Frances Correa

While physicians in high-risk specialties face a near certainty of a malpractice claim at some point in their careers, only a small minority will end up making an indemnity payment to a patient.

The probability of facing a malpractice claim increases with length of time in practice, based on data from 1991 through 2005 from a large national malpractice carrier insuring more than 40,000 physicians in all 50 states and the District of Columbia and published Aug. 17 in the New England Journal of Medicine.

Among physicians in high-risk specialties such as neurosurgery, general surgery, and obstetrics/gynecology, an estimated 88% were projected to face their first claim by age 45 and an estimated 99% by age 65. In low-risk specialties such as family medicine, pediatrics, and psychiatry, 36% of physicians were projected to face their first claim by age 45 years and 75% by age 65 years, Dr. Anupam Jena of Harvard Medical School and his colleagues wrote.

In contrast, the projected rates of indemnity claims paid to plaintiffs were lower. By age 45, 33% of physicians in high-risk specialties were projected to have had a claim paid, rising to 71% by age 65 years. For physicians in low-risk specialties, 5% were projected to have had a claim paid by age 45 years, rising to 19% by age 65 years (N. Engl. J. Med. 2011;365:629-36).

"If you’ve hit 65 and you haven’t had a claim, that’s rare; that’s almost impossible in our data," Dr. Jena said in an interview, adding that high-risk specialties often come with higher salaries, which could be what balances out the risk factor for physicians.

Overall, 7.4%* of physicians were sued for malpractice each year of the study, with 1.6% having an indemnity payment made each year.

Dr. Jena and colleagues also found that specialties in which physicians were more likely to face a malpractice claim were not the ones where indemnity payments were most prevalent.

For example, 19.1% of neurosurgeons faced a claim each year, according to the analysis, compared to 3.1% of pediatricians. However, the average indemnity payment for neurosurgeons was $344,811, lower than the average of $520,924 for pediatricians.

While few claims resulted in payment, researchers said they were surprised by how many physicians face malpractice claims every year.

"A lot of those claims do not resolve in a payment to the patient, but they still involve significant monetary costs to both the physician and the insurer," Dr. Jena said. "The physician has loss of productivity because they’re not able to see patients as they defend cases ... and then there are all sorts of non-monetary costs that we simply cannot measure," Dr. Jena said in an interview.

Among all specialties, neurosurgery had the highest risk of being sued (19.1%), followed by thoracic-cardiovascular surgery (18.9%), and general surgery (15.3%). Specialties with the lowest risk of facing being sued included psychiatry (2.6%), pediatrics (3.1%), and family medicine (5.2%). The average payment for all specialties was $273,887.

Some lawmakers and health care organizations have advocated for national medical malpractice reform, or tort reform, as a means of lowering health care costs; California and Texas already have $250,000 caps noneconomic damages. However, there’s little evidence that proves these measures are lowering health care costs. Even without tort reform, Dr. Jena said that he believes the best solution is one that roots out frivolous claims.

"There are some claims which have merit and should be fully investigated and should be brought before a jury or settled, and there are also claims that don’t have that same merit. And those are the claims that we really should try to identify and limit early."

The study received funding from the National Institute on Aging and the RAND Institute for Civil Justice; one coauthor received grant support from the RAND Institute for Civil Justice.

* Correction, 8/18/2011: The original version of this article misstated the percentage of physicians sued for malpractice each year of the study. This version has been corrected.

LISTEN: Dr. Jena discusses his study.

While physicians in high-risk specialties face a near certainty of a malpractice claim at some point in their careers, only a small minority will end up making an indemnity payment to a patient.

The probability of facing a malpractice claim increases with length of time in practice, based on data from 1991 through 2005 from a large national malpractice carrier insuring more than 40,000 physicians in all 50 states and the District of Columbia and published Aug. 17 in the New England Journal of Medicine.

Among physicians in high-risk specialties such as neurosurgery, general surgery, and obstetrics/gynecology, an estimated 88% were projected to face their first claim by age 45 and an estimated 99% by age 65. In low-risk specialties such as family medicine, pediatrics, and psychiatry, 36% of physicians were projected to face their first claim by age 45 years and 75% by age 65 years, Dr. Anupam Jena of Harvard Medical School and his colleagues wrote.

In contrast, the projected rates of indemnity claims paid to plaintiffs were lower. By age 45, 33% of physicians in high-risk specialties were projected to have had a claim paid, rising to 71% by age 65 years. For physicians in low-risk specialties, 5% were projected to have had a claim paid by age 45 years, rising to 19% by age 65 years (N. Engl. J. Med. 2011;365:629-36).

"If you’ve hit 65 and you haven’t had a claim, that’s rare; that’s almost impossible in our data," Dr. Jena said in an interview, adding that high-risk specialties often come with higher salaries, which could be what balances out the risk factor for physicians.

Overall, 7.4%* of physicians were sued for malpractice each year of the study, with 1.6% having an indemnity payment made each year.

Dr. Jena and colleagues also found that specialties in which physicians were more likely to face a malpractice claim were not the ones where indemnity payments were most prevalent.

For example, 19.1% of neurosurgeons faced a claim each year, according to the analysis, compared to 3.1% of pediatricians. However, the average indemnity payment for neurosurgeons was $344,811, lower than the average of $520,924 for pediatricians.

While few claims resulted in payment, researchers said they were surprised by how many physicians face malpractice claims every year.

"A lot of those claims do not resolve in a payment to the patient, but they still involve significant monetary costs to both the physician and the insurer," Dr. Jena said. "The physician has loss of productivity because they’re not able to see patients as they defend cases ... and then there are all sorts of non-monetary costs that we simply cannot measure," Dr. Jena said in an interview.

Among all specialties, neurosurgery had the highest risk of being sued (19.1%), followed by thoracic-cardiovascular surgery (18.9%), and general surgery (15.3%). Specialties with the lowest risk of facing being sued included psychiatry (2.6%), pediatrics (3.1%), and family medicine (5.2%). The average payment for all specialties was $273,887.

Some lawmakers and health care organizations have advocated for national medical malpractice reform, or tort reform, as a means of lowering health care costs; California and Texas already have $250,000 caps noneconomic damages. However, there’s little evidence that proves these measures are lowering health care costs. Even without tort reform, Dr. Jena said that he believes the best solution is one that roots out frivolous claims.

"There are some claims which have merit and should be fully investigated and should be brought before a jury or settled, and there are also claims that don’t have that same merit. And those are the claims that we really should try to identify and limit early."

The study received funding from the National Institute on Aging and the RAND Institute for Civil Justice; one coauthor received grant support from the RAND Institute for Civil Justice.

* Correction, 8/18/2011: The original version of this article misstated the percentage of physicians sued for malpractice each year of the study. This version has been corrected.

LISTEN: Dr. Jena discusses his study.

While physicians in high-risk specialties face a near certainty of a malpractice claim at some point in their careers, only a small minority will end up making an indemnity payment to a patient.

The probability of facing a malpractice claim increases with length of time in practice, based on data from 1991 through 2005 from a large national malpractice carrier insuring more than 40,000 physicians in all 50 states and the District of Columbia and published Aug. 17 in the New England Journal of Medicine.

Among physicians in high-risk specialties such as neurosurgery, general surgery, and obstetrics/gynecology, an estimated 88% were projected to face their first claim by age 45 and an estimated 99% by age 65. In low-risk specialties such as family medicine, pediatrics, and psychiatry, 36% of physicians were projected to face their first claim by age 45 years and 75% by age 65 years, Dr. Anupam Jena of Harvard Medical School and his colleagues wrote.

In contrast, the projected rates of indemnity claims paid to plaintiffs were lower. By age 45, 33% of physicians in high-risk specialties were projected to have had a claim paid, rising to 71% by age 65 years. For physicians in low-risk specialties, 5% were projected to have had a claim paid by age 45 years, rising to 19% by age 65 years (N. Engl. J. Med. 2011;365:629-36).

"If you’ve hit 65 and you haven’t had a claim, that’s rare; that’s almost impossible in our data," Dr. Jena said in an interview, adding that high-risk specialties often come with higher salaries, which could be what balances out the risk factor for physicians.

Overall, 7.4%* of physicians were sued for malpractice each year of the study, with 1.6% having an indemnity payment made each year.

Dr. Jena and colleagues also found that specialties in which physicians were more likely to face a malpractice claim were not the ones where indemnity payments were most prevalent.

For example, 19.1% of neurosurgeons faced a claim each year, according to the analysis, compared to 3.1% of pediatricians. However, the average indemnity payment for neurosurgeons was $344,811, lower than the average of $520,924 for pediatricians.

While few claims resulted in payment, researchers said they were surprised by how many physicians face malpractice claims every year.

"A lot of those claims do not resolve in a payment to the patient, but they still involve significant monetary costs to both the physician and the insurer," Dr. Jena said. "The physician has loss of productivity because they’re not able to see patients as they defend cases ... and then there are all sorts of non-monetary costs that we simply cannot measure," Dr. Jena said in an interview.

Among all specialties, neurosurgery had the highest risk of being sued (19.1%), followed by thoracic-cardiovascular surgery (18.9%), and general surgery (15.3%). Specialties with the lowest risk of facing being sued included psychiatry (2.6%), pediatrics (3.1%), and family medicine (5.2%). The average payment for all specialties was $273,887.

Some lawmakers and health care organizations have advocated for national medical malpractice reform, or tort reform, as a means of lowering health care costs; California and Texas already have $250,000 caps noneconomic damages. However, there’s little evidence that proves these measures are lowering health care costs. Even without tort reform, Dr. Jena said that he believes the best solution is one that roots out frivolous claims.

"There are some claims which have merit and should be fully investigated and should be brought before a jury or settled, and there are also claims that don’t have that same merit. And those are the claims that we really should try to identify and limit early."

The study received funding from the National Institute on Aging and the RAND Institute for Civil Justice; one coauthor received grant support from the RAND Institute for Civil Justice.

* Correction, 8/18/2011: The original version of this article misstated the percentage of physicians sued for malpractice each year of the study. This version has been corrected.

LISTEN: Dr. Jena discusses his study.

An incentive program within large physician groups delivered better care for patients and lower costs for Medicare, according to an analysis by the Centers for Medicare and Medicaid Services.

While federal officials and participants alike hailed the groups’ achievements in quality improvement and cost savings, some observers questioned whether the project’s results could be duplicated by smaller group practices.

The CMS this month released the results from the Medicare Physician Group Practice Demonstration (PGP), which ran from April 2005 through March 2010. CMS officials said the 5-year program has helped shape their thinking on accountable care organizations.

"Our experience under the demonstration was that physician groups are willing to engage in pay-for-performance incentive programs when the quality measures are consistent with clinical practice and high-quality care," said CMS spokesman Donald McLeod.

The 10 organizations in the PGP were asked to meet 32 quality measures in four areas: diabetes, heart failure, coronary artery disease, and preventive care. There were also group-specific quality improvement targets. In addition, the groups were required to generate Medicare cost savings of at least 2% of their target expenditures in order to earn incentive payments.

Participants included Billings (Mont.) Clinic; the Everett (Wash.) Clinic; the Forsyth Medical Group in Winston-Salem, N.C.; the Geisinger Health System in Danville, Pa.; Middlesex Health System in Middletown, Conn.; Park Nicollet Health System in Minneapolis, Minn., St. John’s Health System in Springfield, Mo.; Marshfield (Wis.) Clinic; University of Michigan (Ann Arbor) Faculty Group Practice; and Dartmouth-Hitchcock (N.H.) Clinic.

In the project’s fifth year, 7 of the 10 participating groups achieved all 32 quality measures, and the remaining 3 achieved at least 30. However, only four groups generated enough savings to cash in on the incentive payments ($29.4 million/group). Half of the group’s incentive payments were based on achieving quality measures and half on cost savings.

Geisinger saw a 1.4% increase in expenditures, compared with the national average of 5.5%, according to Dr. Thomas R. Graf, associate chief medical officer of population health for Geisinger.

"If medical costs for Medicare beneficiaries anywhere in the United States were typically going down, we wouldn’t have a health care crisis," Dr. Graf said. "We think, actually, we’re on the right track."

Despite the increase in costs, Geisinger decreased its rehospitalization rates by 40% through an expanded medical home program, Dr. Graf said. General rehospitalization rates decreased by 20%. The hospital also saw a 237% increase in the use of preventive services, from 9.2% of Medicare patients in 2007 to 31% in 2011.

Middlesex Health System officials said the demonstration gave them the chance to get their feet wet in a system that represents the future of health care.

"This was an opportunity to be involved in a program that was ahead of the curve and that was likely where health care was going," said Dr. Arthur McDowell, vice president of clinical affairs at Middlesex Hospital.

However, Dr. McDowell said the necessary investments could make it harder for smaller practices to become a part of the movement.

"The amount of infrastructure that you would need to implement to really do it well would require significant amount more investment, and without seeding that investment or taking significant risk, it becomes harder for smaller organizations," Dr. McDowell said.

The American Academy of Family Physicians shared similar concerns.

Participants in the demonstration were all large, well-established health systems. With half of the AAFP’s membership working in practices of five or fewer physicians, academy officials said the demonstration results may not apply to those physicians.

"How this information translates to the rest of the health care system, particularly small practices, I think remains a big unknown," said Dr. Glen Stream, president-elect of the AAFP. "We have to make sure that [rural] practices and the patients that they serve are taken care of in whatever process evolves in this ACO environment."

As the models for accountable care organizations take shape, the CMS continues to investigate incentive payment methods and effective systems of quality measurement. "This demonstration ... provides CMS with an accessible group of physician practices that can provide input as we develop alternative accountable care organization payment models," noted Mr. McLeod.

All 10 of the demonstration participants have stayed on to participate in a 2-year PGP Transition Demonstration, which started in January. The transition demonstration focuses on primary care and includes quality assessment using a national, rather than regional, benchmark.

An incentive program within large physician groups delivered better care for patients and lower costs for Medicare, according to an analysis by the Centers for Medicare and Medicaid Services.

While federal officials and participants alike hailed the groups’ achievements in quality improvement and cost savings, some observers questioned whether the project’s results could be duplicated by smaller group practices.

The CMS this month released the results from the Medicare Physician Group Practice Demonstration (PGP), which ran from April 2005 through March 2010. CMS officials said the 5-year program has helped shape their thinking on accountable care organizations.

"Our experience under the demonstration was that physician groups are willing to engage in pay-for-performance incentive programs when the quality measures are consistent with clinical practice and high-quality care," said CMS spokesman Donald McLeod.

The 10 organizations in the PGP were asked to meet 32 quality measures in four areas: diabetes, heart failure, coronary artery disease, and preventive care. There were also group-specific quality improvement targets. In addition, the groups were required to generate Medicare cost savings of at least 2% of their target expenditures in order to earn incentive payments.

Participants included Billings (Mont.) Clinic; the Everett (Wash.) Clinic; the Forsyth Medical Group in Winston-Salem, N.C.; the Geisinger Health System in Danville, Pa.; Middlesex Health System in Middletown, Conn.; Park Nicollet Health System in Minneapolis, Minn., St. John’s Health System in Springfield, Mo.; Marshfield (Wis.) Clinic; University of Michigan (Ann Arbor) Faculty Group Practice; and Dartmouth-Hitchcock (N.H.) Clinic.

In the project’s fifth year, 7 of the 10 participating groups achieved all 32 quality measures, and the remaining 3 achieved at least 30. However, only four groups generated enough savings to cash in on the incentive payments ($29.4 million/group). Half of the group’s incentive payments were based on achieving quality measures and half on cost savings.

Geisinger saw a 1.4% increase in expenditures, compared with the national average of 5.5%, according to Dr. Thomas R. Graf, associate chief medical officer of population health for Geisinger.

"If medical costs for Medicare beneficiaries anywhere in the United States were typically going down, we wouldn’t have a health care crisis," Dr. Graf said. "We think, actually, we’re on the right track."

Despite the increase in costs, Geisinger decreased its rehospitalization rates by 40% through an expanded medical home program, Dr. Graf said. General rehospitalization rates decreased by 20%. The hospital also saw a 237% increase in the use of preventive services, from 9.2% of Medicare patients in 2007 to 31% in 2011.

Middlesex Health System officials said the demonstration gave them the chance to get their feet wet in a system that represents the future of health care.

"This was an opportunity to be involved in a program that was ahead of the curve and that was likely where health care was going," said Dr. Arthur McDowell, vice president of clinical affairs at Middlesex Hospital.

However, Dr. McDowell said the necessary investments could make it harder for smaller practices to become a part of the movement.

"The amount of infrastructure that you would need to implement to really do it well would require significant amount more investment, and without seeding that investment or taking significant risk, it becomes harder for smaller organizations," Dr. McDowell said.

The American Academy of Family Physicians shared similar concerns.

Participants in the demonstration were all large, well-established health systems. With half of the AAFP’s membership working in practices of five or fewer physicians, academy officials said the demonstration results may not apply to those physicians.

"How this information translates to the rest of the health care system, particularly small practices, I think remains a big unknown," said Dr. Glen Stream, president-elect of the AAFP. "We have to make sure that [rural] practices and the patients that they serve are taken care of in whatever process evolves in this ACO environment."

As the models for accountable care organizations take shape, the CMS continues to investigate incentive payment methods and effective systems of quality measurement. "This demonstration ... provides CMS with an accessible group of physician practices that can provide input as we develop alternative accountable care organization payment models," noted Mr. McLeod.

All 10 of the demonstration participants have stayed on to participate in a 2-year PGP Transition Demonstration, which started in January. The transition demonstration focuses on primary care and includes quality assessment using a national, rather than regional, benchmark.

An incentive program within large physician groups delivered better care for patients and lower costs for Medicare, according to an analysis by the Centers for Medicare and Medicaid Services.

While federal officials and participants alike hailed the groups’ achievements in quality improvement and cost savings, some observers questioned whether the project’s results could be duplicated by smaller group practices.

The CMS this month released the results from the Medicare Physician Group Practice Demonstration (PGP), which ran from April 2005 through March 2010. CMS officials said the 5-year program has helped shape their thinking on accountable care organizations.

"Our experience under the demonstration was that physician groups are willing to engage in pay-for-performance incentive programs when the quality measures are consistent with clinical practice and high-quality care," said CMS spokesman Donald McLeod.

The 10 organizations in the PGP were asked to meet 32 quality measures in four areas: diabetes, heart failure, coronary artery disease, and preventive care. There were also group-specific quality improvement targets. In addition, the groups were required to generate Medicare cost savings of at least 2% of their target expenditures in order to earn incentive payments.

Participants included Billings (Mont.) Clinic; the Everett (Wash.) Clinic; the Forsyth Medical Group in Winston-Salem, N.C.; the Geisinger Health System in Danville, Pa.; Middlesex Health System in Middletown, Conn.; Park Nicollet Health System in Minneapolis, Minn., St. John’s Health System in Springfield, Mo.; Marshfield (Wis.) Clinic; University of Michigan (Ann Arbor) Faculty Group Practice; and Dartmouth-Hitchcock (N.H.) Clinic.

In the project’s fifth year, 7 of the 10 participating groups achieved all 32 quality measures, and the remaining 3 achieved at least 30. However, only four groups generated enough savings to cash in on the incentive payments ($29.4 million/group). Half of the group’s incentive payments were based on achieving quality measures and half on cost savings.

Geisinger saw a 1.4% increase in expenditures, compared with the national average of 5.5%, according to Dr. Thomas R. Graf, associate chief medical officer of population health for Geisinger.

"If medical costs for Medicare beneficiaries anywhere in the United States were typically going down, we wouldn’t have a health care crisis," Dr. Graf said. "We think, actually, we’re on the right track."

Despite the increase in costs, Geisinger decreased its rehospitalization rates by 40% through an expanded medical home program, Dr. Graf said. General rehospitalization rates decreased by 20%. The hospital also saw a 237% increase in the use of preventive services, from 9.2% of Medicare patients in 2007 to 31% in 2011.

Middlesex Health System officials said the demonstration gave them the chance to get their feet wet in a system that represents the future of health care.

"This was an opportunity to be involved in a program that was ahead of the curve and that was likely where health care was going," said Dr. Arthur McDowell, vice president of clinical affairs at Middlesex Hospital.

However, Dr. McDowell said the necessary investments could make it harder for smaller practices to become a part of the movement.

"The amount of infrastructure that you would need to implement to really do it well would require significant amount more investment, and without seeding that investment or taking significant risk, it becomes harder for smaller organizations," Dr. McDowell said.

The American Academy of Family Physicians shared similar concerns.

Participants in the demonstration were all large, well-established health systems. With half of the AAFP’s membership working in practices of five or fewer physicians, academy officials said the demonstration results may not apply to those physicians.

"How this information translates to the rest of the health care system, particularly small practices, I think remains a big unknown," said Dr. Glen Stream, president-elect of the AAFP. "We have to make sure that [rural] practices and the patients that they serve are taken care of in whatever process evolves in this ACO environment."

As the models for accountable care organizations take shape, the CMS continues to investigate incentive payment methods and effective systems of quality measurement. "This demonstration ... provides CMS with an accessible group of physician practices that can provide input as we develop alternative accountable care organization payment models," noted Mr. McLeod.

All 10 of the demonstration participants have stayed on to participate in a 2-year PGP Transition Demonstration, which started in January. The transition demonstration focuses on primary care and includes quality assessment using a national, rather than regional, benchmark.

The high costs of health care in the current uncertain economic environment are leading more consumers to delay medical care. That’s according to the Deloitte Center for Health Solutions’ 2011 Survey of Health Care Consumers, which included 15,000 health care consumers from 12 countries.

Among American respondents, 25% said they have skipped seeing a doctor when they were sick or injured. Among that 25%, 49% said they skipped going to a doctor because of costs. That’s compared with 39% in Belgium, 35% in China, 34% in Mexico, 5% in Canada, and 7% in the United Kingdom and Luxembourg.

An additional 63% of Americans said their monthly health care costs make it harder for them to fund their housing, groceries, fuel, and education. Executive director Paul H. Keckley, Ph.D., said this year’s results indicate a global concern.

"Regardless of the type of health care system – government-run or private – consumers around the world are feeling the pinch," Dr. Keckley said in a statement.

While Americans might be skipping doctor’s visits, it’s not because they don’t need care. In times of economic downturn and high unemployment, the need for psychiatric care is highest, according to Dr. Lee H. Beecher, a psychiatrist who practices in St. Louis Park, Minn. He added that high premiums rates for private insurance plans and low reimbursement rates for Medicare and Medicaid payments are decreasing patient access to care.

Without a fix to the reimbursement systems and higher pay for outpatient services, Dr. Beecher said, more psychiatrists will be forced to work within a hospital system or the public sector. This, he said, will mean a more assembly-line approach to care, and less time to dedicate to patients.

"You might be able to see a psychiatrist every 3 to 6 months ... you don’t have a doctor-patient relationship with the psychiatrist as a patient in these public programs," Dr. Beecher said in an interview.

As of January 2013, physicians will face a 30% cut in reimbursement rates under Medicare. In addition, the bill to raise the national debt ceiling included a committee tasked with assessing additional cuts down the line. Unless Congress takes action, physicians face an additional 2% cut by January 2014 and possible further cuts by the committee.

Deloitte has been measuring consumer trends in the health care system since 2008.

The high costs of health care in the current uncertain economic environment are leading more consumers to delay medical care. That’s according to the Deloitte Center for Health Solutions’ 2011 Survey of Health Care Consumers, which included 15,000 health care consumers from 12 countries.

Among American respondents, 25% said they have skipped seeing a doctor when they were sick or injured. Among that 25%, 49% said they skipped going to a doctor because of costs. That’s compared with 39% in Belgium, 35% in China, 34% in Mexico, 5% in Canada, and 7% in the United Kingdom and Luxembourg.

An additional 63% of Americans said their monthly health care costs make it harder for them to fund their housing, groceries, fuel, and education. Executive director Paul H. Keckley, Ph.D., said this year’s results indicate a global concern.

"Regardless of the type of health care system – government-run or private – consumers around the world are feeling the pinch," Dr. Keckley said in a statement.

While Americans might be skipping doctor’s visits, it’s not because they don’t need care. In times of economic downturn and high unemployment, the need for psychiatric care is highest, according to Dr. Lee H. Beecher, a psychiatrist who practices in St. Louis Park, Minn. He added that high premiums rates for private insurance plans and low reimbursement rates for Medicare and Medicaid payments are decreasing patient access to care.

Without a fix to the reimbursement systems and higher pay for outpatient services, Dr. Beecher said, more psychiatrists will be forced to work within a hospital system or the public sector. This, he said, will mean a more assembly-line approach to care, and less time to dedicate to patients.

"You might be able to see a psychiatrist every 3 to 6 months ... you don’t have a doctor-patient relationship with the psychiatrist as a patient in these public programs," Dr. Beecher said in an interview.

As of January 2013, physicians will face a 30% cut in reimbursement rates under Medicare. In addition, the bill to raise the national debt ceiling included a committee tasked with assessing additional cuts down the line. Unless Congress takes action, physicians face an additional 2% cut by January 2014 and possible further cuts by the committee.

Deloitte has been measuring consumer trends in the health care system since 2008.

The high costs of health care in the current uncertain economic environment are leading more consumers to delay medical care. That’s according to the Deloitte Center for Health Solutions’ 2011 Survey of Health Care Consumers, which included 15,000 health care consumers from 12 countries.

Among American respondents, 25% said they have skipped seeing a doctor when they were sick or injured. Among that 25%, 49% said they skipped going to a doctor because of costs. That’s compared with 39% in Belgium, 35% in China, 34% in Mexico, 5% in Canada, and 7% in the United Kingdom and Luxembourg.

An additional 63% of Americans said their monthly health care costs make it harder for them to fund their housing, groceries, fuel, and education. Executive director Paul H. Keckley, Ph.D., said this year’s results indicate a global concern.

"Regardless of the type of health care system – government-run or private – consumers around the world are feeling the pinch," Dr. Keckley said in a statement.

While Americans might be skipping doctor’s visits, it’s not because they don’t need care. In times of economic downturn and high unemployment, the need for psychiatric care is highest, according to Dr. Lee H. Beecher, a psychiatrist who practices in St. Louis Park, Minn. He added that high premiums rates for private insurance plans and low reimbursement rates for Medicare and Medicaid payments are decreasing patient access to care.

Without a fix to the reimbursement systems and higher pay for outpatient services, Dr. Beecher said, more psychiatrists will be forced to work within a hospital system or the public sector. This, he said, will mean a more assembly-line approach to care, and less time to dedicate to patients.

"You might be able to see a psychiatrist every 3 to 6 months ... you don’t have a doctor-patient relationship with the psychiatrist as a patient in these public programs," Dr. Beecher said in an interview.

As of January 2013, physicians will face a 30% cut in reimbursement rates under Medicare. In addition, the bill to raise the national debt ceiling included a committee tasked with assessing additional cuts down the line. Unless Congress takes action, physicians face an additional 2% cut by January 2014 and possible further cuts by the committee.

Deloitte has been measuring consumer trends in the health care system since 2008.

Desert dwellers can rest easier: There’s now an antidote for at least one nocturnal danger.

The Food and Drug Administration has approved the first treatment for scorpion stings. The antidote, Anascorp, was specifically approved for the treatment of stings by the Centruroides scorpion, also called the bark scorpion. Centruroides are found primarily in the Southwest and are the most common scorpions in the United States. Poison centers in Arizona document 11,000 scorpion stings every year, according to the Arizona Poison and Drug Information Center.

Researchers in Mexico developed Anascorp from horse plasma. In a placebo-controlled, double-blind study of 15 children with scorpion sting symptoms, researchers observed that participants who took Anascorp were symptom-free within 4 hours. In comparison, children with severe symptoms usually spend several days in an ICU. Severe symptoms include difficulty breathing, loss of muscle control, fluid in the lungs, slurred speech, abnormal eye movement, trouble swallowing, blurred vision, and excess saliva.

Dr. Karen Midthun, director of the FDA’s Center for Biologics Evaluation and Research, said this development will improve care especially for children, who are most vulnerable to developing severe symptoms.

"Scorpion stings can be life-threatening, especially in infants and children," Dr. Midthun said in a statement. "This product provides a new treatment for children and adults and is designed specifically for scorpion stings."

Rare Disease Therapeutics will market the drug to health care facilities in areas where bark scorpions are found, such as parts of Arizona, New Mexico, and Nevada.

According to the FDA, the most common side effects of the antidote include vomiting, fever, rash, nausea, itchiness, headache, runny nose, and muscle pain. The FDA recommends that sting victims who are children or who are experiencing severe symptoms should seek immediate medical treatment. If the victim is 5 years old or younger, or if an older patient has more than minor discomfort, the FDA recommends calling the poison control center at 1-800-222-1222.

* Correction, 10/21/2011: The original version of this article contained a photograph of a scorpion that has since been removed because it did not depict the Centruroides scorpion.

Desert dwellers can rest easier: There’s now an antidote for at least one nocturnal danger.

The Food and Drug Administration has approved the first treatment for scorpion stings. The antidote, Anascorp, was specifically approved for the treatment of stings by the Centruroides scorpion, also called the bark scorpion. Centruroides are found primarily in the Southwest and are the most common scorpions in the United States. Poison centers in Arizona document 11,000 scorpion stings every year, according to the Arizona Poison and Drug Information Center.

Researchers in Mexico developed Anascorp from horse plasma. In a placebo-controlled, double-blind study of 15 children with scorpion sting symptoms, researchers observed that participants who took Anascorp were symptom-free within 4 hours. In comparison, children with severe symptoms usually spend several days in an ICU. Severe symptoms include difficulty breathing, loss of muscle control, fluid in the lungs, slurred speech, abnormal eye movement, trouble swallowing, blurred vision, and excess saliva.

Dr. Karen Midthun, director of the FDA’s Center for Biologics Evaluation and Research, said this development will improve care especially for children, who are most vulnerable to developing severe symptoms.

"Scorpion stings can be life-threatening, especially in infants and children," Dr. Midthun said in a statement. "This product provides a new treatment for children and adults and is designed specifically for scorpion stings."

Rare Disease Therapeutics will market the drug to health care facilities in areas where bark scorpions are found, such as parts of Arizona, New Mexico, and Nevada.

According to the FDA, the most common side effects of the antidote include vomiting, fever, rash, nausea, itchiness, headache, runny nose, and muscle pain. The FDA recommends that sting victims who are children or who are experiencing severe symptoms should seek immediate medical treatment. If the victim is 5 years old or younger, or if an older patient has more than minor discomfort, the FDA recommends calling the poison control center at 1-800-222-1222.

* Correction, 10/21/2011: The original version of this article contained a photograph of a scorpion that has since been removed because it did not depict the Centruroides scorpion.

Desert dwellers can rest easier: There’s now an antidote for at least one nocturnal danger.

The Food and Drug Administration has approved the first treatment for scorpion stings. The antidote, Anascorp, was specifically approved for the treatment of stings by the Centruroides scorpion, also called the bark scorpion. Centruroides are found primarily in the Southwest and are the most common scorpions in the United States. Poison centers in Arizona document 11,000 scorpion stings every year, according to the Arizona Poison and Drug Information Center.

Researchers in Mexico developed Anascorp from horse plasma. In a placebo-controlled, double-blind study of 15 children with scorpion sting symptoms, researchers observed that participants who took Anascorp were symptom-free within 4 hours. In comparison, children with severe symptoms usually spend several days in an ICU. Severe symptoms include difficulty breathing, loss of muscle control, fluid in the lungs, slurred speech, abnormal eye movement, trouble swallowing, blurred vision, and excess saliva.

Dr. Karen Midthun, director of the FDA’s Center for Biologics Evaluation and Research, said this development will improve care especially for children, who are most vulnerable to developing severe symptoms.

"Scorpion stings can be life-threatening, especially in infants and children," Dr. Midthun said in a statement. "This product provides a new treatment for children and adults and is designed specifically for scorpion stings."

Rare Disease Therapeutics will market the drug to health care facilities in areas where bark scorpions are found, such as parts of Arizona, New Mexico, and Nevada.

According to the FDA, the most common side effects of the antidote include vomiting, fever, rash, nausea, itchiness, headache, runny nose, and muscle pain. The FDA recommends that sting victims who are children or who are experiencing severe symptoms should seek immediate medical treatment. If the victim is 5 years old or younger, or if an older patient has more than minor discomfort, the FDA recommends calling the poison control center at 1-800-222-1222.

* Correction, 10/21/2011: The original version of this article contained a photograph of a scorpion that has since been removed because it did not depict the Centruroides scorpion.

Medicare beneficiaries with prescription drug coverage under Part D will pay about $1 less in monthly premiums next year for a basic plan, the Health and Human Services department announced Aug. 4. The projected premium drop is based on bids submitted by Part D plans for 2012.

"No seniors should ever have to choose between medication they need to be healthy and putting food on their table, and the health care law is helping to make sure they don’t have that terrible choice," HHS Secretary Kathleen Sebelius said during a press briefing.

Further, about 900,000 beneficiaries have hit the Part D coverage gap or "doughnut hole" this year and have become eligible for a 50% discount on covered brand-name drugs. As of June, that discount – a provision of the Affordable Care Act – has saved Medicare beneficiaries about $462 million, Ms. Sebelius said. Under ACA, the administration aims to close the doughnut hole by 2020.

"There [are] still critical gaps in coverage, especially for prescription drugs," Ms. Sebelius said. She added that 25% of seniors have reported that high costs have lead them to skip dosages of medicine, cut pills in half, or simply not fill their prescriptions.

Although lawmakers have finally passed an agreement to raise the nation’s debt limit, Medicare remains vulnerable to cuts. HHS officials would not comment on how beneficiaries could potentially be affected.

Under the Budget Control Act of 2011, the bipartisan 12-member Joint Select Committee on Deficit Reduction, also known as the Super Committee, will have until Nov. 23 to decide where to trim out an additional more than $1 trillion.

Medicare beneficiaries with prescription drug coverage under Part D will pay about $1 less in monthly premiums next year for a basic plan, the Health and Human Services department announced Aug. 4. The projected premium drop is based on bids submitted by Part D plans for 2012.

"No seniors should ever have to choose between medication they need to be healthy and putting food on their table, and the health care law is helping to make sure they don’t have that terrible choice," HHS Secretary Kathleen Sebelius said during a press briefing.

Further, about 900,000 beneficiaries have hit the Part D coverage gap or "doughnut hole" this year and have become eligible for a 50% discount on covered brand-name drugs. As of June, that discount – a provision of the Affordable Care Act – has saved Medicare beneficiaries about $462 million, Ms. Sebelius said. Under ACA, the administration aims to close the doughnut hole by 2020.

"There [are] still critical gaps in coverage, especially for prescription drugs," Ms. Sebelius said. She added that 25% of seniors have reported that high costs have lead them to skip dosages of medicine, cut pills in half, or simply not fill their prescriptions.

Although lawmakers have finally passed an agreement to raise the nation’s debt limit, Medicare remains vulnerable to cuts. HHS officials would not comment on how beneficiaries could potentially be affected.

Under the Budget Control Act of 2011, the bipartisan 12-member Joint Select Committee on Deficit Reduction, also known as the Super Committee, will have until Nov. 23 to decide where to trim out an additional more than $1 trillion.

Medicare beneficiaries with prescription drug coverage under Part D will pay about $1 less in monthly premiums next year for a basic plan, the Health and Human Services department announced Aug. 4. The projected premium drop is based on bids submitted by Part D plans for 2012.

"No seniors should ever have to choose between medication they need to be healthy and putting food on their table, and the health care law is helping to make sure they don’t have that terrible choice," HHS Secretary Kathleen Sebelius said during a press briefing.

Further, about 900,000 beneficiaries have hit the Part D coverage gap or "doughnut hole" this year and have become eligible for a 50% discount on covered brand-name drugs. As of June, that discount – a provision of the Affordable Care Act – has saved Medicare beneficiaries about $462 million, Ms. Sebelius said. Under ACA, the administration aims to close the doughnut hole by 2020.

"There [are] still critical gaps in coverage, especially for prescription drugs," Ms. Sebelius said. She added that 25% of seniors have reported that high costs have lead them to skip dosages of medicine, cut pills in half, or simply not fill their prescriptions.

Although lawmakers have finally passed an agreement to raise the nation’s debt limit, Medicare remains vulnerable to cuts. HHS officials would not comment on how beneficiaries could potentially be affected.

Under the Budget Control Act of 2011, the bipartisan 12-member Joint Select Committee on Deficit Reduction, also known as the Super Committee, will have until Nov. 23 to decide where to trim out an additional more than $1 trillion.

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-Wis.) said during a 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 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 recommendations 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 with 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 address 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.

Republicans ignore the fact that their budget proposal could double costs for Medicare patients.

Source REP. WAXMAN

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-Wis.) said during a 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 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 recommendations 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 with 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 address 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.

Republicans ignore the fact that their budget proposal could double costs for Medicare patients.

Source REP. WAXMAN

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-Wis.) said during a 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 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 recommendations 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 with 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 address 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.

Republicans ignore the fact that their budget proposal could double costs for Medicare patients.

Source REP. WAXMAN

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.

The new insurers “will provide consumers more choices [and] greater plan accountability, and help ensure a more competitive insurance market,” Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at the 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 do large businesses.

Although 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.

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

Despite opportunity for consumer benefits, the CMS is also bracing for potential costs, including default on the loans. According to the proposed rule, the 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.

The agency will be pushing to have a CO-OP available in every state; so far, it estimates that 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.

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.

The new insurers “will provide consumers more choices [and] greater plan accountability, and help ensure a more competitive insurance market,” Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at the 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 do large businesses.

Although 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.

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

Despite opportunity for consumer benefits, the CMS is also bracing for potential costs, including default on the loans. According to the proposed rule, the 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.

The agency will be pushing to have a CO-OP available in every state; so far, it estimates that 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.

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.

The new insurers “will provide consumers more choices [and] greater plan accountability, and help ensure a more competitive insurance market,” Steve Larsen, director of the Center for Consumer Information and Insurance Oversight at the 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 do large businesses.

Although 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.

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

Despite opportunity for consumer benefits, the CMS is also bracing for potential costs, including default on the loans. According to the proposed rule, the 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.

The agency will be pushing to have a CO-OP available in every state; so far, it estimates that 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.

Major Finding: Overdose deaths from oxycodone and alprazolam more than doubled during 2003-2009 in Florida, whereas overdose deaths from heroin were halved.

Data Source: Data from Florida medical examiners.

Disclosures: The researchers reported no relevant financial disclosures.

Deaths from prescription drug overdose rose 84% in Florida in 2003-2009, 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%), contrasting starkly 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 per 100,000 people) in Florida was four times the amount of deaths from illicit drugs (3.4 per 100,000), according to the data reported in MMWR.

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 of undetermined intent, and fewer 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;60;26:869-72).

The authors noted 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 their customers travel from Appalachian states 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.

Major Finding: Overdose deaths from oxycodone and alprazolam more than doubled during 2003-2009 in Florida, whereas overdose deaths from heroin were halved.

Data Source: Data from Florida medical examiners.

Disclosures: The researchers reported no relevant financial disclosures.

Deaths from prescription drug overdose rose 84% in Florida in 2003-2009, 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%), contrasting starkly 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 per 100,000 people) in Florida was four times the amount of deaths from illicit drugs (3.4 per 100,000), according to the data reported in MMWR.

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 of undetermined intent, and fewer 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;60;26:869-72).

The authors noted 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 their customers travel from Appalachian states 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.

Major Finding: Overdose deaths from oxycodone and alprazolam more than doubled during 2003-2009 in Florida, whereas overdose deaths from heroin were halved.

Data Source: Data from Florida medical examiners.

Disclosures: The researchers reported no relevant financial disclosures.

Deaths from prescription drug overdose rose 84% in Florida in 2003-2009, 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%), contrasting starkly 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 per 100,000 people) in Florida was four times the amount of deaths from illicit drugs (3.4 per 100,000), according to the data reported in MMWR.

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 of undetermined intent, and fewer 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;60;26:869-72).

The authors noted 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 their customers travel from Appalachian states 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.

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 recommendations 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 its own, the recommendations 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 with 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.”

IPAB opponents disagree with the requirement that the House and Senate approve recommendations 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.

Republicans ignore estimates that their budget proposal could double costs for Medicare beneficiaries.

Source REP. WAXMAN

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 recommendations 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 its own, the recommendations 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 with 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.”

IPAB opponents disagree with the requirement that the House and Senate approve recommendations 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.

Republicans ignore estimates that their budget proposal could double costs for Medicare beneficiaries.

Source REP. WAXMAN

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 recommendations 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 its own, the recommendations 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 with 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.”

IPAB opponents disagree with the requirement that the House and Senate approve recommendations 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.

Republicans ignore estimates that their budget proposal could double costs for Medicare beneficiaries.

Source REP. WAXMAN

Major Finding: Only 23% of surveyed parents said they had no concerns about childhood vaccination.

Data Source: A study conducted by the CDC based on research from a 2010 HealthStyles survey.

Disclosures: No disclosures were provided. All of the researchers worked with the CDC.

More than three-quarters of surveyed parents said they were concerned about the safety and discomfort of childhood vaccines, with only 23% of respondents saying they had no concerns about childhood vaccination, according to a study conducted by the Centers for Disease Control and Prevention.

Many of those concerns have arisen among parents because of a lack of experience with some of the diseases for which children are vaccinated, CDC researchers explained, as well as a misconception of the potential side effects of vaccines.

Most vaccine-preventable diseases, such as diphtheria and polio, are rarely seen in the United States, said Glen Nowak, one of the study's main researchers and senior adviser for the CDC's National Center for Immunization and Respiratory Diseases (Health Aff. 2011;30:61151-9).

However, some vaccine-preventable diseases have been on the rise, Mr. Nowak said in an interview, including whooping cough and measles.

In the CDC study, parental concerns about vaccinating children included:

▸ Worries about the pain of receiving so many shots in a single visit to the doctor's office (38% of respondents).

▸ Concerns that children receive too many vaccines in the first 2 years of life (34%).

▸ Fears that vaccines may cause fevers in children (32%).

▸ Concerns that vaccines may cause learning disabilities such as autism (30%).

▸ Concerns that vaccines' ingredients are unsafe (26%).

The study was based on data from 2010 HealthStyles e-mail survey of parental vaccine behavior for 4,198 households nationwide.

The CDC study limited its analysis to the 476 respondents who reported having one or more children age 6 years or younger.

Parents who don't vaccinate their children are taking a double risk, he added.

“One is that you're taking the risk that your child won't get that disease or that illness, and two [is] that if they get that disease or illness, that it won't turn out to be a very severe case,” Mr. Nowak said.

There is a lingering resistance to vaccines that sprang from a 1998 study that linked childhood vaccines and autism, said Mr. Nowak.

The study later was found to be fraudulent, and subsequent research has disproved such findings.

Nonetheless, nearly a third of survey respondents still said they were concerned that vaccines could cause learning disabilities such as autism.

Dr. Garry Gardner said that although nearly 90% of parents in his practice are comfortable with vaccines, vaccine confidence is still an issue.

“There's still this persistent misconception about [childhood vaccines] and autism that just doesn't seem to go away,” noted Dr. Gardner, a pediatrician practicing in Darien, Ill.

He said once or twice a week he encounters parents who are reluctant to vaccinate their children and many of those parents still believe in the autism/vaccine connection.

Further resistance among a small percentage of his patients also comes from a general distrust in traditional medicine and the misconception that too many vaccines could adversely affect a child's immune system.

More than half of the parents in the CDC study identified their physicians as their most trusted source of information.

However, 24% said that the Internet was one of their top three sources of childhood vaccination information.

The researchers cautioned that although hesitance about vaccination may not translate to refusal to vaccinate, physicians should respect and address the concerns associated with childhood vaccination.

Major Finding: Only 23% of surveyed parents said they had no concerns about childhood vaccination.

Data Source: A study conducted by the CDC based on research from a 2010 HealthStyles survey.

Disclosures: No disclosures were provided. All of the researchers worked with the CDC.

More than three-quarters of surveyed parents said they were concerned about the safety and discomfort of childhood vaccines, with only 23% of respondents saying they had no concerns about childhood vaccination, according to a study conducted by the Centers for Disease Control and Prevention.

Many of those concerns have arisen among parents because of a lack of experience with some of the diseases for which children are vaccinated, CDC researchers explained, as well as a misconception of the potential side effects of vaccines.

Most vaccine-preventable diseases, such as diphtheria and polio, are rarely seen in the United States, said Glen Nowak, one of the study's main researchers and senior adviser for the CDC's National Center for Immunization and Respiratory Diseases (Health Aff. 2011;30:61151-9).

However, some vaccine-preventable diseases have been on the rise, Mr. Nowak said in an interview, including whooping cough and measles.

In the CDC study, parental concerns about vaccinating children included:

▸ Worries about the pain of receiving so many shots in a single visit to the doctor's office (38% of respondents).

▸ Concerns that children receive too many vaccines in the first 2 years of life (34%).

▸ Fears that vaccines may cause fevers in children (32%).

▸ Concerns that vaccines may cause learning disabilities such as autism (30%).

▸ Concerns that vaccines' ingredients are unsafe (26%).

The study was based on data from 2010 HealthStyles e-mail survey of parental vaccine behavior for 4,198 households nationwide.

The CDC study limited its analysis to the 476 respondents who reported having one or more children age 6 years or younger.

Parents who don't vaccinate their children are taking a double risk, he added.

“One is that you're taking the risk that your child won't get that disease or that illness, and two [is] that if they get that disease or illness, that it won't turn out to be a very severe case,” Mr. Nowak said.

There is a lingering resistance to vaccines that sprang from a 1998 study that linked childhood vaccines and autism, said Mr. Nowak.

The study later was found to be fraudulent, and subsequent research has disproved such findings.

Nonetheless, nearly a third of survey respondents still said they were concerned that vaccines could cause learning disabilities such as autism.

Dr. Garry Gardner said that although nearly 90% of parents in his practice are comfortable with vaccines, vaccine confidence is still an issue.

“There's still this persistent misconception about [childhood vaccines] and autism that just doesn't seem to go away,” noted Dr. Gardner, a pediatrician practicing in Darien, Ill.

He said once or twice a week he encounters parents who are reluctant to vaccinate their children and many of those parents still believe in the autism/vaccine connection.

Further resistance among a small percentage of his patients also comes from a general distrust in traditional medicine and the misconception that too many vaccines could adversely affect a child's immune system.

More than half of the parents in the CDC study identified their physicians as their most trusted source of information.

However, 24% said that the Internet was one of their top three sources of childhood vaccination information.

The researchers cautioned that although hesitance about vaccination may not translate to refusal to vaccinate, physicians should respect and address the concerns associated with childhood vaccination.

Major Finding: Only 23% of surveyed parents said they had no concerns about childhood vaccination.

Data Source: A study conducted by the CDC based on research from a 2010 HealthStyles survey.

Disclosures: No disclosures were provided. All of the researchers worked with the CDC.

More than three-quarters of surveyed parents said they were concerned about the safety and discomfort of childhood vaccines, with only 23% of respondents saying they had no concerns about childhood vaccination, according to a study conducted by the Centers for Disease Control and Prevention.

Many of those concerns have arisen among parents because of a lack of experience with some of the diseases for which children are vaccinated, CDC researchers explained, as well as a misconception of the potential side effects of vaccines.

Most vaccine-preventable diseases, such as diphtheria and polio, are rarely seen in the United States, said Glen Nowak, one of the study's main researchers and senior adviser for the CDC's National Center for Immunization and Respiratory Diseases (Health Aff. 2011;30:61151-9).

However, some vaccine-preventable diseases have been on the rise, Mr. Nowak said in an interview, including whooping cough and measles.

In the CDC study, parental concerns about vaccinating children included:

▸ Worries about the pain of receiving so many shots in a single visit to the doctor's office (38% of respondents).

▸ Concerns that children receive too many vaccines in the first 2 years of life (34%).

▸ Fears that vaccines may cause fevers in children (32%).

▸ Concerns that vaccines may cause learning disabilities such as autism (30%).

▸ Concerns that vaccines' ingredients are unsafe (26%).

The study was based on data from 2010 HealthStyles e-mail survey of parental vaccine behavior for 4,198 households nationwide.

The CDC study limited its analysis to the 476 respondents who reported having one or more children age 6 years or younger.

Parents who don't vaccinate their children are taking a double risk, he added.

“One is that you're taking the risk that your child won't get that disease or that illness, and two [is] that if they get that disease or illness, that it won't turn out to be a very severe case,” Mr. Nowak said.

There is a lingering resistance to vaccines that sprang from a 1998 study that linked childhood vaccines and autism, said Mr. Nowak.

The study later was found to be fraudulent, and subsequent research has disproved such findings.

Nonetheless, nearly a third of survey respondents still said they were concerned that vaccines could cause learning disabilities such as autism.

Dr. Garry Gardner said that although nearly 90% of parents in his practice are comfortable with vaccines, vaccine confidence is still an issue.

“There's still this persistent misconception about [childhood vaccines] and autism that just doesn't seem to go away,” noted Dr. Gardner, a pediatrician practicing in Darien, Ill.

He said once or twice a week he encounters parents who are reluctant to vaccinate their children and many of those parents still believe in the autism/vaccine connection.

Further resistance among a small percentage of his patients also comes from a general distrust in traditional medicine and the misconception that too many vaccines could adversely affect a child's immune system.

More than half of the parents in the CDC study identified their physicians as their most trusted source of information.

However, 24% said that the Internet was one of their top three sources of childhood vaccination information.

The researchers cautioned that although hesitance about vaccination may not translate to refusal to vaccinate, physicians should respect and address the concerns associated with childhood vaccination.