Jane Anderson

Cardiopulmonary resuscitation training should be a requirement for graduation from high school and should include instruction on the purpose of an automated external defibrillator and how to use one, according to an American Heart Association consensus statement released Jan. 10.

Photo credit:Flickr user John Trainor (Creative Commons)

The science advisory statement, developed in collaboration with the American Academy of Pediatrics and the American College of Emergency Physicians and published in the journal Circulation, also recommends that students have opportunities to practice and master psychomotor skills related to CPR, since trainees do not learn enough unless they get the chance to practice.

Although secondary school students most likely won’t encounter a victim of cardiac arrest at school, they may encounter one elsewhere in the community, and teaching CPR skills early can lead to more proficiency later, the AHA statement said.

"Increasing the percentage of the population trained in CPR is an integral part of an overall strategy to improve community response" to out-of-hospital cardiac arrests, the statement said. "Schools provide excellent access to a large part of the community. ... Therefore, over time, a significant percentage of the overall community will receive training."

In 2003, the International Liaison Committee on Resuscitation recommended that CPR instruction be incorporated into standard school curriculums, and the next year the AHA recommended that schools train all teachers in CPR and first aid and train all students in CPR in order to prepare for potential medical emergencies on campus.

As of the 2009-2010 school year, laws or curriculum standards in six states require CPR training as a component of mandatory health education, while 30 states encourage schools to teach CPR, according to the AHA statement. However, implementation of these laws isn’t uniform, and not all schools teach CPR, even in states that have the strongest language encouraging such training, the AHA statement said.

Therefore, requiring CPR training as a condition of high school graduation would significantly increase the level of CPR knowledge in the community over time, the statement said, adding, "the evidence shows that previous training, at any interval before there is a need to use the skills learned, will increase the likelihood that a bystander will provide appropriate care to a victim."

It’s critical to target the correct age group for training, the AHA statement said. Students younger than about 13 years old may not have the necessary physical strength to perform correct chest compressions. Therefore, "it is reasonable to limit practice of adult CPR chest compression skills to children in middle school (around 13 years old) and older," the statement said (Circulation 2011;123:[doi: 10.1161/CIR.0b013e31820b5328]).

Programs designed for schools should include the core skills of conventional CPR and hands-only CPR developed by the AHA, and should emphasize recognition of the emergency and provision of high-quality chest compressions, the statement said.

The statement does not urge mandatory automated external defibrillator (AED) skills practice, although it recommends that schools providing AED skills practice give students an opportunity to practice and master all steps of CPR and AED use, with special emphasis on minimal interruptions in performance of CPR, correct application of pads to an appropriate surrogate for the human thorax, and proper "clearing" of the patient when so instructed by the AED.

Schools have cited a lack of available class time as a barrier to implementing CPR instruction. However, it should be possible for schools to implement such training as part of health courses or as part of a "community service" requirement for high school graduation, the AHA said. In addition, schools can make use of video-based, self-directed training programs and online or other e-learning programs, the statement said.

Several members of the writing committee had relationships that the AHA deemed significant: Dr. Tom P. Aufderheide of the Medical College of Wisconsin, Milwaukee, has received research support from Zoll Medical and Advanced Circulatory Inc.; and has served as an advisor or consultant to Medtronic and JoLife Inc.; Dr. Keith Lurie of the University of Wisconsin is also founder and chief medical officer of Advanced Circulatory Systems, as well as the inventor of that company’s ResQPOD. Dr. Vincent N. Mosesso Jr. of the University of Pittsburgh has received research support from Zoll Medical.

Cardiopulmonary resuscitation training should be a requirement for graduation from high school and should include instruction on the purpose of an automated external defibrillator and how to use one, according to an American Heart Association consensus statement released Jan. 10.

Photo credit:Flickr user John Trainor (Creative Commons)

The science advisory statement, developed in collaboration with the American Academy of Pediatrics and the American College of Emergency Physicians and published in the journal Circulation, also recommends that students have opportunities to practice and master psychomotor skills related to CPR, since trainees do not learn enough unless they get the chance to practice.

Although secondary school students most likely won’t encounter a victim of cardiac arrest at school, they may encounter one elsewhere in the community, and teaching CPR skills early can lead to more proficiency later, the AHA statement said.

"Increasing the percentage of the population trained in CPR is an integral part of an overall strategy to improve community response" to out-of-hospital cardiac arrests, the statement said. "Schools provide excellent access to a large part of the community. ... Therefore, over time, a significant percentage of the overall community will receive training."

In 2003, the International Liaison Committee on Resuscitation recommended that CPR instruction be incorporated into standard school curriculums, and the next year the AHA recommended that schools train all teachers in CPR and first aid and train all students in CPR in order to prepare for potential medical emergencies on campus.

As of the 2009-2010 school year, laws or curriculum standards in six states require CPR training as a component of mandatory health education, while 30 states encourage schools to teach CPR, according to the AHA statement. However, implementation of these laws isn’t uniform, and not all schools teach CPR, even in states that have the strongest language encouraging such training, the AHA statement said.

Therefore, requiring CPR training as a condition of high school graduation would significantly increase the level of CPR knowledge in the community over time, the statement said, adding, "the evidence shows that previous training, at any interval before there is a need to use the skills learned, will increase the likelihood that a bystander will provide appropriate care to a victim."

It’s critical to target the correct age group for training, the AHA statement said. Students younger than about 13 years old may not have the necessary physical strength to perform correct chest compressions. Therefore, "it is reasonable to limit practice of adult CPR chest compression skills to children in middle school (around 13 years old) and older," the statement said (Circulation 2011;123:[doi: 10.1161/CIR.0b013e31820b5328]).

Programs designed for schools should include the core skills of conventional CPR and hands-only CPR developed by the AHA, and should emphasize recognition of the emergency and provision of high-quality chest compressions, the statement said.

The statement does not urge mandatory automated external defibrillator (AED) skills practice, although it recommends that schools providing AED skills practice give students an opportunity to practice and master all steps of CPR and AED use, with special emphasis on minimal interruptions in performance of CPR, correct application of pads to an appropriate surrogate for the human thorax, and proper "clearing" of the patient when so instructed by the AED.

Schools have cited a lack of available class time as a barrier to implementing CPR instruction. However, it should be possible for schools to implement such training as part of health courses or as part of a "community service" requirement for high school graduation, the AHA said. In addition, schools can make use of video-based, self-directed training programs and online or other e-learning programs, the statement said.

Several members of the writing committee had relationships that the AHA deemed significant: Dr. Tom P. Aufderheide of the Medical College of Wisconsin, Milwaukee, has received research support from Zoll Medical and Advanced Circulatory Inc.; and has served as an advisor or consultant to Medtronic and JoLife Inc.; Dr. Keith Lurie of the University of Wisconsin is also founder and chief medical officer of Advanced Circulatory Systems, as well as the inventor of that company’s ResQPOD. Dr. Vincent N. Mosesso Jr. of the University of Pittsburgh has received research support from Zoll Medical.

Cardiopulmonary resuscitation training should be a requirement for graduation from high school and should include instruction on the purpose of an automated external defibrillator and how to use one, according to an American Heart Association consensus statement released Jan. 10.

Photo credit:Flickr user John Trainor (Creative Commons)

The science advisory statement, developed in collaboration with the American Academy of Pediatrics and the American College of Emergency Physicians and published in the journal Circulation, also recommends that students have opportunities to practice and master psychomotor skills related to CPR, since trainees do not learn enough unless they get the chance to practice.

Although secondary school students most likely won’t encounter a victim of cardiac arrest at school, they may encounter one elsewhere in the community, and teaching CPR skills early can lead to more proficiency later, the AHA statement said.

"Increasing the percentage of the population trained in CPR is an integral part of an overall strategy to improve community response" to out-of-hospital cardiac arrests, the statement said. "Schools provide excellent access to a large part of the community. ... Therefore, over time, a significant percentage of the overall community will receive training."

In 2003, the International Liaison Committee on Resuscitation recommended that CPR instruction be incorporated into standard school curriculums, and the next year the AHA recommended that schools train all teachers in CPR and first aid and train all students in CPR in order to prepare for potential medical emergencies on campus.

As of the 2009-2010 school year, laws or curriculum standards in six states require CPR training as a component of mandatory health education, while 30 states encourage schools to teach CPR, according to the AHA statement. However, implementation of these laws isn’t uniform, and not all schools teach CPR, even in states that have the strongest language encouraging such training, the AHA statement said.

Therefore, requiring CPR training as a condition of high school graduation would significantly increase the level of CPR knowledge in the community over time, the statement said, adding, "the evidence shows that previous training, at any interval before there is a need to use the skills learned, will increase the likelihood that a bystander will provide appropriate care to a victim."

It’s critical to target the correct age group for training, the AHA statement said. Students younger than about 13 years old may not have the necessary physical strength to perform correct chest compressions. Therefore, "it is reasonable to limit practice of adult CPR chest compression skills to children in middle school (around 13 years old) and older," the statement said (Circulation 2011;123:[doi: 10.1161/CIR.0b013e31820b5328]).

Programs designed for schools should include the core skills of conventional CPR and hands-only CPR developed by the AHA, and should emphasize recognition of the emergency and provision of high-quality chest compressions, the statement said.

The statement does not urge mandatory automated external defibrillator (AED) skills practice, although it recommends that schools providing AED skills practice give students an opportunity to practice and master all steps of CPR and AED use, with special emphasis on minimal interruptions in performance of CPR, correct application of pads to an appropriate surrogate for the human thorax, and proper "clearing" of the patient when so instructed by the AED.

Schools have cited a lack of available class time as a barrier to implementing CPR instruction. However, it should be possible for schools to implement such training as part of health courses or as part of a "community service" requirement for high school graduation, the AHA said. In addition, schools can make use of video-based, self-directed training programs and online or other e-learning programs, the statement said.

Several members of the writing committee had relationships that the AHA deemed significant: Dr. Tom P. Aufderheide of the Medical College of Wisconsin, Milwaukee, has received research support from Zoll Medical and Advanced Circulatory Inc.; and has served as an advisor or consultant to Medtronic and JoLife Inc.; Dr. Keith Lurie of the University of Wisconsin is also founder and chief medical officer of Advanced Circulatory Systems, as well as the inventor of that company’s ResQPOD. Dr. Vincent N. Mosesso Jr. of the University of Pittsburgh has received research support from Zoll Medical.

Although base salary plus added bonuses based on quality and productivity measures represent the predominant compensation structure for hospitalists, methodologies for paying hospitalists vary widely and appear to be evolving toward paying a higher percentage of compensation as incentives, experts said.

Photo credit: Flickr user Todd Kravos (Creative Commons)

The bulk of hospitalist reimbursement is centered on salary, but productivity and quality incentives can provide as much as 30%, 40%, or even 50% of compensation, according to Jeffery Milburn, a consultant with MGMA Healthcare Consulting Group.

"Employers – especially hospitals – are paying more at the moment to try and align hospital and physician goals," he said.

Dr. Steven Deitelzweig, chairman of hospital medicine at Ochsner Medical Center, New Orleans, agreed. "Base plus incentives are becoming the rule, with the incentives focusing on the hospital’s goals and objectives for the calendar year."

Dr. Deitelzweig added that incentives can be tied to the gamut of hospital goals, from increasing relative value units (RVUs) and diagnosis-related group payment to quality and outcomes measures such as mortality and complication rates. Under health care reform, greater emphasis is likely to be placed on utilization measures, such as readmission rates and discharge times. Patient satisfaction, academic productivity, and "general citizenship," which can include working on committees or spearheading new programs, may also play a role.

A small number of hospitalists are reimbursed solely on the basis of their productivity, Mr. Milburn said. In those cases, the hospital or physician group measures work RVUs or patient encounters and pays a flat rate based on how much work the physician performs, "regardless of how many days or hours you work."

It can be difficult to craft these types of productivity incentives for hospitalists because they have limited control over the patient population at any given time, he said. "Hospitals don’t want them churning patients or overcoding, and hospitals don’t want them fraudulently billing to make up their productivity," he said.

Quality incentive payments based on patient satisfaction can be tricky as well, Mr. Milburn said, adding, "half the time the patient doesn’t even remember who called on them. Also, a lot of patients are going to see two or three different hospitalists during their stays."

In most cases, the physicians and the facility determine what to measure together – that way, the hospitalists buy into the measures.

Hospitalists seem comfortable with most payment methodologies, as long as they’re communicated fairly, Dr. Deitelzweig agreed.

In most practice environments, new physicians tend to prefer guaranteed compensation in the form of straight salary. As physicians become more experienced, they’re more willing to accept productivity-based compensation plans, Mr. Milburn said.

Dr. Alpesh Amin, professor and chairman of medicine at the University of California, Irvine, and executive director of its hospitalist program, said he thinks incentive payments that provide about 20%-30% in compensation above a base salary work well. "If you just give someone a $5,000 bonus, how meaningful is that for someone who makes $200,000?" he asks. "A $50,000-$60,000 bonus is a lot more meaningful."

The bonus also should be above a fair salary, not "something that gets them back to a reasonable market value salary," Dr. Amin said.

Incentive plans based on individual RVUs have limitations because hospitalists don’t have complete control over their work RVUs, he said. Metrics that measure whether hospitalists are documenting and coding to an appropriate maximum level potentially can work better, he said. Another component to an incentive program could involve chart reviews.

Some portion of a bonus could be tied to metrics for the entire group, while another part of the bonus could be tied to individual goals, such as working to develop a new program or being involved in committees, Dr. Amin said.

At the University of California, Irvine, hospitalist incentive pay is based on readmission rates, as well as on core measures in pneumonia, heart failure, and pressure ulcer prevention. His group has had a compensation system like this for more than a decade. "We have very little turnover," he said. "People seem to be happy."

Although base salary plus added bonuses based on quality and productivity measures represent the predominant compensation structure for hospitalists, methodologies for paying hospitalists vary widely and appear to be evolving toward paying a higher percentage of compensation as incentives, experts said.

Photo credit: Flickr user Todd Kravos (Creative Commons)

The bulk of hospitalist reimbursement is centered on salary, but productivity and quality incentives can provide as much as 30%, 40%, or even 50% of compensation, according to Jeffery Milburn, a consultant with MGMA Healthcare Consulting Group.

"Employers – especially hospitals – are paying more at the moment to try and align hospital and physician goals," he said.

Dr. Steven Deitelzweig, chairman of hospital medicine at Ochsner Medical Center, New Orleans, agreed. "Base plus incentives are becoming the rule, with the incentives focusing on the hospital’s goals and objectives for the calendar year."

Dr. Deitelzweig added that incentives can be tied to the gamut of hospital goals, from increasing relative value units (RVUs) and diagnosis-related group payment to quality and outcomes measures such as mortality and complication rates. Under health care reform, greater emphasis is likely to be placed on utilization measures, such as readmission rates and discharge times. Patient satisfaction, academic productivity, and "general citizenship," which can include working on committees or spearheading new programs, may also play a role.

A small number of hospitalists are reimbursed solely on the basis of their productivity, Mr. Milburn said. In those cases, the hospital or physician group measures work RVUs or patient encounters and pays a flat rate based on how much work the physician performs, "regardless of how many days or hours you work."

It can be difficult to craft these types of productivity incentives for hospitalists because they have limited control over the patient population at any given time, he said. "Hospitals don’t want them churning patients or overcoding, and hospitals don’t want them fraudulently billing to make up their productivity," he said.

Quality incentive payments based on patient satisfaction can be tricky as well, Mr. Milburn said, adding, "half the time the patient doesn’t even remember who called on them. Also, a lot of patients are going to see two or three different hospitalists during their stays."

In most cases, the physicians and the facility determine what to measure together – that way, the hospitalists buy into the measures.

Hospitalists seem comfortable with most payment methodologies, as long as they’re communicated fairly, Dr. Deitelzweig agreed.

In most practice environments, new physicians tend to prefer guaranteed compensation in the form of straight salary. As physicians become more experienced, they’re more willing to accept productivity-based compensation plans, Mr. Milburn said.

Dr. Alpesh Amin, professor and chairman of medicine at the University of California, Irvine, and executive director of its hospitalist program, said he thinks incentive payments that provide about 20%-30% in compensation above a base salary work well. "If you just give someone a $5,000 bonus, how meaningful is that for someone who makes $200,000?" he asks. "A $50,000-$60,000 bonus is a lot more meaningful."

The bonus also should be above a fair salary, not "something that gets them back to a reasonable market value salary," Dr. Amin said.

Incentive plans based on individual RVUs have limitations because hospitalists don’t have complete control over their work RVUs, he said. Metrics that measure whether hospitalists are documenting and coding to an appropriate maximum level potentially can work better, he said. Another component to an incentive program could involve chart reviews.

Some portion of a bonus could be tied to metrics for the entire group, while another part of the bonus could be tied to individual goals, such as working to develop a new program or being involved in committees, Dr. Amin said.

At the University of California, Irvine, hospitalist incentive pay is based on readmission rates, as well as on core measures in pneumonia, heart failure, and pressure ulcer prevention. His group has had a compensation system like this for more than a decade. "We have very little turnover," he said. "People seem to be happy."

Although base salary plus added bonuses based on quality and productivity measures represent the predominant compensation structure for hospitalists, methodologies for paying hospitalists vary widely and appear to be evolving toward paying a higher percentage of compensation as incentives, experts said.

Photo credit: Flickr user Todd Kravos (Creative Commons)

The bulk of hospitalist reimbursement is centered on salary, but productivity and quality incentives can provide as much as 30%, 40%, or even 50% of compensation, according to Jeffery Milburn, a consultant with MGMA Healthcare Consulting Group.

"Employers – especially hospitals – are paying more at the moment to try and align hospital and physician goals," he said.

Dr. Steven Deitelzweig, chairman of hospital medicine at Ochsner Medical Center, New Orleans, agreed. "Base plus incentives are becoming the rule, with the incentives focusing on the hospital’s goals and objectives for the calendar year."

Dr. Deitelzweig added that incentives can be tied to the gamut of hospital goals, from increasing relative value units (RVUs) and diagnosis-related group payment to quality and outcomes measures such as mortality and complication rates. Under health care reform, greater emphasis is likely to be placed on utilization measures, such as readmission rates and discharge times. Patient satisfaction, academic productivity, and "general citizenship," which can include working on committees or spearheading new programs, may also play a role.

A small number of hospitalists are reimbursed solely on the basis of their productivity, Mr. Milburn said. In those cases, the hospital or physician group measures work RVUs or patient encounters and pays a flat rate based on how much work the physician performs, "regardless of how many days or hours you work."

It can be difficult to craft these types of productivity incentives for hospitalists because they have limited control over the patient population at any given time, he said. "Hospitals don’t want them churning patients or overcoding, and hospitals don’t want them fraudulently billing to make up their productivity," he said.

Quality incentive payments based on patient satisfaction can be tricky as well, Mr. Milburn said, adding, "half the time the patient doesn’t even remember who called on them. Also, a lot of patients are going to see two or three different hospitalists during their stays."

In most cases, the physicians and the facility determine what to measure together – that way, the hospitalists buy into the measures.

Hospitalists seem comfortable with most payment methodologies, as long as they’re communicated fairly, Dr. Deitelzweig agreed.

In most practice environments, new physicians tend to prefer guaranteed compensation in the form of straight salary. As physicians become more experienced, they’re more willing to accept productivity-based compensation plans, Mr. Milburn said.

Dr. Alpesh Amin, professor and chairman of medicine at the University of California, Irvine, and executive director of its hospitalist program, said he thinks incentive payments that provide about 20%-30% in compensation above a base salary work well. "If you just give someone a $5,000 bonus, how meaningful is that for someone who makes $200,000?" he asks. "A $50,000-$60,000 bonus is a lot more meaningful."

The bonus also should be above a fair salary, not "something that gets them back to a reasonable market value salary," Dr. Amin said.

Incentive plans based on individual RVUs have limitations because hospitalists don’t have complete control over their work RVUs, he said. Metrics that measure whether hospitalists are documenting and coding to an appropriate maximum level potentially can work better, he said. Another component to an incentive program could involve chart reviews.

Some portion of a bonus could be tied to metrics for the entire group, while another part of the bonus could be tied to individual goals, such as working to develop a new program or being involved in committees, Dr. Amin said.

At the University of California, Irvine, hospitalist incentive pay is based on readmission rates, as well as on core measures in pneumonia, heart failure, and pressure ulcer prevention. His group has had a compensation system like this for more than a decade. "We have very little turnover," he said. "People seem to be happy."

Although base salary plus added bonuses based on quality and productivity measures represent the predominant compensation structure for hospitalists, methodologies for paying hospitalists vary widely and appear to be evolving toward paying a higher percentage of compensation as incentives, experts said.

The bulk of hospitalist reimbursement is centered on salary, but productivity and quality incentives can provide as much as 30%, 40%, or even 50% of compensation, according to Jeffery Milburn, a consultant with MGMA Healthcare Consulting Group.

"Employers – especially hospitals – are paying more at the moment to try and align hospital and physician goals," he said.

Dr. Steven Deitelzweig, chairman of hospital medicine at Ochsner Medical Center, New Orleans, agreed. "Base plus incentives are becoming the rule, with the incentives focusing on the hospital’s goals and objectives for the calendar year."

Dr. Deitelzweig added that incentives can be tied to the gamut of hospital goals, from increasing relative value units (RVUs) and diagnosis-related group payment to quality and outcomes measures such as mortality and complication rates. Under health care reform, greater emphasis is likely to be placed on utilization measures, such as readmission rates and discharge times. Patient satisfaction, academic productivity, and "general citizenship," which can include working on committees or spearheading new programs, may also play a role.

A small number of hospitalists are reimbursed solely on the basis of their productivity, Mr. Milburn said. In those cases, the hospital or physician group measures work RVUs or patient encounters and pays a flat rate based on how much work the physician performs, "regardless of how many days or hours you work."

It can be difficult to craft these types of productivity incentives for hospitalists because they have limited control over the patient population at any given time, he said. "Hospitals don’t want them churning patients or overcoding, and hospitals don’t want them fraudulently billing to make up their productivity," he said.

Quality incentive payments based on patient satisfaction can be tricky as well, Mr. Milburn said, adding, "half the time the patient doesn’t even remember who called on them. Also, a lot of patients are going to see two or three different hospitalists during their stays."

In most cases, the physicians and the facility determine what to measure together – that way, the hospitalists buy into the measures.

Hospitalists seem comfortable with most payment methodologies, as long as they’re communicated fairly, Dr. Deitelzweig agreed.

In most practice environments, new physicians tend to prefer guaranteed compensation in the form of straight salary. As physicians become more experienced, they’re more willing to accept productivity-based compensation plans, Mr. Milburn said.

Dr. Alpesh Amin, professor and chairman of medicine at the University of California, Irvine, and executive director of its hospitalist program, said he thinks incentive payments that provide about 20%-30% in compensation above a base salary work well. "If you just give someone a $5,000 bonus, how meaningful is that for someone who makes $200,000?" he asks. "A $50,000-$60,000 bonus is a lot more meaningful."

The bonus also should be above a fair salary, not "something that gets them back to a reasonable market value salary," Dr. Amin said.

Incentive plans based on individual RVUs have limitations because hospitalists don’t have complete control over their work RVUs, he said. Metrics that measure whether hospitalists are documenting and coding to an appropriate maximum level potentially can work better, he said. Another component to an incentive program could involve chart reviews.

Some portion of a bonus could be tied to metrics for the entire group, while another part of the bonus could be tied to individual goals, such as working to develop a new program or being involved in committees, Dr. Amin said.

At the University of California, Irvine, hospitalist incentive pay is based on readmission rates, as well as on core measures in pneumonia, heart failure, and pressure ulcer prevention. His group has had a compensation system like this for more than a decade. "We have very little turnover," he said. "People seem to be happy."

Although base salary plus added bonuses based on quality and productivity measures represent the predominant compensation structure for hospitalists, methodologies for paying hospitalists vary widely and appear to be evolving toward paying a higher percentage of compensation as incentives, experts said.

The bulk of hospitalist reimbursement is centered on salary, but productivity and quality incentives can provide as much as 30%, 40%, or even 50% of compensation, according to Jeffery Milburn, a consultant with MGMA Healthcare Consulting Group.

"Employers – especially hospitals – are paying more at the moment to try and align hospital and physician goals," he said.

Dr. Steven Deitelzweig, chairman of hospital medicine at Ochsner Medical Center, New Orleans, agreed. "Base plus incentives are becoming the rule, with the incentives focusing on the hospital’s goals and objectives for the calendar year."

Dr. Deitelzweig added that incentives can be tied to the gamut of hospital goals, from increasing relative value units (RVUs) and diagnosis-related group payment to quality and outcomes measures such as mortality and complication rates. Under health care reform, greater emphasis is likely to be placed on utilization measures, such as readmission rates and discharge times. Patient satisfaction, academic productivity, and "general citizenship," which can include working on committees or spearheading new programs, may also play a role.

A small number of hospitalists are reimbursed solely on the basis of their productivity, Mr. Milburn said. In those cases, the hospital or physician group measures work RVUs or patient encounters and pays a flat rate based on how much work the physician performs, "regardless of how many days or hours you work."

It can be difficult to craft these types of productivity incentives for hospitalists because they have limited control over the patient population at any given time, he said. "Hospitals don’t want them churning patients or overcoding, and hospitals don’t want them fraudulently billing to make up their productivity," he said.

Quality incentive payments based on patient satisfaction can be tricky as well, Mr. Milburn said, adding, "half the time the patient doesn’t even remember who called on them. Also, a lot of patients are going to see two or three different hospitalists during their stays."

In most cases, the physicians and the facility determine what to measure together – that way, the hospitalists buy into the measures.

Hospitalists seem comfortable with most payment methodologies, as long as they’re communicated fairly, Dr. Deitelzweig agreed.

In most practice environments, new physicians tend to prefer guaranteed compensation in the form of straight salary. As physicians become more experienced, they’re more willing to accept productivity-based compensation plans, Mr. Milburn said.

Dr. Alpesh Amin, professor and chairman of medicine at the University of California, Irvine, and executive director of its hospitalist program, said he thinks incentive payments that provide about 20%-30% in compensation above a base salary work well. "If you just give someone a $5,000 bonus, how meaningful is that for someone who makes $200,000?" he asks. "A $50,000-$60,000 bonus is a lot more meaningful."

The bonus also should be above a fair salary, not "something that gets them back to a reasonable market value salary," Dr. Amin said.

Incentive plans based on individual RVUs have limitations because hospitalists don’t have complete control over their work RVUs, he said. Metrics that measure whether hospitalists are documenting and coding to an appropriate maximum level potentially can work better, he said. Another component to an incentive program could involve chart reviews.

Some portion of a bonus could be tied to metrics for the entire group, while another part of the bonus could be tied to individual goals, such as working to develop a new program or being involved in committees, Dr. Amin said.

At the University of California, Irvine, hospitalist incentive pay is based on readmission rates, as well as on core measures in pneumonia, heart failure, and pressure ulcer prevention. His group has had a compensation system like this for more than a decade. "We have very little turnover," he said. "People seem to be happy."

Although base salary plus added bonuses based on quality and productivity measures represent the predominant compensation structure for hospitalists, methodologies for paying hospitalists vary widely and appear to be evolving toward paying a higher percentage of compensation as incentives, experts said.

The bulk of hospitalist reimbursement is centered on salary, but productivity and quality incentives can provide as much as 30%, 40%, or even 50% of compensation, according to Jeffery Milburn, a consultant with MGMA Healthcare Consulting Group.

"Employers – especially hospitals – are paying more at the moment to try and align hospital and physician goals," he said.

Dr. Steven Deitelzweig, chairman of hospital medicine at Ochsner Medical Center, New Orleans, agreed. "Base plus incentives are becoming the rule, with the incentives focusing on the hospital’s goals and objectives for the calendar year."

Dr. Deitelzweig added that incentives can be tied to the gamut of hospital goals, from increasing relative value units (RVUs) and diagnosis-related group payment to quality and outcomes measures such as mortality and complication rates. Under health care reform, greater emphasis is likely to be placed on utilization measures, such as readmission rates and discharge times. Patient satisfaction, academic productivity, and "general citizenship," which can include working on committees or spearheading new programs, may also play a role.

A small number of hospitalists are reimbursed solely on the basis of their productivity, Mr. Milburn said. In those cases, the hospital or physician group measures work RVUs or patient encounters and pays a flat rate based on how much work the physician performs, "regardless of how many days or hours you work."

It can be difficult to craft these types of productivity incentives for hospitalists because they have limited control over the patient population at any given time, he said. "Hospitals don’t want them churning patients or overcoding, and hospitals don’t want them fraudulently billing to make up their productivity," he said.

Quality incentive payments based on patient satisfaction can be tricky as well, Mr. Milburn said, adding, "half the time the patient doesn’t even remember who called on them. Also, a lot of patients are going to see two or three different hospitalists during their stays."

In most cases, the physicians and the facility determine what to measure together – that way, the hospitalists buy into the measures.

Hospitalists seem comfortable with most payment methodologies, as long as they’re communicated fairly, Dr. Deitelzweig agreed.

In most practice environments, new physicians tend to prefer guaranteed compensation in the form of straight salary. As physicians become more experienced, they’re more willing to accept productivity-based compensation plans, Mr. Milburn said.

Dr. Alpesh Amin, professor and chairman of medicine at the University of California, Irvine, and executive director of its hospitalist program, said he thinks incentive payments that provide about 20%-30% in compensation above a base salary work well. "If you just give someone a $5,000 bonus, how meaningful is that for someone who makes $200,000?" he asks. "A $50,000-$60,000 bonus is a lot more meaningful."

The bonus also should be above a fair salary, not "something that gets them back to a reasonable market value salary," Dr. Amin said.

Incentive plans based on individual RVUs have limitations because hospitalists don’t have complete control over their work RVUs, he said. Metrics that measure whether hospitalists are documenting and coding to an appropriate maximum level potentially can work better, he said. Another component to an incentive program could involve chart reviews.

Some portion of a bonus could be tied to metrics for the entire group, while another part of the bonus could be tied to individual goals, such as working to develop a new program or being involved in committees, Dr. Amin said.

At the University of California, Irvine, hospitalist incentive pay is based on readmission rates, as well as on core measures in pneumonia, heart failure, and pressure ulcer prevention. His group has had a compensation system like this for more than a decade. "We have very little turnover," he said. "People seem to be happy."

Major Finding: About half of the 59.1 million U.S. adults who reported being uninsured for at least part of the last year were nonpoor, with almost a third making between $43,000 and $65,000 a year (three times the federal poverty level for a family of 4).

Data Source: National Health Interview Survey data from 2006 to 2009 and from January to March 2010.

Disclosures: None reported.

An estimated 59.1 million Americans, including one in four aged 18-64 years, went without health insurance for at least part of the previous year, based on interviews done January-March 2010, the Centers for Disease Control and Prevention reported Nov. 9.

Although the percentage of children and teenagers without health insurance fell slightly, the total number of Americans who lacked insurance at some point in the year increased from 58.7 million in 2009, and the total has risen more than 4% since 2008 (MMWR 2010 Nov. 9 [Early Release]: 1–7)

At the same time, the number of Americans without insurance coverage for more than a year increased by 1.1 million to 33.9 million, the CDC reported.

About 84% of those who reported gaps in their health insurance coverage during the last year were aged 18-64, according to the report.

The number of middle-income adults reporting coverage gaps also increased. About 32% of adults under age 64 living in middle-income families – those with incomes of approximately $43,000-$65,000 for a family of four – reported being uninsured for at least part of the previous 12 months, indicating that problems with insurance coverage are extending further into the middle class.

“All of our measures of uninsurance have increased and increased substantially,” Dr. Thomas Frieden, director of the CDC, said in a press conference.

The CDC conducted in-person interviews of a sample of the population during the first quarter of 2010 in an effort to determine the number of uninsured.

It found that “half of the uninsured are nonpoor,” Dr. Frieden said. About 21% make more than three times the federal poverty level (FPL), defined as $65,000 for a family of four, and 9% make more than four times the FPL, or $87,000 for a family of four.

Meanwhile, the percentage of children and teenagers without health insurance fell slightly from 2008 to 2010, from 13% to 12%, according to the report.

The number of chronically uninsured children and teens – those who lacked health insurance for all of the prior year – dropped by 700,000, indicating that efforts to extend coverage to uninsured children through the Children's Health Insurance Program (CHIP) are paying off, the report found.

Being uninsured raised the risk of going without needed care substantially, especially for adults, according to the report. For those aged 18-64 years, those with no health insurance during the preceding year were seven times as likely − 28%, compared with 4% – to forego needed health care because of cost. Uninsured adults who had been diagnosed with diabetes were six times more likely − 47% vs. 8% – to skip necessary care because of cost.

The findings in the report represent a significant problem for the 40% of Americans adults with a chronic disease, Dr. Frieden said.

“Middle-aged adults who don't get preventive care enter Medicare sicker,” said Dr. Frieden, resulting in more hospitalizations and higher costs, especially for those with chronic conditions such as diabetes.

Major Finding: About half of the 59.1 million U.S. adults who reported being uninsured for at least part of the last year were nonpoor, with almost a third making between $43,000 and $65,000 a year (three times the federal poverty level for a family of 4).

Data Source: National Health Interview Survey data from 2006 to 2009 and from January to March 2010.

Disclosures: None reported.

An estimated 59.1 million Americans, including one in four aged 18-64 years, went without health insurance for at least part of the previous year, based on interviews done January-March 2010, the Centers for Disease Control and Prevention reported Nov. 9.

Although the percentage of children and teenagers without health insurance fell slightly, the total number of Americans who lacked insurance at some point in the year increased from 58.7 million in 2009, and the total has risen more than 4% since 2008 (MMWR 2010 Nov. 9 [Early Release]: 1–7)

At the same time, the number of Americans without insurance coverage for more than a year increased by 1.1 million to 33.9 million, the CDC reported.

About 84% of those who reported gaps in their health insurance coverage during the last year were aged 18-64, according to the report.

The number of middle-income adults reporting coverage gaps also increased. About 32% of adults under age 64 living in middle-income families – those with incomes of approximately $43,000-$65,000 for a family of four – reported being uninsured for at least part of the previous 12 months, indicating that problems with insurance coverage are extending further into the middle class.

“All of our measures of uninsurance have increased and increased substantially,” Dr. Thomas Frieden, director of the CDC, said in a press conference.

The CDC conducted in-person interviews of a sample of the population during the first quarter of 2010 in an effort to determine the number of uninsured.

It found that “half of the uninsured are nonpoor,” Dr. Frieden said. About 21% make more than three times the federal poverty level (FPL), defined as $65,000 for a family of four, and 9% make more than four times the FPL, or $87,000 for a family of four.

Meanwhile, the percentage of children and teenagers without health insurance fell slightly from 2008 to 2010, from 13% to 12%, according to the report.

The number of chronically uninsured children and teens – those who lacked health insurance for all of the prior year – dropped by 700,000, indicating that efforts to extend coverage to uninsured children through the Children's Health Insurance Program (CHIP) are paying off, the report found.

Being uninsured raised the risk of going without needed care substantially, especially for adults, according to the report. For those aged 18-64 years, those with no health insurance during the preceding year were seven times as likely − 28%, compared with 4% – to forego needed health care because of cost. Uninsured adults who had been diagnosed with diabetes were six times more likely − 47% vs. 8% – to skip necessary care because of cost.

The findings in the report represent a significant problem for the 40% of Americans adults with a chronic disease, Dr. Frieden said.

“Middle-aged adults who don't get preventive care enter Medicare sicker,” said Dr. Frieden, resulting in more hospitalizations and higher costs, especially for those with chronic conditions such as diabetes.

Major Finding: About half of the 59.1 million U.S. adults who reported being uninsured for at least part of the last year were nonpoor, with almost a third making between $43,000 and $65,000 a year (three times the federal poverty level for a family of 4).

Data Source: National Health Interview Survey data from 2006 to 2009 and from January to March 2010.

Disclosures: None reported.

An estimated 59.1 million Americans, including one in four aged 18-64 years, went without health insurance for at least part of the previous year, based on interviews done January-March 2010, the Centers for Disease Control and Prevention reported Nov. 9.

Although the percentage of children and teenagers without health insurance fell slightly, the total number of Americans who lacked insurance at some point in the year increased from 58.7 million in 2009, and the total has risen more than 4% since 2008 (MMWR 2010 Nov. 9 [Early Release]: 1–7)

At the same time, the number of Americans without insurance coverage for more than a year increased by 1.1 million to 33.9 million, the CDC reported.

About 84% of those who reported gaps in their health insurance coverage during the last year were aged 18-64, according to the report.

The number of middle-income adults reporting coverage gaps also increased. About 32% of adults under age 64 living in middle-income families – those with incomes of approximately $43,000-$65,000 for a family of four – reported being uninsured for at least part of the previous 12 months, indicating that problems with insurance coverage are extending further into the middle class.

“All of our measures of uninsurance have increased and increased substantially,” Dr. Thomas Frieden, director of the CDC, said in a press conference.

The CDC conducted in-person interviews of a sample of the population during the first quarter of 2010 in an effort to determine the number of uninsured.

It found that “half of the uninsured are nonpoor,” Dr. Frieden said. About 21% make more than three times the federal poverty level (FPL), defined as $65,000 for a family of four, and 9% make more than four times the FPL, or $87,000 for a family of four.

Meanwhile, the percentage of children and teenagers without health insurance fell slightly from 2008 to 2010, from 13% to 12%, according to the report.

The number of chronically uninsured children and teens – those who lacked health insurance for all of the prior year – dropped by 700,000, indicating that efforts to extend coverage to uninsured children through the Children's Health Insurance Program (CHIP) are paying off, the report found.

Being uninsured raised the risk of going without needed care substantially, especially for adults, according to the report. For those aged 18-64 years, those with no health insurance during the preceding year were seven times as likely − 28%, compared with 4% – to forego needed health care because of cost. Uninsured adults who had been diagnosed with diabetes were six times more likely − 47% vs. 8% – to skip necessary care because of cost.

The findings in the report represent a significant problem for the 40% of Americans adults with a chronic disease, Dr. Frieden said.

“Middle-aged adults who don't get preventive care enter Medicare sicker,” said Dr. Frieden, resulting in more hospitalizations and higher costs, especially for those with chronic conditions such as diabetes.

Major Finding: Physicians practicing primary care medicine are paid at least $20 per hour less than their colleagues who practice surgery and specialty medicine.

Data Source: Reimbursement data from 6,381 physicians providing patient care in the 2004-2005 Community Tracking Study.

Disclosures: The study was supported by grants from the National Institute for Occupational Safety and Health and the University of California, Davis, Office of the Vice Chancellor for Research.

Primary care physicians receive the lowest reimbursement of all physician specialties, indicating a need for reforms that would increase incomes or reduce work hours for primary care physicians.

J. Paul Leigh, Ph.D., and his colleagues at the University of California, Davis, used data from 6,381 physicians providing patient care in the 2004-2005 Community Tracking Study.

Medical specialties were broken down into four broad categories: primary care; surgery; internal medicine subspecialists and pediatric subspecialists; and an “other” category with physicians practicing in areas such as radiation oncology, emergency medicine, ophthalmology, and dermatology.

Wages of procedure-oriented specialists were approximately 36%-48% higher than those of primary care physicians, the investigators found (Arch. Intern. Med. 2010;170:1728-34).

Specialties with statistically higher-than-average wages perform neurologic, orthopedic, or ophthalmologic surgery, use sophisticated technologies such as radiation oncology equipment, or administer expensive drugs such as oncology drugs in office settings, they found.

Lower-paid specialties were largely nonprocedural and relied instead on talking to and examining patients, they noted, adding that “the major exception is critical-care internal medicine.”

Major Finding: Physicians practicing primary care medicine are paid at least $20 per hour less than their colleagues who practice surgery and specialty medicine.

Data Source: Reimbursement data from 6,381 physicians providing patient care in the 2004-2005 Community Tracking Study.

Disclosures: The study was supported by grants from the National Institute for Occupational Safety and Health and the University of California, Davis, Office of the Vice Chancellor for Research.

Primary care physicians receive the lowest reimbursement of all physician specialties, indicating a need for reforms that would increase incomes or reduce work hours for primary care physicians.

J. Paul Leigh, Ph.D., and his colleagues at the University of California, Davis, used data from 6,381 physicians providing patient care in the 2004-2005 Community Tracking Study.

Medical specialties were broken down into four broad categories: primary care; surgery; internal medicine subspecialists and pediatric subspecialists; and an “other” category with physicians practicing in areas such as radiation oncology, emergency medicine, ophthalmology, and dermatology.

Wages of procedure-oriented specialists were approximately 36%-48% higher than those of primary care physicians, the investigators found (Arch. Intern. Med. 2010;170:1728-34).

Specialties with statistically higher-than-average wages perform neurologic, orthopedic, or ophthalmologic surgery, use sophisticated technologies such as radiation oncology equipment, or administer expensive drugs such as oncology drugs in office settings, they found.

Lower-paid specialties were largely nonprocedural and relied instead on talking to and examining patients, they noted, adding that “the major exception is critical-care internal medicine.”

Major Finding: Physicians practicing primary care medicine are paid at least $20 per hour less than their colleagues who practice surgery and specialty medicine.

Data Source: Reimbursement data from 6,381 physicians providing patient care in the 2004-2005 Community Tracking Study.

Disclosures: The study was supported by grants from the National Institute for Occupational Safety and Health and the University of California, Davis, Office of the Vice Chancellor for Research.

Primary care physicians receive the lowest reimbursement of all physician specialties, indicating a need for reforms that would increase incomes or reduce work hours for primary care physicians.

J. Paul Leigh, Ph.D., and his colleagues at the University of California, Davis, used data from 6,381 physicians providing patient care in the 2004-2005 Community Tracking Study.

Medical specialties were broken down into four broad categories: primary care; surgery; internal medicine subspecialists and pediatric subspecialists; and an “other” category with physicians practicing in areas such as radiation oncology, emergency medicine, ophthalmology, and dermatology.

Wages of procedure-oriented specialists were approximately 36%-48% higher than those of primary care physicians, the investigators found (Arch. Intern. Med. 2010;170:1728-34).

Specialties with statistically higher-than-average wages perform neurologic, orthopedic, or ophthalmologic surgery, use sophisticated technologies such as radiation oncology equipment, or administer expensive drugs such as oncology drugs in office settings, they found.

Lower-paid specialties were largely nonprocedural and relied instead on talking to and examining patients, they noted, adding that “the major exception is critical-care internal medicine.”

School Lunch Bill Approved

About 115,000 children will be newly eligible for free or reduced-price lunches under a bill President Obama signed in December. The law authorizes $4.5 billion to increase reimbursement to school districts by 6 cents per meal and to expand after-school and summer food programs for children from low-income families. Under the legislation, schools must reduce the fat and calorie content of meals and establish policies to combat childhood obesity. The legislation “makes significant progress toward ending child hunger and obesity by expanding access to federal child nutrition programs and improving the nutritional value they provide,” said American Academy of Pediatrics President O. Marion Burton in a statement.

Kids Don't Eat Like Parents

Parents' diets may not have as much influence over their children's as previously thought, a study found. The report in the Journal of Epidemiology and Community Health combined data from 24 previous studies and found only a weak association between what parents eat and the diets their children adopt. The researchers, mainly from Johns Hopkins University, noted that most of the studies had been based on small samples and that findings varied significantly. Child self-reported intakes showed a weaker correlation with parents' diets than other assessments, the researchers said.

The End of Measles and Rubella

A group organized by the Pan American Health Organization is developing a plan to eventually confirm the elimination of measles, rubella, and congenital rubella in the Americas. The expert committee is modeling some of its strategy on the drives to confirm the elimination of endemic smallpox and polio from the region, according to the announcement of the panel's creation. The Americas reported its last endemic case of measles in November 2002, with all subsequent cases having been imported or tied to an imported case. The last endemic case of rubella in the Americas was reported in February 2009.

Fewer Drugs, Fewer Emergencies

Emergency department visits for adverse reactions to cough and cold medications fell by more than one-half for children younger than age 2 years following the withdrawal from the market of medications labeled for infants, according to a study in Pediatrics. However, children continue to ingest over-the-counter cough and cold drugs accidentally, and that problem needs to be addressed to truly curb the number of drug-reaction emergencies, the authors said. Manufacturers voluntarily withdrew the products for infants in 2007, after numerous reports of adverse reactions. When the researchers compared data from the 14 months prior to and after the withdrawal, they found that ED visits related to cough and cold drug reactions in children younger than 2 fell from 28% to 13% of total emergency visits. “Further reductions likely will require packaging improvements to reduce harm from unsupervised ingestions and continued education about avoiding cough and cold medications use for young children,” the authors said.

Service Corps Wins Funding

The National Health Service Corps will receive $290 million in new funding from last year's health care reform legislation to address shortages in the primary care workforce, the Department of Health and Human Services said. By the end of 2011, more than 10,800 clinicians will be caring for more than 11 million people, more than tripling the corps workforce since 2008, according to HHS. With even more funding from the legislation, the corps is expected to support more than 15,000 new primary care professionals by 2015, the agency said. Also under the legislation, primary care professionals will for the first time have the option of working half-time to fulfill their service obligations. The corps offers primary care medical, dental, and mental health clinicians up to $60,000 to repay student loans in exchange for 2 years of service at health care facilities in medically underserved areas.

McDonald's Sued Over Toys

A California mother of two, with help from the food-activist group the Center for Science in the Public Interest, is suing McDonald's for using toys to entice children to demand and eat what she says are nutritionally unsound Happy Meals. The class action lawsuit, filed in California Superior Court in San Francisco, argues that McDonald's intentionally targets children with its toys and advertising of meals that contain large amounts of fried food and sugary drinks. “I am concerned about the health of my children and feel that McDonald's should be a very limited part of their diet and their childhood experience,” said plaintiff Monet Parham in a statement. “But as other busy, working moms and dads know, we have to say 'no' to our young children so many times, and McDonald's makes that so much harder to do. I object to the fact that McDonald's is getting into my kids' heads without my permission.” The suit asks the court to prohibit McDonald's from advertising Happy Meals with toys in California.

School Lunch Bill Approved

About 115,000 children will be newly eligible for free or reduced-price lunches under a bill President Obama signed in December. The law authorizes $4.5 billion to increase reimbursement to school districts by 6 cents per meal and to expand after-school and summer food programs for children from low-income families. Under the legislation, schools must reduce the fat and calorie content of meals and establish policies to combat childhood obesity. The legislation “makes significant progress toward ending child hunger and obesity by expanding access to federal child nutrition programs and improving the nutritional value they provide,” said American Academy of Pediatrics President O. Marion Burton in a statement.

Kids Don't Eat Like Parents

Parents' diets may not have as much influence over their children's as previously thought, a study found. The report in the Journal of Epidemiology and Community Health combined data from 24 previous studies and found only a weak association between what parents eat and the diets their children adopt. The researchers, mainly from Johns Hopkins University, noted that most of the studies had been based on small samples and that findings varied significantly. Child self-reported intakes showed a weaker correlation with parents' diets than other assessments, the researchers said.

The End of Measles and Rubella

A group organized by the Pan American Health Organization is developing a plan to eventually confirm the elimination of measles, rubella, and congenital rubella in the Americas. The expert committee is modeling some of its strategy on the drives to confirm the elimination of endemic smallpox and polio from the region, according to the announcement of the panel's creation. The Americas reported its last endemic case of measles in November 2002, with all subsequent cases having been imported or tied to an imported case. The last endemic case of rubella in the Americas was reported in February 2009.

Fewer Drugs, Fewer Emergencies

Emergency department visits for adverse reactions to cough and cold medications fell by more than one-half for children younger than age 2 years following the withdrawal from the market of medications labeled for infants, according to a study in Pediatrics. However, children continue to ingest over-the-counter cough and cold drugs accidentally, and that problem needs to be addressed to truly curb the number of drug-reaction emergencies, the authors said. Manufacturers voluntarily withdrew the products for infants in 2007, after numerous reports of adverse reactions. When the researchers compared data from the 14 months prior to and after the withdrawal, they found that ED visits related to cough and cold drug reactions in children younger than 2 fell from 28% to 13% of total emergency visits. “Further reductions likely will require packaging improvements to reduce harm from unsupervised ingestions and continued education about avoiding cough and cold medications use for young children,” the authors said.

Service Corps Wins Funding

The National Health Service Corps will receive $290 million in new funding from last year's health care reform legislation to address shortages in the primary care workforce, the Department of Health and Human Services said. By the end of 2011, more than 10,800 clinicians will be caring for more than 11 million people, more than tripling the corps workforce since 2008, according to HHS. With even more funding from the legislation, the corps is expected to support more than 15,000 new primary care professionals by 2015, the agency said. Also under the legislation, primary care professionals will for the first time have the option of working half-time to fulfill their service obligations. The corps offers primary care medical, dental, and mental health clinicians up to $60,000 to repay student loans in exchange for 2 years of service at health care facilities in medically underserved areas.

McDonald's Sued Over Toys

A California mother of two, with help from the food-activist group the Center for Science in the Public Interest, is suing McDonald's for using toys to entice children to demand and eat what she says are nutritionally unsound Happy Meals. The class action lawsuit, filed in California Superior Court in San Francisco, argues that McDonald's intentionally targets children with its toys and advertising of meals that contain large amounts of fried food and sugary drinks. “I am concerned about the health of my children and feel that McDonald's should be a very limited part of their diet and their childhood experience,” said plaintiff Monet Parham in a statement. “But as other busy, working moms and dads know, we have to say 'no' to our young children so many times, and McDonald's makes that so much harder to do. I object to the fact that McDonald's is getting into my kids' heads without my permission.” The suit asks the court to prohibit McDonald's from advertising Happy Meals with toys in California.

School Lunch Bill Approved

About 115,000 children will be newly eligible for free or reduced-price lunches under a bill President Obama signed in December. The law authorizes $4.5 billion to increase reimbursement to school districts by 6 cents per meal and to expand after-school and summer food programs for children from low-income families. Under the legislation, schools must reduce the fat and calorie content of meals and establish policies to combat childhood obesity. The legislation “makes significant progress toward ending child hunger and obesity by expanding access to federal child nutrition programs and improving the nutritional value they provide,” said American Academy of Pediatrics President O. Marion Burton in a statement.

Kids Don't Eat Like Parents

Parents' diets may not have as much influence over their children's as previously thought, a study found. The report in the Journal of Epidemiology and Community Health combined data from 24 previous studies and found only a weak association between what parents eat and the diets their children adopt. The researchers, mainly from Johns Hopkins University, noted that most of the studies had been based on small samples and that findings varied significantly. Child self-reported intakes showed a weaker correlation with parents' diets than other assessments, the researchers said.

The End of Measles and Rubella

A group organized by the Pan American Health Organization is developing a plan to eventually confirm the elimination of measles, rubella, and congenital rubella in the Americas. The expert committee is modeling some of its strategy on the drives to confirm the elimination of endemic smallpox and polio from the region, according to the announcement of the panel's creation. The Americas reported its last endemic case of measles in November 2002, with all subsequent cases having been imported or tied to an imported case. The last endemic case of rubella in the Americas was reported in February 2009.

Fewer Drugs, Fewer Emergencies

Emergency department visits for adverse reactions to cough and cold medications fell by more than one-half for children younger than age 2 years following the withdrawal from the market of medications labeled for infants, according to a study in Pediatrics. However, children continue to ingest over-the-counter cough and cold drugs accidentally, and that problem needs to be addressed to truly curb the number of drug-reaction emergencies, the authors said. Manufacturers voluntarily withdrew the products for infants in 2007, after numerous reports of adverse reactions. When the researchers compared data from the 14 months prior to and after the withdrawal, they found that ED visits related to cough and cold drug reactions in children younger than 2 fell from 28% to 13% of total emergency visits. “Further reductions likely will require packaging improvements to reduce harm from unsupervised ingestions and continued education about avoiding cough and cold medications use for young children,” the authors said.

Service Corps Wins Funding

The National Health Service Corps will receive $290 million in new funding from last year's health care reform legislation to address shortages in the primary care workforce, the Department of Health and Human Services said. By the end of 2011, more than 10,800 clinicians will be caring for more than 11 million people, more than tripling the corps workforce since 2008, according to HHS. With even more funding from the legislation, the corps is expected to support more than 15,000 new primary care professionals by 2015, the agency said. Also under the legislation, primary care professionals will for the first time have the option of working half-time to fulfill their service obligations. The corps offers primary care medical, dental, and mental health clinicians up to $60,000 to repay student loans in exchange for 2 years of service at health care facilities in medically underserved areas.

McDonald's Sued Over Toys

A California mother of two, with help from the food-activist group the Center for Science in the Public Interest, is suing McDonald's for using toys to entice children to demand and eat what she says are nutritionally unsound Happy Meals. The class action lawsuit, filed in California Superior Court in San Francisco, argues that McDonald's intentionally targets children with its toys and advertising of meals that contain large amounts of fried food and sugary drinks. “I am concerned about the health of my children and feel that McDonald's should be a very limited part of their diet and their childhood experience,” said plaintiff Monet Parham in a statement. “But as other busy, working moms and dads know, we have to say 'no' to our young children so many times, and McDonald's makes that so much harder to do. I object to the fact that McDonald's is getting into my kids' heads without my permission.” The suit asks the court to prohibit McDonald's from advertising Happy Meals with toys in California.

HHS Seeks Better Chronic Care

The Department of Health and Human Services says it has a new strategy to improve the care of patients with multiple chronic conditions while cutting costs. The effort will give health professionals new information on such care and will facilitate research under the auspices of the Centers for Disease Control and Prevention and the Centers for Medicare and Medicaid Services. More than one-quarter of all Americans – and two-thirds of older Americans – live with multiple chronic conditions, according to HHS. “Focusing on the integration and coordination of care … is critical to achieve better care and health for beneficiaries, and lower costs through greater efficiency and quality,” said CMS Administrator Donald Berwick in a statement.

State Smokes Heart Disease

The Massachusetts Medicaid program has curbed smoking prevalence and hospital admissions for some smoking-related diseases, according to a study published online in Public Library of Science Medicine. In 2006, the program began comprehensive coverage of tobacco cessation therapies and counseling. About 75,000 Medicaid recipients used that benefit from 2006 to early 2009, and smoking dropped 10% among the Medicaid population, reported researchers from the state's Tobacco Cessation and Prevention Program and Harvard Medical School, Boston. The rate of Medicaid hospital admissions for coronary atherosclerosis declined 49%, and that for acute myocardial infarction dropped 46%. But there was no change in admissions for lung diseases or some other tobacco-related conditions.

Medical Prices Vary Worldwide

U.S. prices for medical procedures again surpassed those in other countries, according to a survey by the International Federation of Health Plans. For example, the average hospital stay costs $1,679 in Spain and $7,707 in Canada but can range from $14,427 to $45,902 in the United States. One month's supply of esomeprazole (Nexium) costs $30 in the United Kingdom but $186 in this country. The difference was greatest for surgery, according to the 2010 edition of the federation's annual survey. For example, cataract surgery cost an average of $1,667 in Spain but $14,764 in the United States. “As countries around the world look at the impact of their health care systems on their economies, the cost per unit of services, procedures, and drugs is a key factor that needs to be understood,” said the federation's chief executive, Tom Sackville, in a statement.

Primary Care Strategy Needed

A nonpartisan think tank is calling for a national strategy to reinvent primary care so it uses lesser-trained health workers to provide more patient care. The recommendations from the Hope Street Group, developed with input from numerous prominent health policy makers, would reorient primary care toward prevention, wellness, and disease management, according to the report. The document calls for using workers “trained at the community college and vocational levels to help people with health care that does not entail examining the patient.” It also urges the federal government to foster an environment in which new practice models, payment structures, and technologies can be tested and disseminated more rapidly. The country's health care system needs to implement payment reform and strategies to address the health of populations rather than just individuals, according to the report.

Life Expectancy Declines a Bit

Overall life expectancy in the United States declined by about 1 month from 2007 to 2008, but it will take more years to determine whether that represents a trend, according to the CDC's National Center for Health Statistics. Life expectancy at birth fell from 77.9 years in 2007 to 77.8 years in 2008 for both men and women. However, black men gained a record-high life expectancy of 70.2 years in 2008, up from 70.0 years in 2007, and the gap between white and black populations was 4.6 years in 2008, a decrease of two-tenths of a year from 2007, the agency said. Heart disease and cancer, the two leading causes of death, accounted for 48% of all deaths in 2008. Stroke fell from the third leading cause of death to the fourth, while chronic lower respiratory diseases took its place as number three, the CDC said. However, that shift may be due to a modification in how deaths from chronic lower respiratory diseases are classified, the agency said.

HIV Testing Reaches Record High

While the number of U.S. adults tested for HIV reached a record high in 2009, 55% of all adults and 28% of adults with at least one HIV risk factor still haven't been tested, the CDC said. The agency recommended in 2006 that HIV testing become a routine part of medical care for adults and adolescents and that high-risk individuals be tested once a year. In 2009, nearly 83 million adults aged 18-64 years said they had been tested for HIV at least once. However, only 60% of gay or bisexual men said they had been tested in the past year. The agency estimated that about 1.1 million U.S. adults are living with HIV, including about 200,000 who don't know their HIV status.

HHS Seeks Better Chronic Care

The Department of Health and Human Services says it has a new strategy to improve the care of patients with multiple chronic conditions while cutting costs. The effort will give health professionals new information on such care and will facilitate research under the auspices of the Centers for Disease Control and Prevention and the Centers for Medicare and Medicaid Services. More than one-quarter of all Americans – and two-thirds of older Americans – live with multiple chronic conditions, according to HHS. “Focusing on the integration and coordination of care … is critical to achieve better care and health for beneficiaries, and lower costs through greater efficiency and quality,” said CMS Administrator Donald Berwick in a statement.

State Smokes Heart Disease

The Massachusetts Medicaid program has curbed smoking prevalence and hospital admissions for some smoking-related diseases, according to a study published online in Public Library of Science Medicine. In 2006, the program began comprehensive coverage of tobacco cessation therapies and counseling. About 75,000 Medicaid recipients used that benefit from 2006 to early 2009, and smoking dropped 10% among the Medicaid population, reported researchers from the state's Tobacco Cessation and Prevention Program and Harvard Medical School, Boston. The rate of Medicaid hospital admissions for coronary atherosclerosis declined 49%, and that for acute myocardial infarction dropped 46%. But there was no change in admissions for lung diseases or some other tobacco-related conditions.

Medical Prices Vary Worldwide

U.S. prices for medical procedures again surpassed those in other countries, according to a survey by the International Federation of Health Plans. For example, the average hospital stay costs $1,679 in Spain and $7,707 in Canada but can range from $14,427 to $45,902 in the United States. One month's supply of esomeprazole (Nexium) costs $30 in the United Kingdom but $186 in this country. The difference was greatest for surgery, according to the 2010 edition of the federation's annual survey. For example, cataract surgery cost an average of $1,667 in Spain but $14,764 in the United States. “As countries around the world look at the impact of their health care systems on their economies, the cost per unit of services, procedures, and drugs is a key factor that needs to be understood,” said the federation's chief executive, Tom Sackville, in a statement.

Primary Care Strategy Needed

A nonpartisan think tank is calling for a national strategy to reinvent primary care so it uses lesser-trained health workers to provide more patient care. The recommendations from the Hope Street Group, developed with input from numerous prominent health policy makers, would reorient primary care toward prevention, wellness, and disease management, according to the report. The document calls for using workers “trained at the community college and vocational levels to help people with health care that does not entail examining the patient.” It also urges the federal government to foster an environment in which new practice models, payment structures, and technologies can be tested and disseminated more rapidly. The country's health care system needs to implement payment reform and strategies to address the health of populations rather than just individuals, according to the report.

Life Expectancy Declines a Bit

Overall life expectancy in the United States declined by about 1 month from 2007 to 2008, but it will take more years to determine whether that represents a trend, according to the CDC's National Center for Health Statistics. Life expectancy at birth fell from 77.9 years in 2007 to 77.8 years in 2008 for both men and women. However, black men gained a record-high life expectancy of 70.2 years in 2008, up from 70.0 years in 2007, and the gap between white and black populations was 4.6 years in 2008, a decrease of two-tenths of a year from 2007, the agency said. Heart disease and cancer, the two leading causes of death, accounted for 48% of all deaths in 2008. Stroke fell from the third leading cause of death to the fourth, while chronic lower respiratory diseases took its place as number three, the CDC said. However, that shift may be due to a modification in how deaths from chronic lower respiratory diseases are classified, the agency said.

HIV Testing Reaches Record High

While the number of U.S. adults tested for HIV reached a record high in 2009, 55% of all adults and 28% of adults with at least one HIV risk factor still haven't been tested, the CDC said. The agency recommended in 2006 that HIV testing become a routine part of medical care for adults and adolescents and that high-risk individuals be tested once a year. In 2009, nearly 83 million adults aged 18-64 years said they had been tested for HIV at least once. However, only 60% of gay or bisexual men said they had been tested in the past year. The agency estimated that about 1.1 million U.S. adults are living with HIV, including about 200,000 who don't know their HIV status.

HHS Seeks Better Chronic Care

The Department of Health and Human Services says it has a new strategy to improve the care of patients with multiple chronic conditions while cutting costs. The effort will give health professionals new information on such care and will facilitate research under the auspices of the Centers for Disease Control and Prevention and the Centers for Medicare and Medicaid Services. More than one-quarter of all Americans – and two-thirds of older Americans – live with multiple chronic conditions, according to HHS. “Focusing on the integration and coordination of care … is critical to achieve better care and health for beneficiaries, and lower costs through greater efficiency and quality,” said CMS Administrator Donald Berwick in a statement.

State Smokes Heart Disease

The Massachusetts Medicaid program has curbed smoking prevalence and hospital admissions for some smoking-related diseases, according to a study published online in Public Library of Science Medicine. In 2006, the program began comprehensive coverage of tobacco cessation therapies and counseling. About 75,000 Medicaid recipients used that benefit from 2006 to early 2009, and smoking dropped 10% among the Medicaid population, reported researchers from the state's Tobacco Cessation and Prevention Program and Harvard Medical School, Boston. The rate of Medicaid hospital admissions for coronary atherosclerosis declined 49%, and that for acute myocardial infarction dropped 46%. But there was no change in admissions for lung diseases or some other tobacco-related conditions.

Medical Prices Vary Worldwide

U.S. prices for medical procedures again surpassed those in other countries, according to a survey by the International Federation of Health Plans. For example, the average hospital stay costs $1,679 in Spain and $7,707 in Canada but can range from $14,427 to $45,902 in the United States. One month's supply of esomeprazole (Nexium) costs $30 in the United Kingdom but $186 in this country. The difference was greatest for surgery, according to the 2010 edition of the federation's annual survey. For example, cataract surgery cost an average of $1,667 in Spain but $14,764 in the United States. “As countries around the world look at the impact of their health care systems on their economies, the cost per unit of services, procedures, and drugs is a key factor that needs to be understood,” said the federation's chief executive, Tom Sackville, in a statement.

Primary Care Strategy Needed

A nonpartisan think tank is calling for a national strategy to reinvent primary care so it uses lesser-trained health workers to provide more patient care. The recommendations from the Hope Street Group, developed with input from numerous prominent health policy makers, would reorient primary care toward prevention, wellness, and disease management, according to the report. The document calls for using workers “trained at the community college and vocational levels to help people with health care that does not entail examining the patient.” It also urges the federal government to foster an environment in which new practice models, payment structures, and technologies can be tested and disseminated more rapidly. The country's health care system needs to implement payment reform and strategies to address the health of populations rather than just individuals, according to the report.

Life Expectancy Declines a Bit

Overall life expectancy in the United States declined by about 1 month from 2007 to 2008, but it will take more years to determine whether that represents a trend, according to the CDC's National Center for Health Statistics. Life expectancy at birth fell from 77.9 years in 2007 to 77.8 years in 2008 for both men and women. However, black men gained a record-high life expectancy of 70.2 years in 2008, up from 70.0 years in 2007, and the gap between white and black populations was 4.6 years in 2008, a decrease of two-tenths of a year from 2007, the agency said. Heart disease and cancer, the two leading causes of death, accounted for 48% of all deaths in 2008. Stroke fell from the third leading cause of death to the fourth, while chronic lower respiratory diseases took its place as number three, the CDC said. However, that shift may be due to a modification in how deaths from chronic lower respiratory diseases are classified, the agency said.

HIV Testing Reaches Record High

While the number of U.S. adults tested for HIV reached a record high in 2009, 55% of all adults and 28% of adults with at least one HIV risk factor still haven't been tested, the CDC said. The agency recommended in 2006 that HIV testing become a routine part of medical care for adults and adolescents and that high-risk individuals be tested once a year. In 2009, nearly 83 million adults aged 18-64 years said they had been tested for HIV at least once. However, only 60% of gay or bisexual men said they had been tested in the past year. The agency estimated that about 1.1 million U.S. adults are living with HIV, including about 200,000 who don't know their HIV status.

A 40% tax on all sugar-sweetened beverages could cut consumption enough to result in a slight weight loss, especially among people who live in middle-income households, and could raise up to $2.5 billion in tax revenue, according to a study published Dec. 13 in Archives of Internal Medicine.

© Lori Martin/Fotolia.com

Such a tax could reduce beverage purchases enough to eliminate an average 12 kcal/day from an average consumer’s diet, resulting in weight loss of about 1.5 pounds/year (Arch. Intern. Med. 2010;170:2028-34).

"Large taxes on sugar-sweetened beverages are likely to be effective at positively influencing weight outcomes, especially among middle-income households," wrote Eric A. Finkelstein, Ph.D., of the Duke–National University of Singapore Graduate Medical School, and his associates. "These taxes would also generate substantial revenue that could be used to fund obesity prevention efforts or for other causes."

The authors used data from the 2006 Nielsen Homescan panel, in which a national sample of households scanned and transmitted their store-bought food and beverage purchases weekly for 12 months. To predict the effects of 20% and 40% taxes on sugar-sweetened beverage purchases, they analyzed price changes and their effects on monthly purchases.

Larger taxes that include all sugar-sweetened beverages would have a greater effect on purchases than a smaller tax on only carbonated soda, they found.

For example, a 20% tax on only sugar-sweetened sodas would reduce purchases of beverages, for an average drop of about 4 kcal/day per capita. Meanwhile, a 40% tax on all sugar-sweetened beverages would cut daily consumption by more than 17 kcal, but because consumers would make up some of those calories from other types of beverages, overall calories from all beverages would drop by about 12 kcal, the investigators found.

Taxing all sugar-sweetened beverages, including carbonated sodas, sports/energy drinks, and fruit drinks, would produce weight-loss results that are 60% greater than those produced by a tax on soda alone, the investigators wrote. "This happens because the expanded tax makes it more difficult to substitute similar products in efforts to avoid the price increase," they wrote.

People who live in households with the lowest level of income drank the most sugar-sweetened beverages, but people in middle-income families would feel the effects of such a tax more acutely because they consume less soda, which tends to be less expensive, and more sports/energy and fruit drinks, which tend to cost more, the investigators found.

A 40% tax on all sugar-sweetened beverages would increase food expenditures by only about $30 per household, per year, the study said. Across all households, a 40% sales tax on sugar-sweetened beverages would produce about $2.5 billion annually, while a 20% tax would raise about $1.5 billion. "If this revenue were used directly for obesity prevention efforts, this could indirectly increase the effectiveness of targeted beverage taxes," the authors wrote.

The study was supported by the Robert Wood Johnson Foundation. The authors said they had no relevant financial disclosures.

A 40% tax on all sugar-sweetened beverages could cut consumption enough to result in a slight weight loss, especially among people who live in middle-income households, and could raise up to $2.5 billion in tax revenue, according to a study published Dec. 13 in Archives of Internal Medicine.

© Lori Martin/Fotolia.com

Such a tax could reduce beverage purchases enough to eliminate an average 12 kcal/day from an average consumer’s diet, resulting in weight loss of about 1.5 pounds/year (Arch. Intern. Med. 2010;170:2028-34).

"Large taxes on sugar-sweetened beverages are likely to be effective at positively influencing weight outcomes, especially among middle-income households," wrote Eric A. Finkelstein, Ph.D., of the Duke–National University of Singapore Graduate Medical School, and his associates. "These taxes would also generate substantial revenue that could be used to fund obesity prevention efforts or for other causes."

The authors used data from the 2006 Nielsen Homescan panel, in which a national sample of households scanned and transmitted their store-bought food and beverage purchases weekly for 12 months. To predict the effects of 20% and 40% taxes on sugar-sweetened beverage purchases, they analyzed price changes and their effects on monthly purchases.

Larger taxes that include all sugar-sweetened beverages would have a greater effect on purchases than a smaller tax on only carbonated soda, they found.

For example, a 20% tax on only sugar-sweetened sodas would reduce purchases of beverages, for an average drop of about 4 kcal/day per capita. Meanwhile, a 40% tax on all sugar-sweetened beverages would cut daily consumption by more than 17 kcal, but because consumers would make up some of those calories from other types of beverages, overall calories from all beverages would drop by about 12 kcal, the investigators found.

Taxing all sugar-sweetened beverages, including carbonated sodas, sports/energy drinks, and fruit drinks, would produce weight-loss results that are 60% greater than those produced by a tax on soda alone, the investigators wrote. "This happens because the expanded tax makes it more difficult to substitute similar products in efforts to avoid the price increase," they wrote.

People who live in households with the lowest level of income drank the most sugar-sweetened beverages, but people in middle-income families would feel the effects of such a tax more acutely because they consume less soda, which tends to be less expensive, and more sports/energy and fruit drinks, which tend to cost more, the investigators found.

A 40% tax on all sugar-sweetened beverages would increase food expenditures by only about $30 per household, per year, the study said. Across all households, a 40% sales tax on sugar-sweetened beverages would produce about $2.5 billion annually, while a 20% tax would raise about $1.5 billion. "If this revenue were used directly for obesity prevention efforts, this could indirectly increase the effectiveness of targeted beverage taxes," the authors wrote.

The study was supported by the Robert Wood Johnson Foundation. The authors said they had no relevant financial disclosures.

A 40% tax on all sugar-sweetened beverages could cut consumption enough to result in a slight weight loss, especially among people who live in middle-income households, and could raise up to $2.5 billion in tax revenue, according to a study published Dec. 13 in Archives of Internal Medicine.

© Lori Martin/Fotolia.com

Such a tax could reduce beverage purchases enough to eliminate an average 12 kcal/day from an average consumer’s diet, resulting in weight loss of about 1.5 pounds/year (Arch. Intern. Med. 2010;170:2028-34).

"Large taxes on sugar-sweetened beverages are likely to be effective at positively influencing weight outcomes, especially among middle-income households," wrote Eric A. Finkelstein, Ph.D., of the Duke–National University of Singapore Graduate Medical School, and his associates. "These taxes would also generate substantial revenue that could be used to fund obesity prevention efforts or for other causes."

The authors used data from the 2006 Nielsen Homescan panel, in which a national sample of households scanned and transmitted their store-bought food and beverage purchases weekly for 12 months. To predict the effects of 20% and 40% taxes on sugar-sweetened beverage purchases, they analyzed price changes and their effects on monthly purchases.

Larger taxes that include all sugar-sweetened beverages would have a greater effect on purchases than a smaller tax on only carbonated soda, they found.

For example, a 20% tax on only sugar-sweetened sodas would reduce purchases of beverages, for an average drop of about 4 kcal/day per capita. Meanwhile, a 40% tax on all sugar-sweetened beverages would cut daily consumption by more than 17 kcal, but because consumers would make up some of those calories from other types of beverages, overall calories from all beverages would drop by about 12 kcal, the investigators found.

Taxing all sugar-sweetened beverages, including carbonated sodas, sports/energy drinks, and fruit drinks, would produce weight-loss results that are 60% greater than those produced by a tax on soda alone, the investigators wrote. "This happens because the expanded tax makes it more difficult to substitute similar products in efforts to avoid the price increase," they wrote.

People who live in households with the lowest level of income drank the most sugar-sweetened beverages, but people in middle-income families would feel the effects of such a tax more acutely because they consume less soda, which tends to be less expensive, and more sports/energy and fruit drinks, which tend to cost more, the investigators found.

A 40% tax on all sugar-sweetened beverages would increase food expenditures by only about $30 per household, per year, the study said. Across all households, a 40% sales tax on sugar-sweetened beverages would produce about $2.5 billion annually, while a 20% tax would raise about $1.5 billion. "If this revenue were used directly for obesity prevention efforts, this could indirectly increase the effectiveness of targeted beverage taxes," the authors wrote.

The study was supported by the Robert Wood Johnson Foundation. The authors said they had no relevant financial disclosures.

The American Board of Psychiatry and Neurology has voted to create a new epilepsy subspecialty, potentially helping to improve the quality of care for epilepsy patients while better training physicians in an area that has become increasingly complex, with multiple new advances in diagnosis and management.

The epilepsy subspecialty, officially created in November by the American Board of Medical Specialties (ABMS), becomes the 13th subspecialty within the fields of neurology and psychiatry. Physicians who receive subspecialty certification in epilepsy will need to understand the pathophysiology, genetics, pathology, diagnosis, and treatment of seizure disorders at a level far beyond that of a general or child neurologist, the American Board of Psychiatry and Neurology (ABPN) said.

Neurologists who treat large numbers of epilepsy patients realized the need for subspecialty training specifically in epilepsy because of the incredible increase in potential diagnostic tools and treatments for the disorder, said Dr. Joseph Drazkowski, director of the electroencephalography laboratory at the Mayo Clinic in Scottsdale, Ariz.

"Therapies have evolved over the years – they’ve become more effective, and at the same time more complicated," Dr. Drazkowski said in an interview. "The seizures themselves haven’t changed, but the number of seizure meds has grown exponentially."

At the same time, diagnostic procedures and surgical procedures for epilepsy have grown much more technical, he said, adding, "not everybody can do those technical procedures."

In addition, more devices to diagnose and treat epilepsy are under development, which likely will make epilepsy care even more complex. Any time there’s this type of increase in complexity surrounding diagnosis and treatment, "there’s a need for standards," Dr. Drazkowski said. "Those standards should be created and those standards should be met."

The American Academy of Neurology requested that ABPN consider the new subspecialty, Dr. Larry Faulkner, ABPN’s president and CEO, said in an interview. The board has very specific requirements, including training specific to the new subspecialty and "a critical mass of people practicing" in that area.

Now that the ABMS has approved the new specialty, a panel of epilepsy experts, chaired by Dr. Patricia Crumrine, director of EEG and the medical epilepsy program at Children’s Hospital of Pittsburgh, will develop the outline for the new subspecialty and the questions for the new board exam, Dr. Faulkner said.

At the same time, ABPN will ask the Accreditation Council for Graduate Medical Education to begin developing guidelines for residency training in epilepsy. New residency programs are at least 4 or 5 years away, Dr. Faulkner said.

Dr. Crumrine said in an e-mail interview that she anticipates neurologists whose primary practice involves patients with epilepsy to sit for the new exam during the grandfather period, when physicians can take the exam without going through an epilepsy residency program.

Despite the new subspecialty, there will be many areas in the country where patients won’t have access to subspecialists, she said. "In these regions, the general neurologist will still see patients with epilepsy. Additionally, not every patient with epilepsy will need to see a subspecialist all the time. For many patients, the epilepsy will be easily managed by the primary care physician or general neurologist. The subspecialist will most likely see those patients who do not respond to initial therapies."

The new subspecialty will help patients who have especially difficult-to-control epilepsy, Dr. Crumrine said. "This subspecialty provides the medical community with a population of specialists who are trained in the field of epilepsy [and] knowledgeable of the most up-to-date therapies and side effects of these treatments."

Of course, the downside of having a subspecialty is that some patients won’t have access to an epilepsy subspecialist, Dr. Drazkowski said. "A good number of epilepsy patients come from lower socioeconomic brackets, and a lot have access issues."

Still, the new subspecialty represents a positive development overall, he said, adding that he will be taking the board exam as soon as it is available.

The American Board of Psychiatry and Neurology has voted to create a new epilepsy subspecialty, potentially helping to improve the quality of care for epilepsy patients while better training physicians in an area that has become increasingly complex, with multiple new advances in diagnosis and management.

The epilepsy subspecialty, officially created in November by the American Board of Medical Specialties (ABMS), becomes the 13th subspecialty within the fields of neurology and psychiatry. Physicians who receive subspecialty certification in epilepsy will need to understand the pathophysiology, genetics, pathology, diagnosis, and treatment of seizure disorders at a level far beyond that of a general or child neurologist, the American Board of Psychiatry and Neurology (ABPN) said.

Neurologists who treat large numbers of epilepsy patients realized the need for subspecialty training specifically in epilepsy because of the incredible increase in potential diagnostic tools and treatments for the disorder, said Dr. Joseph Drazkowski, director of the electroencephalography laboratory at the Mayo Clinic in Scottsdale, Ariz.

"Therapies have evolved over the years – they’ve become more effective, and at the same time more complicated," Dr. Drazkowski said in an interview. "The seizures themselves haven’t changed, but the number of seizure meds has grown exponentially."

At the same time, diagnostic procedures and surgical procedures for epilepsy have grown much more technical, he said, adding, "not everybody can do those technical procedures."

In addition, more devices to diagnose and treat epilepsy are under development, which likely will make epilepsy care even more complex. Any time there’s this type of increase in complexity surrounding diagnosis and treatment, "there’s a need for standards," Dr. Drazkowski said. "Those standards should be created and those standards should be met."

The American Academy of Neurology requested that ABPN consider the new subspecialty, Dr. Larry Faulkner, ABPN’s president and CEO, said in an interview. The board has very specific requirements, including training specific to the new subspecialty and "a critical mass of people practicing" in that area.

Now that the ABMS has approved the new specialty, a panel of epilepsy experts, chaired by Dr. Patricia Crumrine, director of EEG and the medical epilepsy program at Children’s Hospital of Pittsburgh, will develop the outline for the new subspecialty and the questions for the new board exam, Dr. Faulkner said.

At the same time, ABPN will ask the Accreditation Council for Graduate Medical Education to begin developing guidelines for residency training in epilepsy. New residency programs are at least 4 or 5 years away, Dr. Faulkner said.

Dr. Crumrine said in an e-mail interview that she anticipates neurologists whose primary practice involves patients with epilepsy to sit for the new exam during the grandfather period, when physicians can take the exam without going through an epilepsy residency program.

Despite the new subspecialty, there will be many areas in the country where patients won’t have access to subspecialists, she said. "In these regions, the general neurologist will still see patients with epilepsy. Additionally, not every patient with epilepsy will need to see a subspecialist all the time. For many patients, the epilepsy will be easily managed by the primary care physician or general neurologist. The subspecialist will most likely see those patients who do not respond to initial therapies."

The new subspecialty will help patients who have especially difficult-to-control epilepsy, Dr. Crumrine said. "This subspecialty provides the medical community with a population of specialists who are trained in the field of epilepsy [and] knowledgeable of the most up-to-date therapies and side effects of these treatments."

Of course, the downside of having a subspecialty is that some patients won’t have access to an epilepsy subspecialist, Dr. Drazkowski said. "A good number of epilepsy patients come from lower socioeconomic brackets, and a lot have access issues."

Still, the new subspecialty represents a positive development overall, he said, adding that he will be taking the board exam as soon as it is available.

The American Board of Psychiatry and Neurology has voted to create a new epilepsy subspecialty, potentially helping to improve the quality of care for epilepsy patients while better training physicians in an area that has become increasingly complex, with multiple new advances in diagnosis and management.

The epilepsy subspecialty, officially created in November by the American Board of Medical Specialties (ABMS), becomes the 13th subspecialty within the fields of neurology and psychiatry. Physicians who receive subspecialty certification in epilepsy will need to understand the pathophysiology, genetics, pathology, diagnosis, and treatment of seizure disorders at a level far beyond that of a general or child neurologist, the American Board of Psychiatry and Neurology (ABPN) said.

Neurologists who treat large numbers of epilepsy patients realized the need for subspecialty training specifically in epilepsy because of the incredible increase in potential diagnostic tools and treatments for the disorder, said Dr. Joseph Drazkowski, director of the electroencephalography laboratory at the Mayo Clinic in Scottsdale, Ariz.

"Therapies have evolved over the years – they’ve become more effective, and at the same time more complicated," Dr. Drazkowski said in an interview. "The seizures themselves haven’t changed, but the number of seizure meds has grown exponentially."

At the same time, diagnostic procedures and surgical procedures for epilepsy have grown much more technical, he said, adding, "not everybody can do those technical procedures."

In addition, more devices to diagnose and treat epilepsy are under development, which likely will make epilepsy care even more complex. Any time there’s this type of increase in complexity surrounding diagnosis and treatment, "there’s a need for standards," Dr. Drazkowski said. "Those standards should be created and those standards should be met."

The American Academy of Neurology requested that ABPN consider the new subspecialty, Dr. Larry Faulkner, ABPN’s president and CEO, said in an interview. The board has very specific requirements, including training specific to the new subspecialty and "a critical mass of people practicing" in that area.

Now that the ABMS has approved the new specialty, a panel of epilepsy experts, chaired by Dr. Patricia Crumrine, director of EEG and the medical epilepsy program at Children’s Hospital of Pittsburgh, will develop the outline for the new subspecialty and the questions for the new board exam, Dr. Faulkner said.

At the same time, ABPN will ask the Accreditation Council for Graduate Medical Education to begin developing guidelines for residency training in epilepsy. New residency programs are at least 4 or 5 years away, Dr. Faulkner said.

Dr. Crumrine said in an e-mail interview that she anticipates neurologists whose primary practice involves patients with epilepsy to sit for the new exam during the grandfather period, when physicians can take the exam without going through an epilepsy residency program.

Despite the new subspecialty, there will be many areas in the country where patients won’t have access to subspecialists, she said. "In these regions, the general neurologist will still see patients with epilepsy. Additionally, not every patient with epilepsy will need to see a subspecialist all the time. For many patients, the epilepsy will be easily managed by the primary care physician or general neurologist. The subspecialist will most likely see those patients who do not respond to initial therapies."

The new subspecialty will help patients who have especially difficult-to-control epilepsy, Dr. Crumrine said. "This subspecialty provides the medical community with a population of specialists who are trained in the field of epilepsy [and] knowledgeable of the most up-to-date therapies and side effects of these treatments."

Of course, the downside of having a subspecialty is that some patients won’t have access to an epilepsy subspecialist, Dr. Drazkowski said. "A good number of epilepsy patients come from lower socioeconomic brackets, and a lot have access issues."

Still, the new subspecialty represents a positive development overall, he said, adding that he will be taking the board exam as soon as it is available.

Endocrinologists Must Educate

Endocrinologists have a responsibility to educate other health professionals on the most up-to-date treatments and guidelines in the field, even when those sessions are sponsored by industry, the American Association of Clinical Endocrinologists said in a statement. “Educational presentations provide the scientific background, the data, and the reasoning to understand new treatment options and make better use of old ones,” said the statement from the board of directors. “To make this education accessible it must take place in as many settings as possible, and when sponsored by industry it operates under very strict rules of conduct.” Eeducators take time away from their practices to prepare for and present the programs, the board noted, adding that “the legitimate concerns surrounding the abuses of a limited number of physicians should not undermine a fundamental tenet in the practice of medicine – the commitment to the lifelong study and furthering of medical knowledge required to continuously improve patient care.”

Endocrinologists Top Payment List

Eleven of the 43 physicians who earned more than $200,000 each from seven large pharmaceutical companies hold board certification in endocrinology – more than in any other specialty – according to an analysis by the journalism advocacy group ProPublica. Endocrinology is a “hotly competitive area because of the multibillion dollar market for diabetes drugs,” ProPublica said. The list's overall top earner, endocrinologist Firhaad Ismail of Las Vegas, earned $303,558 in 2009 from drug makers. Another endocrinologist, Dr. Samuel Dagogo-Jack of Memphis, occupies the No. 3 position on the list with a $257,012 income from the companies. Only 3 of the top 43 earners are women, and all of them are endocrinologists, ProPublica said. Seven drug manufacturers have published payments to individual physicians on their Web sites, and the new list reflects those data.

Educator MS Program Launched

Teachers College, Columbia University's graduate school of education, will launch the nation's first master's degree program for diabetes educators in the fall of 2011. The online program, based in the college's department of health and behavior studies, is intended to equip clinicians and care managers with greater research-based understanding of how diabetes develops and affects different populations, the school said. The program will train diabetes educators to help patients manage treatment and help caregivers secure Medicare and Medicaid reimbursements for such training. It also will address multicultural issues in diabetes. The interdisciplinary 36-credit program will lead to a master of science degree. Twenty-five students are expected to enroll in its inaugural class.

$1.6 Million Will Fight Disparities

The Robert Wood Johnson Foundation has awarded four health care organizations a total of $1.6 million to test programs aimed at eliminating racial and ethnic health disparities in diabetes, cardiovascular disease, and depression care. The University of Illinois at Chicago, insurer WellPoint Inc., Sutter Health in San Francisco, and Lancaster General Health in Pennsylvania each will receive up to $400,000 to evaluate the impact of chronic disease programs designed to close racial and ethnic care gaps. The grantees will test interventions against the diseases in at least three community settings to find differences in effect between various settings and patient groups, according to the foundation.

Hospital Adverse Events Common

More than 13% of Medicare beneficiaries hospitalized in late 2008 had at least one adverse event causing lasting harm during their stays. Among them, 1.5% experienced an event that contributed to their deaths, according to a report from the Health and Human Services Office of the Inspector General. Another 13% of hospitalized beneficiaries experienced temporary harm, such as hypoglycemia, the report found. The combination of events cost Medicare an estimated $324 million in October 2008, the month the report covered, which means that such events could cost $4.4 billion a year. Physicians reviewing the data said 44% of the adverse events were preventable.

Endocrinologists Must Educate

Endocrinologists have a responsibility to educate other health professionals on the most up-to-date treatments and guidelines in the field, even when those sessions are sponsored by industry, the American Association of Clinical Endocrinologists said in a statement. “Educational presentations provide the scientific background, the data, and the reasoning to understand new treatment options and make better use of old ones,” said the statement from the board of directors. “To make this education accessible it must take place in as many settings as possible, and when sponsored by industry it operates under very strict rules of conduct.” Eeducators take time away from their practices to prepare for and present the programs, the board noted, adding that “the legitimate concerns surrounding the abuses of a limited number of physicians should not undermine a fundamental tenet in the practice of medicine – the commitment to the lifelong study and furthering of medical knowledge required to continuously improve patient care.”

Endocrinologists Top Payment List

Eleven of the 43 physicians who earned more than $200,000 each from seven large pharmaceutical companies hold board certification in endocrinology – more than in any other specialty – according to an analysis by the journalism advocacy group ProPublica. Endocrinology is a “hotly competitive area because of the multibillion dollar market for diabetes drugs,” ProPublica said. The list's overall top earner, endocrinologist Firhaad Ismail of Las Vegas, earned $303,558 in 2009 from drug makers. Another endocrinologist, Dr. Samuel Dagogo-Jack of Memphis, occupies the No. 3 position on the list with a $257,012 income from the companies. Only 3 of the top 43 earners are women, and all of them are endocrinologists, ProPublica said. Seven drug manufacturers have published payments to individual physicians on their Web sites, and the new list reflects those data.

Educator MS Program Launched

Teachers College, Columbia University's graduate school of education, will launch the nation's first master's degree program for diabetes educators in the fall of 2011. The online program, based in the college's department of health and behavior studies, is intended to equip clinicians and care managers with greater research-based understanding of how diabetes develops and affects different populations, the school said. The program will train diabetes educators to help patients manage treatment and help caregivers secure Medicare and Medicaid reimbursements for such training. It also will address multicultural issues in diabetes. The interdisciplinary 36-credit program will lead to a master of science degree. Twenty-five students are expected to enroll in its inaugural class.

$1.6 Million Will Fight Disparities

The Robert Wood Johnson Foundation has awarded four health care organizations a total of $1.6 million to test programs aimed at eliminating racial and ethnic health disparities in diabetes, cardiovascular disease, and depression care. The University of Illinois at Chicago, insurer WellPoint Inc., Sutter Health in San Francisco, and Lancaster General Health in Pennsylvania each will receive up to $400,000 to evaluate the impact of chronic disease programs designed to close racial and ethnic care gaps. The grantees will test interventions against the diseases in at least three community settings to find differences in effect between various settings and patient groups, according to the foundation.

Hospital Adverse Events Common

More than 13% of Medicare beneficiaries hospitalized in late 2008 had at least one adverse event causing lasting harm during their stays. Among them, 1.5% experienced an event that contributed to their deaths, according to a report from the Health and Human Services Office of the Inspector General. Another 13% of hospitalized beneficiaries experienced temporary harm, such as hypoglycemia, the report found. The combination of events cost Medicare an estimated $324 million in October 2008, the month the report covered, which means that such events could cost $4.4 billion a year. Physicians reviewing the data said 44% of the adverse events were preventable.

Endocrinologists Must Educate

Endocrinologists have a responsibility to educate other health professionals on the most up-to-date treatments and guidelines in the field, even when those sessions are sponsored by industry, the American Association of Clinical Endocrinologists said in a statement. “Educational presentations provide the scientific background, the data, and the reasoning to understand new treatment options and make better use of old ones,” said the statement from the board of directors. “To make this education accessible it must take place in as many settings as possible, and when sponsored by industry it operates under very strict rules of conduct.” Eeducators take time away from their practices to prepare for and present the programs, the board noted, adding that “the legitimate concerns surrounding the abuses of a limited number of physicians should not undermine a fundamental tenet in the practice of medicine – the commitment to the lifelong study and furthering of medical knowledge required to continuously improve patient care.”

Endocrinologists Top Payment List

Eleven of the 43 physicians who earned more than $200,000 each from seven large pharmaceutical companies hold board certification in endocrinology – more than in any other specialty – according to an analysis by the journalism advocacy group ProPublica. Endocrinology is a “hotly competitive area because of the multibillion dollar market for diabetes drugs,” ProPublica said. The list's overall top earner, endocrinologist Firhaad Ismail of Las Vegas, earned $303,558 in 2009 from drug makers. Another endocrinologist, Dr. Samuel Dagogo-Jack of Memphis, occupies the No. 3 position on the list with a $257,012 income from the companies. Only 3 of the top 43 earners are women, and all of them are endocrinologists, ProPublica said. Seven drug manufacturers have published payments to individual physicians on their Web sites, and the new list reflects those data.

Educator MS Program Launched

Teachers College, Columbia University's graduate school of education, will launch the nation's first master's degree program for diabetes educators in the fall of 2011. The online program, based in the college's department of health and behavior studies, is intended to equip clinicians and care managers with greater research-based understanding of how diabetes develops and affects different populations, the school said. The program will train diabetes educators to help patients manage treatment and help caregivers secure Medicare and Medicaid reimbursements for such training. It also will address multicultural issues in diabetes. The interdisciplinary 36-credit program will lead to a master of science degree. Twenty-five students are expected to enroll in its inaugural class.

$1.6 Million Will Fight Disparities

The Robert Wood Johnson Foundation has awarded four health care organizations a total of $1.6 million to test programs aimed at eliminating racial and ethnic health disparities in diabetes, cardiovascular disease, and depression care. The University of Illinois at Chicago, insurer WellPoint Inc., Sutter Health in San Francisco, and Lancaster General Health in Pennsylvania each will receive up to $400,000 to evaluate the impact of chronic disease programs designed to close racial and ethnic care gaps. The grantees will test interventions against the diseases in at least three community settings to find differences in effect between various settings and patient groups, according to the foundation.

Hospital Adverse Events Common

More than 13% of Medicare beneficiaries hospitalized in late 2008 had at least one adverse event causing lasting harm during their stays. Among them, 1.5% experienced an event that contributed to their deaths, according to a report from the Health and Human Services Office of the Inspector General. Another 13% of hospitalized beneficiaries experienced temporary harm, such as hypoglycemia, the report found. The combination of events cost Medicare an estimated $324 million in October 2008, the month the report covered, which means that such events could cost $4.4 billion a year. Physicians reviewing the data said 44% of the adverse events were preventable.