry Waxman (D-Calif.) and Rep. Frank Pallone (D-N.J.) defended the health reform law and its capacity to improve Medicare.

“Republicans just assert [that the Affordable Care Act] doesn’t control costs and then they attack the new law’s comprehensive approach it takes to control costs,” Mr. Waxman said during a July 13 hearing of the House Energy and Commerce Committee’s Subcommittee on Health. He argued that Republicans also ignore Congressional Budget Office estimates that the Republican budget proposal could double costs for Medicare beneficiaries once the law is fully enacted in 2022.

The IPAB is a board created by the Affordable Care Act. Slated to start in 2014, the board will consist of 15 members appointed by the president, plus three ex-officio members from the Executive Branch. The IPAB will make yearly recommendation to Congress on how to stay within Medicare budget targets; if Congress does not reject the recommendations by a two-thirds majority or come up with equivalent savings of their own, the recommendations will become law automatically.

During rounds of questioning before both committees, Health and Human Services Secretary Kathleen Sebelius drove home the point that the IPAB recommendations would keep Congress in the “driver’s seat,” requiring its approval. Ms. Sebelius also argued in favor of the board’s potential to improve the health care system, and added that the Republican budget plan would do the opposite.

“I think [the IPAB] could look at a lot of the underlying rising costs, and recommend payment strategies that much more closely align what doctors tell me they really want to do,” Ms. Sebelius testified. “I would suggest that the House Republican plan just shifts costs onto seniors and those with disabilities, and does not addresses the underlying costs at all.”

IPAB opponents disagree with the requirement that the House and Senate approve IPAB recommendation by a two-thirds vote. They said that this cedes to the board powers that the Constitution gives to Congress, making the IPAB fundamentally unconstitutional.

Although the board is charged with devising recommendations to reduce costs within Medicare, it lacks the ability to increase revenue or change existing benefits. This is one of the reasons opponents argue against the board’s potential to enact further cuts in provider payments and, in their view, decrease access to care.

Rep. Tom Price (R-Ga.), who is also an orthopedic surgeon, spoke before the committee. “If I’m told by the federal government that I will not be paid for a service, what happens in my presentation of the options to that patient?

“As that treating physician, I may be coerced by the federal government into not even presenting that option to the patient,” Rep. Price said.

WASHINGTON – Partisan squabbling from both sides of the aisle was the highlight of 2 days of House committee hearings on the Independent Payment Advisory Board.

“The Affordable Care Act ends the Medicare guarantee; it ends Medicare as we know it,” chairman Paul Ryan (R-Wisc.) said during a July 12 hearing before the House Budget Committee. “Nobody is arguing against capping spending around here. The only difference is, this law empowers the [Independent Payment Advisory Board] with the unilateral power to decide how to live underneath that cap.”

Rep. Henry Waxman (D-Calif.) and Rep. Frank Pallone (D-N.J.) defended the health reform law and its capacity to improve Medicare.

“Republicans just assert [that the Affordable Care Act] doesn’t control costs and then they attack the new law’s comprehensive approach it takes to control costs,” Mr. Waxman said during a July 13 hearing of the House Energy and Commerce Committee’s Subcommittee on Health. He argued that Republicans also ignore Congressional Budget Office estimates that the Republican budget proposal could double costs for Medicare beneficiaries once the law is fully enacted in 2022.

The IPAB is a board created by the Affordable Care Act. Slated to start in 2014, the board will consist of 15 members appointed by the president, plus three ex-officio members from the Executive Branch. The IPAB will make yearly recommendation to Congress on how to stay within Medicare budget targets; if Congress does not reject the recommendations by a two-thirds majority or come up with equivalent savings of their own, the recommendations will become law automatically.

During rounds of questioning before both committees, Health and Human Services Secretary Kathleen Sebelius drove home the point that the IPAB recommendations would keep Congress in the “driver’s seat,” requiring its approval. Ms. Sebelius also argued in favor of the board’s potential to improve the health care system, and added that the Republican budget plan would do the opposite.

“I think [the IPAB] could look at a lot of the underlying rising costs, and recommend payment strategies that much more closely align what doctors tell me they really want to do,” Ms. Sebelius testified. “I would suggest that the House Republican plan just shifts costs onto seniors and those with disabilities, and does not addresses the underlying costs at all.”

IPAB opponents disagree with the requirement that the House and Senate approve IPAB recommendation by a two-thirds vote. They said that this cedes to the board powers that the Constitution gives to Congress, making the IPAB fundamentally unconstitutional.

Although the board is charged with devising recommendations to reduce costs within Medicare, it lacks the ability to increase revenue or change existing benefits. This is one of the reasons opponents argue against the board’s potential to enact further cuts in provider payments and, in their view, decrease access to care.

Rep. Tom Price (R-Ga.), who is also an orthopedic surgeon, spoke before the committee. “If I’m told by the federal government that I will not be paid for a service, what happens in my presentation of the options to that patient?

“As that treating physician, I may be coerced by the federal government into not even presenting that option to the patient,” Rep. Price said.

A 40% premium cut and simpler enrollment procedures are two changes the federal government is employing to increase enrollment in the Pre-Existing Condition Insurance Plan, Health and Human Services Secretary Kathleen Sebelius announced during a press briefing.

Launched in July 2010 under the Affordable Care Act (ACA), the Pre-Existing Condition Insurance Plan (PCIP) provides an insurance option for people with preexisting conditions who have been denied coverage and have been without insurance for 6 months or more.

To increase awareness for the program, HHS will offer payment for insurance brokers and agents for successfully connecting eligible enrollees with the PCIP program, said Richard Popper, deputy director of insurance programs in the Office of Consumer Information and Insurance Oversight.

Those seeking coverage under the PCIP will no longer have to wait to receive a denial letter from their insurance company in order to enroll. Instead, they can provide attestation of their condition from their physician, nurse practitioner, or physician assistant. Patients with preexisting conditions still will be required to be without insurance for 6 months before they are eligible for coverage under the plan, said Mr. Popper. He added that HHS does not have the authority to waive the 6-month waiting period under the current health law.

Ms. Sebelius emphasized HHS’s priority to increase enrollment in the program. "It’s encouraging to see more people who need health insurance the most getting it, but we know that’s not enough," Ms. Sebelius said.

The measures comply with the ACA provision requiring the PCIP to align premiums and benefits with the private insurance market, Mr. Popper said. However, he said there’s still plenty of room for new enrollees.

"We’ve been enrolling people at an increasing rate, but we know we have the capacity to cover even more people," Mr. Popper said.

He added that funding for the measures will fall under the original $5 billion set aside for the program through the health reform law, as well as existing member premiums.

Despite original HHS estimates that several hundred thousand people would benefit from the PCIP, 18,313 people were enrolled as of early May.

The PCIP is run by the federal government in 23 states and the District of Columbia; remaining states operate their own programs using funding from the ACA. HHS sent letters to those 27 state programs, encouraging them to consider similar reforms to their programs.

A 40% premium cut and simpler enrollment procedures are two changes the federal government is employing to increase enrollment in the Pre-Existing Condition Insurance Plan, Health and Human Services Secretary Kathleen Sebelius announced during a press briefing.

Launched in July 2010 under the Affordable Care Act (ACA), the Pre-Existing Condition Insurance Plan (PCIP) provides an insurance option for people with preexisting conditions who have been denied coverage and have been without insurance for 6 months or more.

To increase awareness for the program, HHS will offer payment for insurance brokers and agents for successfully connecting eligible enrollees with the PCIP program, said Richard Popper, deputy director of insurance programs in the Office of Consumer Information and Insurance Oversight.

Those seeking coverage under the PCIP will no longer have to wait to receive a denial letter from their insurance company in order to enroll. Instead, they can provide attestation of their condition from their physician, nurse practitioner, or physician assistant. Patients with preexisting conditions still will be required to be without insurance for 6 months before they are eligible for coverage under the plan, said Mr. Popper. He added that HHS does not have the authority to waive the 6-month waiting period under the current health law.

Ms. Sebelius emphasized HHS’s priority to increase enrollment in the program. "It’s encouraging to see more people who need health insurance the most getting it, but we know that’s not enough," Ms. Sebelius said.

The measures comply with the ACA provision requiring the PCIP to align premiums and benefits with the private insurance market, Mr. Popper said. However, he said there’s still plenty of room for new enrollees.

"We’ve been enrolling people at an increasing rate, but we know we have the capacity to cover even more people," Mr. Popper said.

He added that funding for the measures will fall under the original $5 billion set aside for the program through the health reform law, as well as existing member premiums.

Despite original HHS estimates that several hundred thousand people would benefit from the PCIP, 18,313 people were enrolled as of early May.

The PCIP is run by the federal government in 23 states and the District of Columbia; remaining states operate their own programs using funding from the ACA. HHS sent letters to those 27 state programs, encouraging them to consider similar reforms to their programs.

A 40% premium cut and simpler enrollment procedures are two changes the federal government is employing to increase enrollment in the Pre-Existing Condition Insurance Plan, Health and Human Services Secretary Kathleen Sebelius announced during a press briefing.

Launched in July 2010 under the Affordable Care Act (ACA), the Pre-Existing Condition Insurance Plan (PCIP) provides an insurance option for people with preexisting conditions who have been denied coverage and have been without insurance for 6 months or more.

To increase awareness for the program, HHS will offer payment for insurance brokers and agents for successfully connecting eligible enrollees with the PCIP program, said Richard Popper, deputy director of insurance programs in the Office of Consumer Information and Insurance Oversight.

Those seeking coverage under the PCIP will no longer have to wait to receive a denial letter from their insurance company in order to enroll. Instead, they can provide attestation of their condition from their physician, nurse practitioner, or physician assistant. Patients with preexisting conditions still will be required to be without insurance for 6 months before they are eligible for coverage under the plan, said Mr. Popper. He added that HHS does not have the authority to waive the 6-month waiting period under the current health law.

Ms. Sebelius emphasized HHS’s priority to increase enrollment in the program. "It’s encouraging to see more people who need health insurance the most getting it, but we know that’s not enough," Ms. Sebelius said.

The measures comply with the ACA provision requiring the PCIP to align premiums and benefits with the private insurance market, Mr. Popper said. However, he said there’s still plenty of room for new enrollees.

"We’ve been enrolling people at an increasing rate, but we know we have the capacity to cover even more people," Mr. Popper said.

He added that funding for the measures will fall under the original $5 billion set aside for the program through the health reform law, as well as existing member premiums.

Despite original HHS estimates that several hundred thousand people would benefit from the PCIP, 18,313 people were enrolled as of early May.

The PCIP is run by the federal government in 23 states and the District of Columbia; remaining states operate their own programs using funding from the ACA. HHS sent letters to those 27 state programs, encouraging them to consider similar reforms to their programs.

As of July 1, Medicaid will no longer pay heath care providers for preventable, health care–acquired injuries or illnesses. The final rule, which implements a part of the Affordable Care Act, takes another step forward in reducing unnecessary health care costs, Dr. Donald M. Berwick, administrator for the Center for Medicare and Medicaid Services, said during a press briefing.

Provider-preventable conditions that will no longer be reimbursed include catheter-associated vascular infections, pressure ulcers, blood incompatibilities, air embolisms, surgical site infections, wrong surgery, wrong-patient surgery, and wrong surgical site, Dr. Berwick said.

The rule is based on similar measures already implemented under Medicare and independently by many states, Dr. Berwick said. Currently, 27 states prohibit payment for health care–acquired conditions and 17 do not pay for preventable conditions, according to Cindy Mann, director of CMS’s Center for Medicaid, CHIP, and Survey and Certification.

The Washington State Medicaid program is considering ways to increase accountability-based payment systems, according to its chief medical officer, Dr. Jeffery Thompson, who spoke during the briefing. Dr. Thompson said the state has determined it could save as much as $100 million, one-sixth of its budget, by eliminating 30-day hospital readmissions.

Under the provision, states will have the flexibility to expand the list of conditions to not be reimbursed, pending CMS approval. States also will have the option to implement the provisions between July 1, 2011, and July 1, 2012.

As of July 1, Medicaid will no longer pay heath care providers for preventable, health care–acquired injuries or illnesses. The final rule, which implements a part of the Affordable Care Act, takes another step forward in reducing unnecessary health care costs, Dr. Donald M. Berwick, administrator for the Center for Medicare and Medicaid Services, said during a press briefing.

Provider-preventable conditions that will no longer be reimbursed include catheter-associated vascular infections, pressure ulcers, blood incompatibilities, air embolisms, surgical site infections, wrong surgery, wrong-patient surgery, and wrong surgical site, Dr. Berwick said.

The rule is based on similar measures already implemented under Medicare and independently by many states, Dr. Berwick said. Currently, 27 states prohibit payment for health care–acquired conditions and 17 do not pay for preventable conditions, according to Cindy Mann, director of CMS’s Center for Medicaid, CHIP, and Survey and Certification.

The Washington State Medicaid program is considering ways to increase accountability-based payment systems, according to its chief medical officer, Dr. Jeffery Thompson, who spoke during the briefing. Dr. Thompson said the state has determined it could save as much as $100 million, one-sixth of its budget, by eliminating 30-day hospital readmissions.

Under the provision, states will have the flexibility to expand the list of conditions to not be reimbursed, pending CMS approval. States also will have the option to implement the provisions between July 1, 2011, and July 1, 2012.

As of July 1, Medicaid will no longer pay heath care providers for preventable, health care–acquired injuries or illnesses. The final rule, which implements a part of the Affordable Care Act, takes another step forward in reducing unnecessary health care costs, Dr. Donald M. Berwick, administrator for the Center for Medicare and Medicaid Services, said during a press briefing.

Provider-preventable conditions that will no longer be reimbursed include catheter-associated vascular infections, pressure ulcers, blood incompatibilities, air embolisms, surgical site infections, wrong surgery, wrong-patient surgery, and wrong surgical site, Dr. Berwick said.

The rule is based on similar measures already implemented under Medicare and independently by many states, Dr. Berwick said. Currently, 27 states prohibit payment for health care–acquired conditions and 17 do not pay for preventable conditions, according to Cindy Mann, director of CMS’s Center for Medicaid, CHIP, and Survey and Certification.

The Washington State Medicaid program is considering ways to increase accountability-based payment systems, according to its chief medical officer, Dr. Jeffery Thompson, who spoke during the briefing. Dr. Thompson said the state has determined it could save as much as $100 million, one-sixth of its budget, by eliminating 30-day hospital readmissions.

Under the provision, states will have the flexibility to expand the list of conditions to not be reimbursed, pending CMS approval. States also will have the option to implement the provisions between July 1, 2011, and July 1, 2012.

WASHINGTON – At a recent hearing on public reporting of hospital performance data, panelists agreed on the importance of measuring for quality, but not on which measurement standards to use.

Current data used to evaluate performance are limited to too small a number of determining factors, asserted Nancy Foster, vice president for quality and patient safety at the American Hospital Association. Ms. Foster served on the five-person panel at a forum titled "Public Reporting of Quality Outcomes: What’s the Best Path Forward?"

It was sponsored by the Alliance for Health Reform and The Commonwealth Fund.

On March 31, the Centers for Medicare and Medicaid Services published data on hospitals’ incidence of eight conditions: foreign object remaining after surgery, air embolisms, blood incompatibility, late-stage pressure ulcers, falls and trauma, vascular catheter–associated infections, catheter-associated urinary tract infections, and manifestations of poor glycemic control.

The data presents each condition per 1,000 discharges and includes national rates of hospital-association conditions. The data were based on claims information submitted by Medicare patients from October 2008 through June 2010.

Ms. Foster maintains that the CMS data are not clinically sound. One example she gave was of hospitals with high reimbursement rates, so-called safety net hospitals that provide care to all individuals regardless of their ability to pay. These facilities, she emphasized, are generally located in communities that lack sufficient health care resources for the populations they serve.

"It shouldn’t be a surprise to us that if they can’t get their medications following discharge from the hospital, that if they can’t get into the right physician office or rehab treatment or whatever else they need, those patients are going to come back to us in larger numbers than in communities where they have adequate access to all those kinds of resources," Ms. Foster said.

Physicians will sometimes avoid treating patients who are sicker or on Medicaid because they are high risk and could make the hospital’s public reports look bad, said Dr. David Share, vice president of Value Partnerships at Blue Cross Blue Shield of Michigan.

"Sometimes the way we measure [quality] actually forces providers to focus on cohorts of patients who aren’t going to get the most benefit, but they’ll focus there because they’re concerned that they won’t look good if they don’t," Dr. Share said. He added that lower-quality outcomes could also be based on a poor hospital system, not necessarily individual physician performance, which he said should be measured separately.

Gerald Shea, assistant to the president of governmental affairs for the AFL-CIO, Washington, argued that improvement is also a question of cost, which he said amounts to nearly $250,000 to test and institute a quality measure.

"We’ve been severely hampered in this enterprise by basically only being able to develop those measures when somebody came forward and said ‘we’ll pay to develop them.’ "

While he admitted that there may be flaws in the current data from public reporting, Mr. Shea said reports have increased awareness for quality care and encouraged significant changes within hospitals. Since 2000, hospitals have increased their attention on factors including readmission rates, the importance of collegial cooperation, and hospital-association conditions, he said.

The Affordable Care Act will require health exchange plans to publicly report on quality of care based on 65 measures.

"There’s a lot of pressure now and a lot of opportunity to use public reporting and transparency as a true level to foster high performance in the country," said Dr. Anne-Marie Audet, vice president for health systems quality and efficiency at The Commonwealth Fund. Dr. Audet said systems continue to focus on ways to create better care and better health at a lower cost.

Thomas Scully, senior counsel at the law office of Alston & Bird in Washington, also served on the panel.

WASHINGTON – At a recent hearing on public reporting of hospital performance data, panelists agreed on the importance of measuring for quality, but not on which measurement standards to use.

Current data used to evaluate performance are limited to too small a number of determining factors, asserted Nancy Foster, vice president for quality and patient safety at the American Hospital Association. Ms. Foster served on the five-person panel at a forum titled "Public Reporting of Quality Outcomes: What’s the Best Path Forward?"

It was sponsored by the Alliance for Health Reform and The Commonwealth Fund.

On March 31, the Centers for Medicare and Medicaid Services published data on hospitals’ incidence of eight conditions: foreign object remaining after surgery, air embolisms, blood incompatibility, late-stage pressure ulcers, falls and trauma, vascular catheter–associated infections, catheter-associated urinary tract infections, and manifestations of poor glycemic control.

The data presents each condition per 1,000 discharges and includes national rates of hospital-association conditions. The data were based on claims information submitted by Medicare patients from October 2008 through June 2010.

Ms. Foster maintains that the CMS data are not clinically sound. One example she gave was of hospitals with high reimbursement rates, so-called safety net hospitals that provide care to all individuals regardless of their ability to pay. These facilities, she emphasized, are generally located in communities that lack sufficient health care resources for the populations they serve.

"It shouldn’t be a surprise to us that if they can’t get their medications following discharge from the hospital, that if they can’t get into the right physician office or rehab treatment or whatever else they need, those patients are going to come back to us in larger numbers than in communities where they have adequate access to all those kinds of resources," Ms. Foster said.

Physicians will sometimes avoid treating patients who are sicker or on Medicaid because they are high risk and could make the hospital’s public reports look bad, said Dr. David Share, vice president of Value Partnerships at Blue Cross Blue Shield of Michigan.

"Sometimes the way we measure [quality] actually forces providers to focus on cohorts of patients who aren’t going to get the most benefit, but they’ll focus there because they’re concerned that they won’t look good if they don’t," Dr. Share said. He added that lower-quality outcomes could also be based on a poor hospital system, not necessarily individual physician performance, which he said should be measured separately.

Gerald Shea, assistant to the president of governmental affairs for the AFL-CIO, Washington, argued that improvement is also a question of cost, which he said amounts to nearly $250,000 to test and institute a quality measure.

"We’ve been severely hampered in this enterprise by basically only being able to develop those measures when somebody came forward and said ‘we’ll pay to develop them.’ "

While he admitted that there may be flaws in the current data from public reporting, Mr. Shea said reports have increased awareness for quality care and encouraged significant changes within hospitals. Since 2000, hospitals have increased their attention on factors including readmission rates, the importance of collegial cooperation, and hospital-association conditions, he said.

The Affordable Care Act will require health exchange plans to publicly report on quality of care based on 65 measures.

"There’s a lot of pressure now and a lot of opportunity to use public reporting and transparency as a true level to foster high performance in the country," said Dr. Anne-Marie Audet, vice president for health systems quality and efficiency at The Commonwealth Fund. Dr. Audet said systems continue to focus on ways to create better care and better health at a lower cost.

Thomas Scully, senior counsel at the law office of Alston & Bird in Washington, also served on the panel.

WASHINGTON – At a recent hearing on public reporting of hospital performance data, panelists agreed on the importance of measuring for quality, but not on which measurement standards to use.

Current data used to evaluate performance are limited to too small a number of determining factors, asserted Nancy Foster, vice president for quality and patient safety at the American Hospital Association. Ms. Foster served on the five-person panel at a forum titled "Public Reporting of Quality Outcomes: What’s the Best Path Forward?"

It was sponsored by the Alliance for Health Reform and The Commonwealth Fund.

On March 31, the Centers for Medicare and Medicaid Services published data on hospitals’ incidence of eight conditions: foreign object remaining after surgery, air embolisms, blood incompatibility, late-stage pressure ulcers, falls and trauma, vascular catheter–associated infections, catheter-associated urinary tract infections, and manifestations of poor glycemic control.

The data presents each condition per 1,000 discharges and includes national rates of hospital-association conditions. The data were based on claims information submitted by Medicare patients from October 2008 through June 2010.

Ms. Foster maintains that the CMS data are not clinically sound. One example she gave was of hospitals with high reimbursement rates, so-called safety net hospitals that provide care to all individuals regardless of their ability to pay. These facilities, she emphasized, are generally located in communities that lack sufficient health care resources for the populations they serve.

"It shouldn’t be a surprise to us that if they can’t get their medications following discharge from the hospital, that if they can’t get into the right physician office or rehab treatment or whatever else they need, those patients are going to come back to us in larger numbers than in communities where they have adequate access to all those kinds of resources," Ms. Foster said.

Physicians will sometimes avoid treating patients who are sicker or on Medicaid because they are high risk and could make the hospital’s public reports look bad, said Dr. David Share, vice president of Value Partnerships at Blue Cross Blue Shield of Michigan.

"Sometimes the way we measure [quality] actually forces providers to focus on cohorts of patients who aren’t going to get the most benefit, but they’ll focus there because they’re concerned that they won’t look good if they don’t," Dr. Share said. He added that lower-quality outcomes could also be based on a poor hospital system, not necessarily individual physician performance, which he said should be measured separately.

Gerald Shea, assistant to the president of governmental affairs for the AFL-CIO, Washington, argued that improvement is also a question of cost, which he said amounts to nearly $250,000 to test and institute a quality measure.

"We’ve been severely hampered in this enterprise by basically only being able to develop those measures when somebody came forward and said ‘we’ll pay to develop them.’ "

While he admitted that there may be flaws in the current data from public reporting, Mr. Shea said reports have increased awareness for quality care and encouraged significant changes within hospitals. Since 2000, hospitals have increased their attention on factors including readmission rates, the importance of collegial cooperation, and hospital-association conditions, he said.

The Affordable Care Act will require health exchange plans to publicly report on quality of care based on 65 measures.

"There’s a lot of pressure now and a lot of opportunity to use public reporting and transparency as a true level to foster high performance in the country," said Dr. Anne-Marie Audet, vice president for health systems quality and efficiency at The Commonwealth Fund. Dr. Audet said systems continue to focus on ways to create better care and better health at a lower cost.

Thomas Scully, senior counsel at the law office of Alston & Bird in Washington, also served on the panel.

As the 10th anniversary of Sept. 11 nears, many Americans are reflecting on what the historic event meant to them. Dr. David Abend, an editorial advisor to Family Practice News, is one of them.

Dr. Abend was halfway down the Garden State Parkway, on his way to teach a class and do rounds at Union (N.J.) Hospital, when he placed his usual Tuesday morning call to his father. He remembers the unusual worry in his father’s voice about not being able to contact his sister, who was then a lawyer working in Manhattan.

His father said that something had happened in the city, so Dr. Abend turned on the radio to hear that two planes had crashed into the World Trade Center. He turned his car around and spent the rest of the day watching live news coverage with his family. (His sister did arrive home safely.)

Photo credit: Dr. David Abend

Like many, he wanted to help. Finally, in October, Dr. Abend got the opportunity to volunteer his osteopathic skills in manipulative medicine to treat rescue workers and volunteers.

"I thought it was the right thing to do, given what I could offer ... It was either that or enlist. I was ready to just go," said Dr. Abend, who practices in Oradell, N.J.

Equipped with his hands, a heavy heart, and a portable osteopathic treatment table, he drove an hour to the Fresh Kills landfill in Staten Island where the rubble was being deposited. Having previously served as a police surgeon, he had the identification to work and commute without any difficulties.

He treated workers for severe neck and back pain, as well as headaches caused by stress, anxiety, and intense labor. He volunteered there for 6 months before he was called to work out of Nino’s, a lower Manhattan family restaurant that served meals and provided respite to Ground Zero workers 24 hours a day, 7 days a week.

Dr. Abend spent hours treating hundreds of patients from the New York Police Department, the Port Authority Police Department, the Federal Bureau of Investigation, the U.S. Army, the New York City Fire Department, and the American Red Cross.

He swapped stories with first responders who were exhausted from working double and triple shifts.

"It was just a general feeling of camaraderie," Dr. Abend now recalls. "I had a new-found respect for New Yorkers and for how we all came together when I was down there."

This May, the American Red Cross recognized Dr. Abend for his extraordinary community service at its annual Touch of Red Gala. He was the only doctor of osteopathy recognized among the 16 other health care providers who were honored for their humanitarian efforts after a disaster.

Dr. Abend said the experience of volunteering at Fresh Kills and at Ground Zero strengthened his resolve in practicing osteopathic manipulative medicine.

"What I did there gave me a lot of confidence in my field," he said. "It’s kind of like being born again and saying, ‘You know, this stuff really matters.’ " He added that the ability to provide instant relief quickly established a rapport with those he treated.

Dr. Abend said that he hopes the medical community will recognize the power of osteopathic medicine, or what he calls the "best-kept secret" in the medical profession. "Those of us who have continued to embrace and give our patients this, it’s quite an advantage."

As the 10th anniversary of Sept. 11 nears, many Americans are reflecting on what the historic event meant to them. Dr. David Abend, an editorial advisor to Family Practice News, is one of them.

Dr. Abend was halfway down the Garden State Parkway, on his way to teach a class and do rounds at Union (N.J.) Hospital, when he placed his usual Tuesday morning call to his father. He remembers the unusual worry in his father’s voice about not being able to contact his sister, who was then a lawyer working in Manhattan.

His father said that something had happened in the city, so Dr. Abend turned on the radio to hear that two planes had crashed into the World Trade Center. He turned his car around and spent the rest of the day watching live news coverage with his family. (His sister did arrive home safely.)

Photo credit: Dr. David Abend

Like many, he wanted to help. Finally, in October, Dr. Abend got the opportunity to volunteer his osteopathic skills in manipulative medicine to treat rescue workers and volunteers.

"I thought it was the right thing to do, given what I could offer ... It was either that or enlist. I was ready to just go," said Dr. Abend, who practices in Oradell, N.J.

Equipped with his hands, a heavy heart, and a portable osteopathic treatment table, he drove an hour to the Fresh Kills landfill in Staten Island where the rubble was being deposited. Having previously served as a police surgeon, he had the identification to work and commute without any difficulties.

He treated workers for severe neck and back pain, as well as headaches caused by stress, anxiety, and intense labor. He volunteered there for 6 months before he was called to work out of Nino’s, a lower Manhattan family restaurant that served meals and provided respite to Ground Zero workers 24 hours a day, 7 days a week.

Dr. Abend spent hours treating hundreds of patients from the New York Police Department, the Port Authority Police Department, the Federal Bureau of Investigation, the U.S. Army, the New York City Fire Department, and the American Red Cross.

He swapped stories with first responders who were exhausted from working double and triple shifts.

"It was just a general feeling of camaraderie," Dr. Abend now recalls. "I had a new-found respect for New Yorkers and for how we all came together when I was down there."

This May, the American Red Cross recognized Dr. Abend for his extraordinary community service at its annual Touch of Red Gala. He was the only doctor of osteopathy recognized among the 16 other health care providers who were honored for their humanitarian efforts after a disaster.

Dr. Abend said the experience of volunteering at Fresh Kills and at Ground Zero strengthened his resolve in practicing osteopathic manipulative medicine.

"What I did there gave me a lot of confidence in my field," he said. "It’s kind of like being born again and saying, ‘You know, this stuff really matters.’ " He added that the ability to provide instant relief quickly established a rapport with those he treated.

Dr. Abend said that he hopes the medical community will recognize the power of osteopathic medicine, or what he calls the "best-kept secret" in the medical profession. "Those of us who have continued to embrace and give our patients this, it’s quite an advantage."

As the 10th anniversary of Sept. 11 nears, many Americans are reflecting on what the historic event meant to them. Dr. David Abend, an editorial advisor to Family Practice News, is one of them.

Dr. Abend was halfway down the Garden State Parkway, on his way to teach a class and do rounds at Union (N.J.) Hospital, when he placed his usual Tuesday morning call to his father. He remembers the unusual worry in his father’s voice about not being able to contact his sister, who was then a lawyer working in Manhattan.

His father said that something had happened in the city, so Dr. Abend turned on the radio to hear that two planes had crashed into the World Trade Center. He turned his car around and spent the rest of the day watching live news coverage with his family. (His sister did arrive home safely.)

Photo credit: Dr. David Abend

Like many, he wanted to help. Finally, in October, Dr. Abend got the opportunity to volunteer his osteopathic skills in manipulative medicine to treat rescue workers and volunteers.

"I thought it was the right thing to do, given what I could offer ... It was either that or enlist. I was ready to just go," said Dr. Abend, who practices in Oradell, N.J.

Equipped with his hands, a heavy heart, and a portable osteopathic treatment table, he drove an hour to the Fresh Kills landfill in Staten Island where the rubble was being deposited. Having previously served as a police surgeon, he had the identification to work and commute without any difficulties.

He treated workers for severe neck and back pain, as well as headaches caused by stress, anxiety, and intense labor. He volunteered there for 6 months before he was called to work out of Nino’s, a lower Manhattan family restaurant that served meals and provided respite to Ground Zero workers 24 hours a day, 7 days a week.

Dr. Abend spent hours treating hundreds of patients from the New York Police Department, the Port Authority Police Department, the Federal Bureau of Investigation, the U.S. Army, the New York City Fire Department, and the American Red Cross.

He swapped stories with first responders who were exhausted from working double and triple shifts.

"It was just a general feeling of camaraderie," Dr. Abend now recalls. "I had a new-found respect for New Yorkers and for how we all came together when I was down there."

This May, the American Red Cross recognized Dr. Abend for his extraordinary community service at its annual Touch of Red Gala. He was the only doctor of osteopathy recognized among the 16 other health care providers who were honored for their humanitarian efforts after a disaster.

Dr. Abend said the experience of volunteering at Fresh Kills and at Ground Zero strengthened his resolve in practicing osteopathic manipulative medicine.

"What I did there gave me a lot of confidence in my field," he said. "It’s kind of like being born again and saying, ‘You know, this stuff really matters.’ " He added that the ability to provide instant relief quickly established a rapport with those he treated.

Dr. Abend said that he hopes the medical community will recognize the power of osteopathic medicine, or what he calls the "best-kept secret" in the medical profession. "Those of us who have continued to embrace and give our patients this, it’s quite an advantage."

WASHINGTON – States seeking to establish health care insurance exchanges may partner with the federal government, or choose not to, according to rules that set minimum standards for building the exchanges issued by the U.S. Department of Health and Human Services at a July 11 press conference.

Additionally, the newly proposed rules establish a program for small businesses to offer insurance options to their employees.

Photo credit: Frances Correa/Elsevier Global Medical News

Forty-nine states, the District of Columbia, and four territories have accepted grants to help plan and operate the exchanges, according to a statement by HHS. More than "half of all states are taking additional action beyond receiving a planning grant such as passing legislation or taking administrative action to begin building exchanges. States will continue to implement exchanges on different schedules through 2014."

Oklahoma currently is the only state that has rejected the $1 million federal grant offered to states to implement an exchange.

The release of these guidelines is a step forward in promoting a competitive insurance market, HHS Secretary Kathleen Sebelius said at the press conference. Small businesses in particular are at a disadvantage if they are paying substantially more than larger companies for exactly the same coverage.

The high cost of health care is the number one issue for small businesses, agreed Terry Gardiner, national policy director for Small Business Majority. According to Mr. Gardiner, without government intervention, small businesses would suffer a loss of 178,000 jobs, $834 billion in reduced wages for employees, and $2.4 trillion in health care costs over the next 10 years. These numbers are based on a study that Small Business Majority commissioned from Nelson (New Zealand) Marlborough Institute of Technology, he said.

If states don’t have a comprehensive health exchange plan in place by the January 2014 deadline, the federal government will step in with their own plan. However, states will have the option to establish their own exchange in the future if they provide a 12-month notice to HHS, along with a comprehensive plan for implementation and testing, according to Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at the Centers for Medicare and Medicaid Services. If states have some, but not all, requirements in place by the deadline, they could be granted a "conditional" approval on the basis that they have an adequate implementation plan in place.

HHS will evaluate state exchanges based on their ability to fully serve consumers by providing one-stop shopping, a choice of plans, and affordable coverage, said Joel Ario, head of the insurance exchange bureau at HHS. Each state’s capabilities in information technology will also be assessed.

Over the next year, HHS will release further guidelines regarding essential health benefits as well as quality improvement and eligibility enrollment standards. HHS will continue to accept comments on the proposed rules over the next 75 days.

To listen to the full press conference, click on the audio player below.

WASHINGTON – States seeking to establish health care insurance exchanges may partner with the federal government, or choose not to, according to rules that set minimum standards for building the exchanges issued by the U.S. Department of Health and Human Services at a July 11 press conference.

Additionally, the newly proposed rules establish a program for small businesses to offer insurance options to their employees.

Photo credit: Frances Correa/Elsevier Global Medical News

Forty-nine states, the District of Columbia, and four territories have accepted grants to help plan and operate the exchanges, according to a statement by HHS. More than "half of all states are taking additional action beyond receiving a planning grant such as passing legislation or taking administrative action to begin building exchanges. States will continue to implement exchanges on different schedules through 2014."

Oklahoma currently is the only state that has rejected the $1 million federal grant offered to states to implement an exchange.

The release of these guidelines is a step forward in promoting a competitive insurance market, HHS Secretary Kathleen Sebelius said at the press conference. Small businesses in particular are at a disadvantage if they are paying substantially more than larger companies for exactly the same coverage.

The high cost of health care is the number one issue for small businesses, agreed Terry Gardiner, national policy director for Small Business Majority. According to Mr. Gardiner, without government intervention, small businesses would suffer a loss of 178,000 jobs, $834 billion in reduced wages for employees, and $2.4 trillion in health care costs over the next 10 years. These numbers are based on a study that Small Business Majority commissioned from Nelson (New Zealand) Marlborough Institute of Technology, he said.

If states don’t have a comprehensive health exchange plan in place by the January 2014 deadline, the federal government will step in with their own plan. However, states will have the option to establish their own exchange in the future if they provide a 12-month notice to HHS, along with a comprehensive plan for implementation and testing, according to Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at the Centers for Medicare and Medicaid Services. If states have some, but not all, requirements in place by the deadline, they could be granted a "conditional" approval on the basis that they have an adequate implementation plan in place.

HHS will evaluate state exchanges based on their ability to fully serve consumers by providing one-stop shopping, a choice of plans, and affordable coverage, said Joel Ario, head of the insurance exchange bureau at HHS. Each state’s capabilities in information technology will also be assessed.

Over the next year, HHS will release further guidelines regarding essential health benefits as well as quality improvement and eligibility enrollment standards. HHS will continue to accept comments on the proposed rules over the next 75 days.

To listen to the full press conference, click on the audio player below.

WASHINGTON – States seeking to establish health care insurance exchanges may partner with the federal government, or choose not to, according to rules that set minimum standards for building the exchanges issued by the U.S. Department of Health and Human Services at a July 11 press conference.

Additionally, the newly proposed rules establish a program for small businesses to offer insurance options to their employees.

Photo credit: Frances Correa/Elsevier Global Medical News

Forty-nine states, the District of Columbia, and four territories have accepted grants to help plan and operate the exchanges, according to a statement by HHS. More than "half of all states are taking additional action beyond receiving a planning grant such as passing legislation or taking administrative action to begin building exchanges. States will continue to implement exchanges on different schedules through 2014."

Oklahoma currently is the only state that has rejected the $1 million federal grant offered to states to implement an exchange.

The release of these guidelines is a step forward in promoting a competitive insurance market, HHS Secretary Kathleen Sebelius said at the press conference. Small businesses in particular are at a disadvantage if they are paying substantially more than larger companies for exactly the same coverage.

The high cost of health care is the number one issue for small businesses, agreed Terry Gardiner, national policy director for Small Business Majority. According to Mr. Gardiner, without government intervention, small businesses would suffer a loss of 178,000 jobs, $834 billion in reduced wages for employees, and $2.4 trillion in health care costs over the next 10 years. These numbers are based on a study that Small Business Majority commissioned from Nelson (New Zealand) Marlborough Institute of Technology, he said.

If states don’t have a comprehensive health exchange plan in place by the January 2014 deadline, the federal government will step in with their own plan. However, states will have the option to establish their own exchange in the future if they provide a 12-month notice to HHS, along with a comprehensive plan for implementation and testing, according to Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at the Centers for Medicare and Medicaid Services. If states have some, but not all, requirements in place by the deadline, they could be granted a "conditional" approval on the basis that they have an adequate implementation plan in place.

HHS will evaluate state exchanges based on their ability to fully serve consumers by providing one-stop shopping, a choice of plans, and affordable coverage, said Joel Ario, head of the insurance exchange bureau at HHS. Each state’s capabilities in information technology will also be assessed.

Over the next year, HHS will release further guidelines regarding essential health benefits as well as quality improvement and eligibility enrollment standards. HHS will continue to accept comments on the proposed rules over the next 75 days.

To listen to the full press conference, click on the audio player below.

Deaths from prescription drug overdose rose 84% in Florida from 2003 to 2009, based on data from the Florida Medical Examiners Commission.

The greatest increases in death rates were seen in users of oxycodone (265%), alprazolam (234%), and methadone (79%), standing in stark contrast to a decline in cocaine-related deaths (39% from 2007 to 2009) and heroin-related deaths (62% from 2003 to 2009). In 2009, the number of prescription drug–related deaths (13.4/100,000 people) in Florida was four times the amount of deaths from illicit drugs (3.4/100,000), according to the data reported July 7 in Morbidity and Mortality Weekly Report.

The total number of Florida drug-overdose deaths in 2003-2009 was 16,550. Of those, 86% were ruled as unintentional by the medical examiners’ office, 11% were ruled suicides, 3% were described as of undetermined intent, and less than 1% were ruled homicides or pending (numbers do not add to 100% due to rounding).

The Florida data were described as "more timely and specific" than national data derived from death certificates, according to the report.

"These findings indicate a need to strengthen interventions aimed at reducing overdose deaths from prescription drugs in Florida," wrote Bruce Goldberger, Ph.D., of the University of Florida, Gainesville, and his colleagues (MMWR 2011 July 8; 60;26:869-72), who noted that similar trends in drug-related overdose deaths have been reported by the Kentucky Office of the State Medical Examiner.

The authors pointed out a large increase in the number of pain clinics operating in Florida "that prescribe large quantities of oxycodone and alprazolam, some of which is ultimately used for nonmedical purposes." Some of the customers of these clinics travel from Appalachian states including Kentucky to purchase drugs for resale, according to grand jury findings in Broward County, Fla.

The report calls on states to institute drug-monitoring systems, tighten restrictions on pain clinics, and regulate wholesale distributors of frequently abused prescription drugs.

Deaths from prescription drug overdose rose 84% in Florida from 2003 to 2009, based on data from the Florida Medical Examiners Commission.

The greatest increases in death rates were seen in users of oxycodone (265%), alprazolam (234%), and methadone (79%), standing in stark contrast to a decline in cocaine-related deaths (39% from 2007 to 2009) and heroin-related deaths (62% from 2003 to 2009). In 2009, the number of prescription drug–related deaths (13.4/100,000 people) in Florida was four times the amount of deaths from illicit drugs (3.4/100,000), according to the data reported July 7 in Morbidity and Mortality Weekly Report.

The total number of Florida drug-overdose deaths in 2003-2009 was 16,550. Of those, 86% were ruled as unintentional by the medical examiners’ office, 11% were ruled suicides, 3% were described as of undetermined intent, and less than 1% were ruled homicides or pending (numbers do not add to 100% due to rounding).

The Florida data were described as "more timely and specific" than national data derived from death certificates, according to the report.

"These findings indicate a need to strengthen interventions aimed at reducing overdose deaths from prescription drugs in Florida," wrote Bruce Goldberger, Ph.D., of the University of Florida, Gainesville, and his colleagues (MMWR 2011 July 8; 60;26:869-72), who noted that similar trends in drug-related overdose deaths have been reported by the Kentucky Office of the State Medical Examiner.

The authors pointed out a large increase in the number of pain clinics operating in Florida "that prescribe large quantities of oxycodone and alprazolam, some of which is ultimately used for nonmedical purposes." Some of the customers of these clinics travel from Appalachian states including Kentucky to purchase drugs for resale, according to grand jury findings in Broward County, Fla.

The report calls on states to institute drug-monitoring systems, tighten restrictions on pain clinics, and regulate wholesale distributors of frequently abused prescription drugs.

Deaths from prescription drug overdose rose 84% in Florida from 2003 to 2009, based on data from the Florida Medical Examiners Commission.

The greatest increases in death rates were seen in users of oxycodone (265%), alprazolam (234%), and methadone (79%), standing in stark contrast to a decline in cocaine-related deaths (39% from 2007 to 2009) and heroin-related deaths (62% from 2003 to 2009). In 2009, the number of prescription drug–related deaths (13.4/100,000 people) in Florida was four times the amount of deaths from illicit drugs (3.4/100,000), according to the data reported July 7 in Morbidity and Mortality Weekly Report.

The total number of Florida drug-overdose deaths in 2003-2009 was 16,550. Of those, 86% were ruled as unintentional by the medical examiners’ office, 11% were ruled suicides, 3% were described as of undetermined intent, and less than 1% were ruled homicides or pending (numbers do not add to 100% due to rounding).

The Florida data were described as "more timely and specific" than national data derived from death certificates, according to the report.

"These findings indicate a need to strengthen interventions aimed at reducing overdose deaths from prescription drugs in Florida," wrote Bruce Goldberger, Ph.D., of the University of Florida, Gainesville, and his colleagues (MMWR 2011 July 8; 60;26:869-72), who noted that similar trends in drug-related overdose deaths have been reported by the Kentucky Office of the State Medical Examiner.

The authors pointed out a large increase in the number of pain clinics operating in Florida "that prescribe large quantities of oxycodone and alprazolam, some of which is ultimately used for nonmedical purposes." Some of the customers of these clinics travel from Appalachian states including Kentucky to purchase drugs for resale, according to grand jury findings in Broward County, Fla.

The report calls on states to institute drug-monitoring systems, tighten restrictions on pain clinics, and regulate wholesale distributors of frequently abused prescription drugs.