The major failing of the just passed health care reforms are: 1) Inadequate cost controls for individual and family payments concurrent with a public gift of hundreds of billions of dollars to reward the private insurance industry and 2) Lack of any meaningful restriction on claims denials, or recission of coverage when serious conditions arise. Nonetheless, there are some improvements and steps forward, as well as several additional weaknesses.

Pt: One: DIARY OF A WIMPY HEALTH CARE BILL By Rose Ann DeMoro The Huffington Post, March 23, 2010

The positive aspects of the just passed health care reform include: 1) The expansion of Medicaid to cover 16 million additional low-income people, though the program remains significantly underfunded, 2) Increased funding for community health centers, thanks to an amendment by Sen. Bernie Sanders, that will open their doors to nearly double their current patient volume, 3) Some reduction of the infamous "donut hole" gap in prescription drug coverage for which Medicare enrollees have to pay the costs fully out of pocket, 4) Insurance regulation to covering members' dependent children until age 26, 5) disallowing exclusion of of children with pre-existing conditions. 5) Permission for individual states to waive some federal regulations to adopt innovative state programs like an expanded Medicare.

Pt Two: DIARY OF A WIMPY HEALTH CARE BILL By Rose Ann DeMoro The Huffington Post, March 23, 2010

Other troubling limitations of the reform include: 1) No standard benefits package, only a circumspect reference that benefits should be "comparable to" current employer-provided plans, 2) Insurers remain in control of what they offer and what will be a covered service, so they can design plans to attract healthier customers, 3) Claims denial remains an internal process (only reviewed by the states) basically the status quo, 4) Insurers can double charges to employees not well enough, 5) Permission of insurers to sell policies across state lines, so that the most permissive state for poor quality policies will become the gold standard nationally, 6) Allowing insurers to charge three times more based on age plus more for certain conditions, so to continue cherry-pick healthier enrollees, 7) Erosion of women's reproductive rights, with a new executive order that will result in few insurers will covering abortion and perhaps other reproductive services, 8) increased windfall for pharmaceutical giants (prices not negotiated).

Pt Three: DIARY OF A WIMPY HEALTH CARE BILL By Rose Ann DeMoro The Huffington Post, March 23, 2010

Insurers said they would comply with regulations requiring them to cover children with pre-existing conditions. But shortly after the bill's passage, insurers contended that the law didn't require them to accept sick children until 2014. The insurance industry's lobby, AHIP, initially said the law meant only that they needed to cover treatments for sick children who already were customers. Kathleen Sebelius, Obama's Sec of HHS sent AHIP presipent Karen Ignagni a letter pledging clarify that insurers must take applications from sick children starting in September. "Now is not the time to search for non-existent loopholes that preserve a broken system".

FLAP OVER CHILDREN'S COVERAGE SETTLED BY AVERY JOHNSON Wall Street Journal March 30, 2010 A4

Consumer advocates are pleased with the provision of the newly enacted US healthcare reform bill -that sets up an independent agency to compare treatments. The new nonprofit Patient Centered Outcomes Research Institute gets a steady stream of funding from three sources, and a board of experts appointed by Sec. of HHS to be free of obvious conflicts of interest. The goal is to save money and improve health care by cutting through the confusing mass of information put out by drug companies promoting their products. "If I am a doctor, most of the information I have comes from the pharmaceutical representative who comes to my office. That is not independent science," said Larry McNeely of the Public Interest Research Group.

US HEALTHCARE PLAN SETS UP NEW DRUG RESEARCH AGENCY By Maggie Fox WASHINGTON (Reuters) Mar 26

A 21.2% Medicare pay cut will take effect April 1 after the Senate today failed to pass a bill extending the effective date to May 1 before lawmakers recessed. The Senate was poised to vote on the Democrat-sponsored legislation this week, but Sen. Tom Coburn, MD (R-OK), put a procedural block on it, saying Democrats were engaged in a harmful exercise in deficit spending. Sen. Coburn said they should find a way to pay for the bill, which also would have extended expired unemployment compensation benefits and subsidies for health insurance premiums for the out-of-work under the COBRA program, and various tax breaks. When Congress goes back to work on April 12, Senate Democrats will try to pass the 1-month extension again and make it retroactive to April 1. The Centers for Medicare and Medicaid Services has announced that it will freeze payments on physician Medicare claims for the first 10 business days of April and then pay the full amount "as if the reduction never occurred -once the 1-month extension passes in the Senate.

MASSIVE MEDICARE PAY CUT WILL TAKE EFFECT APRIL 1 Robert Lowes March 26, 2010 2010 Medscape Medical News

The US House approved amendments to the country's new healthcare reform law for the second time in 5 days in a 220 to 207 vote. The second vote may have seemed like a ho-hum housekeeping matter -after all, the House only needed to correct technical glitches in the amendment bill, which had no affect on a healthcare reform law. However, the nighttime vote took place with a backdrop of vandalism, acts of intimidation, and death threats directed at a dozen or so House members in the days following House passage of a healthcare reform bill, along with the amendments. One Republican, House Republican Whip Eric Cantor (R-VA), said someone shot a bullet through the window of his campaign office in Richmond, Virginia. Democrats have accused Republicans of indulging in violent political rhetoric that incites actual or threatened violence.

HOUSE PASSES AMENDMENTS TO HEALTHCARE REFORM LAW FOR SECOND TIME Robert Lowes March 25, 2010 2010 Medscape Medical News

In a 56 to 43 vote along partisan lines, the Senate has amended healthcare reform legislation that President Barack Obama had signed into law. The amendments, which appeared in a so-called budget reconciliation bill, do not change the basic framework or cost of reform legislation, but they do offer additional benefits for patients and physicians alike. Most notably, the reconciliation bill will gradually shrink the "doughnut hole" in the Medicare Part D prescription drug plan -a coverage gap that forces Medicare recipients to pay full freight for medications -and completely closes it by 2020. In the meantime, Medicare recipients will receive a $250 rebate this year toward the coverage gap. In addition, under the bill, notoriously low Medicaid reimbursement rates will be hiked to Medicare levels in 2013 and 2014 for general internists, family physicians, and pediatricians.

SENATE APPROVES AMENDMENTS TO HEALTHCARE REFORM LAW Robert Lowes March 25, 2010 2010 Medscape Medical News On March 23 Pres. Obama signed historic healthcare reform legislation that Republican opponents had hoped would be his Waterloo. The signing ceremony comes 2 days after the House passed a Senate reform measure in a 219 to 212 vote in the face of Republican warnings that Democrats were engineering a wasteful government takeover of medicine. The legislation inked by President Obama 3/23 will require most Americans to obtain health insurance, but provide premium subsidies to needy individuals and families. They and small businesses will be able to purchase private coverage through state-based insurance marketplaces called exchanges. The bill increases Medicaid enrollment by almost 50% and imposes pro-patient regulations on private insurers that, among other things, will prohibit them from denying someone coverage based on preexisting conditions, or dropping coverage once sickness strikes. The CBO has estimated that, as amended by the budget reconciliation bill before the Senate, the reform plan would cost $938 billion over 10 years, but ultimately reduce the federal deficit by $143 billion. [But what would the cost of US Health Care be with the status quo of spiraling costs for the next 10 years?]

PRESIDENT OBAMA SIGNS HISTORIC HEALTHCARE REFORM BILL Robert Lowes March 23, 2010 2010 Medscape Medical News

Average healthcare costs for US employers rose by 7.3% in 2009, surpassing inflation and the growth rate in overall healthcare spending. Overall US healthcare spending, including Medicare, Medicaid, and other payers, grew by 4.8% in 2009. "In a year when inflation was non-existent, employer healthcare costs continued to surge, This analysis puts the real-world healthcare challenges facing employers into perspective. These cost increases have come at a particularly difficult time for US companies." They said the year-over-year increase compared to a rise of 6.1% in 2008.

US EMPLOYER HEALTHCARE COSTS UP 7.3% IN 2009 (Reuters) Mar 22

Less than 24 hours after the US House gave final approval to a sweeping overhaul of healthcare, attorneys general from several states said they will sue to block the plan on constitutional grounds. Republican attorneys general in 11 states warned that lawsuits will be filed to stop the federal government overstepping its constitutional powers and usurping states' sovereignty. States are concerned the burden of providing healthcare will fall on them without enough federal support. "To protect all Texans' constitutional rights, preserve the constitutional framework intended by our nation's founders, and defend our state from further infringement by the federal government, the State of Texas and other states will legally challenge the federal health care legislation," said Texas AG, Abbott.

US STATES LAUNCH LAWSUITS AGAINST HEALTHCARE PLAN (Reuters) Mar 22

The Georgia Supreme Court today unanimously overturned that state's law setting a $350,000 limit on damages paid out for pain and suffering in malpractice cases involving physicians. It ruled that the 5-year-old Georgia law violated a person's constitutional right to trial by jury -more specifically, the right of a plaintiff to have a jury set noneconomic damages as it sees fit. For years, organized medicine has lobbied Congress to pass a national cap on noneconomic damages that would replace a patchwork of state laws. But Congress has declined to do so, and the absence of a cap on noneconomic damages in the healthcare reform bill passed by the House yesterday disappointed medical societies that otherwise applauded the legislation. What makes the Georgia high-court decision even more unsettling to organized medicine is that it comes on the heels of the Illinois Supreme Court overturning that state's cap on noneconomic damages back in February. The Illinois court ruled that the law, which set a $500,000 limit in malpractice cases involving physicians, violated the separation-of-powers clause in that state's constitution. In other words, the job of setting damages belong to trial courts, not the legislature.

GEORGIA SUPREME COURT STRIKES DOWN CAP ON NONECONOMIC DAMAGES Robert Lowes March 22, 2010 2010 Medscape Medical News

The AMA announced its qualified support for Democratic healthcare reform legislation scheduled to come before the House this Sunday for a historic vote. "The pending bill isn't perfect, but we can't let the perfect be the enemy of the good," AMA President J. James Rohack, MD, said at a press conference Friday. The AMA board of trustees took its position, said Dr. Rohack, because it considered the status quo unacceptable. "We think doing nothing would only accelerate the total [healthcare] costs to America and increase the total number of uninsured, and we know Foremost among AMA criticisms is the lack of a permanent repeal of Medicare's sustainable growth rate formula, which is set to trigger a 21.2% pay cut for physicians this year.

AMA SUPPORTS LATEST HEALTHCARE REFORM LEGISLATION WITH RESERVATIONS Robert Lowes March 19, 2010 2010 Medscape Medical News

In May, 2002, Jerome Mitchell, a 17-year old college freshman, learned he had contracted HIV. The news, of course, was devastating, but Mitchell believed that he had one thing going for him: On his own initiative, in anticipation of his first year in college, he had purchased his own health insurance. Shortly after his diagnosis, however, his insurance company, Fortis, revoked his policy. Mitchell was told that without further treatment his HIV would become full-blown AIDS within a year or two and he would most likely die within two years after that. In 2004, a jury in Florence County, SC ordered the insurer to pay Mitchell $15 million for wrongly revoking his heath insurance policy. In September 2009, the South Carolina Supreme Court upheld the lower court's verdict. Records from Mitchell's case reveal that Fortis had a policy of targeting policyholders with HIV. A computer program targeted every policyholder recently diagnosed with HIV for an automatic fraud investigation, as the company searched for any pretext to revoke their policy.

INSURER TARGETED HIV PATIENTS TO DROP COVERAGE By Murray Waas (Reuters) Mar 17

When it comes to sizing up physicians as low-cost or high-cost providers, health insurers are frequently not on the money. By applying current 2-tiered methods of cost-profiling to claims data from 4 Massachusetts insurers, the RAND Corporation estimated that 22% of physicians would be misclassified. The RAND data showed that the misclassification rate for vascular surgeons, for example, was 36%. Only 41% of physician cost-profile scores were at least 70% reliable. Health insurers analyze the costs of an individual physician's services -including the medications, tests, and consults he or she orders -to help them decide who should belong to their provider networks, as well as create tiers within those networks. Patients often are given financial incentives such as lower copays if they choose top-tier physicians who supposedly render high-quality, low-cost services.

HEALTH INSURERS FREQUENTLY MISCLASSIFY PHYSICIANS AS LOW-COST OR HIGH-COST PROVIDERS, RAND Reports Robert Lowes March 18, 2010 N Engl J Med. 2010;362:1014-1021.

It's an underfunded public healthcare program with burgeoning enrollment, yet fewer and fewer physicians are willing to see its patients, mostly because of reimbursement rates that are seen as a joke. This formula for a meltdown applies to not only Medicare and its headline-dominating pay problem but also Medicaid. However, the odds of a Medicaid meltdown could lessen depending on what Congress does with healthcare reform in the coming weeks. Medicaid -the combination federal/state program for the poor and underserved -is the neglected half-sister in the healthcare reform debate. President Barack Obama wants the House this week to pass Senate-enacted legislation that would cover 15 million additional Americans under Medicaid over 10 years. Medicaid now pays 72% of medicare rates on average To be sure, Medicaid has performed surprisingly well in light of its funding challenges, at least according to the Kaiser Family Foundation. The program "compares favorably with private coverage in connecting low-income children and adults with key primary and preventive care". Nonetheless, given paltry reimbursement, it is not surprising that physicians are bailing out of Medicaid.

WILL HEALTHCARE REFORM INCREASE MEDICAID PAY AS WELL AS ENROLLMENT? Robert Lowes March 23, 2010 2010 Medscape Medical News

Regular drinkers outnumber regular exercisers, says a new report on health behaviors in the US The CDC study shows that six in 10 American adults were regular drinkers in 2005-2007, but only about three in 10 regularly exercised. Overall, researchers say that since 1997, rates of cigarette smoking have declined by several percentage points, rates of obesity have climbed, and rates of alcohol use, exercise, and sleep have remained relatively unchanged. The results are based on survey data collected from 79,096 interviews with US adults.

GOOD AND BAD HEALTH HABITS IN US Jennifer Warner March 17, 2010

President Barack Obama declared on March 10 the "time for talk is over" and urged the US Congress to vote on healthcare as his health secretary directly challenged insurers to forgo profits to make coverage more affordable. As Obama's motorcade made its way toward the speech venue, hundreds of protesters from both sides lined the streets waving placards that said, "Healthcare for all," "Kill the bill," "Republicans for healthcare reform" and "Say no to socialism." Obama insisted his plan would rein in profit-hungry health companies. Trying to build support for the bill, he and his fellow Democrats have accused the health insurance industry of putting profits before the interests of patients. In Washington, Health Secretary Kathleen Sebelius told a health insurance industry group that failure to pass health reform would cause costs and premiums TO soar. "We will have a situation where the market is unsustainable," Sebelius said in a speech to a conference sponsored by America's Health Insurance Plans.

OBAMA: TIME FOR TALK IS OVER ON HEALTHCARE BILL By Caren Bohan (Reuters) Mar 11

The Senate Mar 10 delayed the effective date of a 21.2% Medicare pay cut for physicians until October 1. The postponement of the massive reduction is part of a bill that extends expired unemployment compensation benefits, subsidies for health insurance premiums for the out-of-work under the COBRA program, and various tax breaks. Most Republicans voted against the measure. One of them -Sen. Jeff Sessions (R-AL) -warned that it would increase the federal deficit by roughly $100 billion. "I'm sure some of my colleagues will say, 'You don't like the unemployed. You don't want to help them,' " Sen. Sessions said. "I'm sure some of my colleagues will say, 'You don't want to pay the doctors. You don't like doctors. You're mean and cold-hearted, and don't worry the debt, Sessions.' But at some point, we have to bring our house under control, just like a family budget."

SENATE DELAYS MEDICARE PAY CUT UNTIL OCTOBER 1 Robert Lowes March 10, 2010 2010 Medscape Medical News

To varying degrees, higher hospital occupancy, lower nurse staffing levels, weekend admission, and admission during high seasonal influenza activity all independently increase the risk of dying in the hospital. "The real study that needs to be done now is an intervention [trial] around these factors: What happens if you do something about these factors? Does that have any impact?" questioned Dr. Conway, a critical care physician and chief of Henry Ford Hospital. In terms of nurse staffing levels, Dr. Conway cautioned, "There is a plateau on how much staffing is effective as it relates to mortality and complications. Assigning a single nurse to every single patient in a hospital is not going to make your mortality rate that much better," he explained. "It levels off around 5-to-1 nursing. If you go down to 10-to-1 nursing, I assure you [the] mortality rate is going to go up."

HIGH HOSPITAL OCCUPANCY CONFERS INCREASED INPATIENT MORTALITY RISK Megan Brooks March 10, 2010 Med Care. 2010;48:224-232. 2010 Medscape Medical News

Comparing medical treatments to find the best and the cheapest may be a pillar of US healthcare reform efforts, but very little such research is being done, according to a report published on Tuesday. Most of the so-called comparative effectiveness research is done at academic institutions or by other noncommercial enterprises, and less than 20% examines the safety of treatments, researchers reported in the Journal of the American Medical Association. Of 328 studies, about a third compared a drug to something else. Just 43% compared one drug to another, 11% compared a drug to a non-drug therapy, 15 % focused on different dosing schedules, 19 % looked at safety and just 2% included an analysis of cost effectiveness. While most drug trials are sponsored by companies, noncommercial entities paid for 87% of the comparative effectiveness studies, Hochman and McCormick found. "Many of our nation's research priorities are driven by the pharmaceutical industry," Hochman said in a statement. "These companies, not surprisingly, focus most of their attention on new therapies."

FEW US STUDIES COMPARE ONE DRUG TO ANOTHER: REPORT by Maggie Fox (Reuters) Mar 09 JAMA 2010;303:951-958.

Health insurance premiums are rising across the nation for certain individuals, the US health secretary said, meeting with four of the nation's largest health insurance companies. The Obama administration, aiming to keep the focus on health reform amid a final push to pass legislation, called for the meeting amid growing controversy that some individuals will see rate hikes of nearly 40% this year for their private health insurance premium. So far, WellPoint has faced the most pressure over its rate hikes under its Anthem Blue Cross plan in California, where some customers were threatened with hikes of up to 39%. The company has delayed those hikes for two months.

US HEALTH SECRETARY PRESSES INSURERS OVER RATES By Susan Heavey (Reuters) Mar 04

The recent case of 2 Texas nurses criminally prosecuted for reporting a physician to the state medical board over patient safety is a call for a healthcare system that does not treat truth-tellers like snitches. "In the world of healthcare quality and safety, we don't use the term 'whistleblower,' " Conway told Medscape Medical News. "Whistleblowing suggests that you have to leave your job and your role to do it. I believe in a nurse reporting what she sees. It's not whistleblowing. It's your job." Alice Bodley, general counsel for the American Nurses Association, also believes the concept of a whistleblower ought to disappear. Instead, hospitals should encourage nurses and other clinicians to speak up about quality-of-care issues, said Bodley. "They'd feel as if they were contributing to the mission of the organization. It's a cultural shift." She described progress toward that goal as "slow and incremental."

WHISTLEBLOWING NURSES CASE HIGHLIGHTS NEED FOR MORE OPEN QUALITY-OF-CARE CULTURE Robert Lowes March 3, 2010 Reuters Health Information 2010

Anyone who expected some glorious "eureka!" moment at the White House healthcare summit today that would forge a compromise on contentious reform proposals between Democrats and Republicans has to be disappointed. Both sides at the summit pounded their long-standing positions, or "talking points," depending on which side was characterizing them, and the 40 legislators of both parties often seemed to be talking past each other. The free-wheeling discussion may have been unprecedented in Washington politics, but few are willing to say that it was likely to move public opinion in one direction or another on reform. To humanize the often arcane debate, Democrats cited numerous examples of average Americans losing their insurance coverage or going without care because they could not afford it. Republicans cited small businesses that felt they could not afford to provide coverage under the proposed bills or physicians who were forced to leave a state or change their practices because of the malpractice climate. An incremental approach was rejected by Sen. Tom Harkin (D-IA). "That's like throwing a 10-foot rope to someone in the water who is 40 feet away. He'll drown."

HEALTHCARE SUMMIT YIELDS NO "EUREKA" MOMENTS Mark Crane February 25, 2010 2010 Medscape Medical News

In a rare display of bipartisan unity, the US House of Reps passed, by a lopsided vote of 406 to 19, legislation that would end health insurance companies' 65-year exemption from a variety of federal antitrust rules. The bill would repeal portions of the McCarran-Ferguson Act, passed in 1945 ans supporters argue that it will restore competition to the health insurance market, which surveys have shown has become increasingly dominated in many areas by 1 or 2 insurers.

HOUSE PASSES BILL REPEALING ANTITRUST EXEMPTION FOR HEALTH INSURERS Wayne J. Guglielmo February 24, 2010 2010 Medscape Medical News

An analysis of published reports on the antidiabetic drug rosiglitazone (Avandia) shows that researchers with ties to industry were more likely to conclude that the drug did not increase risk for myocardial infarction (MI) than those with no industry ties. Among the 202 reports that were evaluated, 107 (53%) had a conflict of interest statement and 90 (45%) had a conflicting financial relationship. Importantly, among researchers who concluded that rosiglitazone does not increase risk for MI, 91% had financial relationships with antihyperglycemic agent manufacturers and 86% had relationships with rosiglitazone manufacturers. Among articles representing unfavorable reviews, only 25% of researchers had financial relationships with antihyperglycemic agent manufacturers.

RESEARCHERS WITH FINANCIAL INTERESTS SHOW STRONG BIAS TOWARD FAVORABLE CONCLUSIONS Nancy A. Melville February 23, 2010 Medscape Medical News

Most directors of internal medicine residency programs feel that industry support is not desirable, but many accept it nonetheless. Interactions with the pharmaceutical industry are known to affect the attitudes and behaviors of medical residents; however, to our knowledge, a nationally representative description of current practices has not been reported." The goals of this study were to determine current attitudes of program directors toward pharmaceutical industry support of their residency programs, whether directors accepted such support, and any potential associations between program characteristics and the acceptance of industry support. In 2006 to 2007, 381 internal medicine residency program directors were asked whether their programs accept support of any kind from the pharmaceutical industry and, if so, why. The most common forms of industry support included food for conferences (90.9%), educational materials (83.3%), office supplies (68.9%), and drug samples (57.6%). In addition, 74.2% of the programs that accepted industry support allowed direct off-site contact with residents, and 40.2% allowed direct on-site contact.

PHARMACEUTICAL INDUSTRY SUPPORT UNDESIRABLE YET ACCEPTED BY DIRECTORS OF RESIDENCY PROGRAMS Fran Lowry February 22, 2010 Arch Intern Med. 2010;170:356-362.

The US government broadened the definition of a human embryonic stem cell on Friday, helping to qualify several corporate and academic experiments for federal funding. The current definition describes embryonic stem cells as coming from the inner layer of a blastocyst. Skirboll said the new definition will include earlier stage embryos. US President Barack Obama lifted some restrictions on the federal funding of human embryonic stem cell research soon after he took office last year but the NIH imposed strict ethical requirements and a review process for funding. "It would have been a disaster to exclude these valuable human embryonic stem cell lines from consideration for federal funding, especially since the leftover embryos used to generate them meet all the NIH requirements," Lanza said by e-mail.

US 'TWEAKS' STEM CELL POLICY By Maggie Fox (Reuters) Feb 19 Reuters Health Information © 2010

The recent news that WellPoint’s Anthem Blue Cross health insurance company in California wanted to increase premiums for individual policyholders as much as 39% is further evidence the current health system is not sustainable. And California isn’t the only state where WellPoint is hiking individual premium rates by double-digit percentages. In fact, double-digit hikes have been implemented or are pending in at least 11 other states among the 14 where WellPoint’s Blue Cross Blue Shield companies are active. In Maine, where WellPoint-owned Anthem Blue Cross and Blue Shield is by far the largest insurer, the company is seeking to raise individual rates an average of 23% this year. This comes after five consecutive years of double-digit premium increases by the company on these policies. WellPoint has grown rapidly since beginning in the late 1990s and has become the nation’s largest health insurer. WellPoint ranks 32nd on the 2009 Fortune 500 list and reported a $4.7 billion profit for 2009, nearly double that in 2008.

RECENT PREMIUM CHANGES IN THE INDIVIDUAL MARKET FROM WELLPOINT INC. SUBSIDIARIES BY STATE By Scot J. Paltrow | February 24, 2010 Center for American Progress

Emergency room doctors and on-call specialists treating poor, uninsured patients at private hospitals in Los Angeles County saw their reimbursement rate slashed by county supervisors in mid-February. The rate cut could lead private hospitals to close emergency rooms and send more patients to crowded county hospitals, officials said. L.A. County reimburses doctors 27% of estimated fees for patients' first three days of care at private hospitals under the Physician Services for Indigents Program. Supervisors voted unanimously to reduce the rate to 18% as of July 1. More than half of Los Angeles County's 72 hospitals are operating at a deficit and two are in bankruptcy, Lott said (Jim Lott, executive vice president of the Hospital Assn. of Southern California). Countywide, 11 hospitals have closed since 2002, all of which had emergency rooms, he said.

L.A. COUNTY SLASHES DOCTORS' REIMBURSEMENT RATE By Molly Hennessy-Fiske and Ron-Gong Lin II Los Angeles Times February 17, 2010

In New York City a major hospital chain and one of the nation’s largest insurance companies are locked in a struggle over control of treatment and costs that could have broad ramifications for millions of people with private health insurance. The fight is between Continuum Health Partners, a consortium of five New York hospitals and UnitedHealthcare. They are in bitter contract negotiations, not just over rates but also over UnitedHealthcare’s demand that the hospitals notify the insurance company within 24 hours after a patient’s admission. If a hospital failed to do so, UnitedHealthcare would cut its reimbursements for the patient by half. UnitedHealthcare says the proposed rule is meant to improve the quality of care and cut costs by allowing insurance case managers to jump in right away.

INSURER STEPS UP FIGHT TO CONTROL HEALTH CARE COST By Anemona Hartocollis The New York Times January 24, 2010

With the possible collapse of the Congressional health care effort, health insurers might seem to have reason to celebrate. The legislation threatened to remake much of their business, with the prospect of burdensome government regulation and less profit from selling coverage to individuals and small businesses. But now, in the possible absence of forced change to their business, the insurers still face the daunting challenge of selling a product that is increasingly out of reach for more Americans as the cost of medical care and thus premiums -continues to climb. Moreover, the industry’s main business of selling coverage through employers has largely stalled, while the weak economy has speeded the loss of customers as people lose their jobs and their health insurance. Without the aid of the government through some provisions of the legislation, some policy analysts say the insurers might be hard pressed to rein in the fees charged by hospitals and doctors. "They’ve lost all the leverage reform would have given them," said Len Nichols, a health care economist for the New America Foundation. And the insurers say they know they cannot fix many of the problems in the health care system without the support of the government.

IF BILLS FAIL, A QUANDARY FOR INSURERS By Reed Abelson The New York Times January 21, 2010

Stanford University announced in mid-January plans to develop new continuing education programs for doctors that will be devoid of the drug industry influence that has often permeated such courses. The work is being done with a $3 MIL grant -from the drug maker Pfizer. Dr. Philip Pizzo, dean of the Stanford medical school, says Pfizer will have no say on how the three-year grant will be spent. The university plans to set up unbiased programs of postgraduate education on the Stanford campus rather than the industry-selected topics of the past that have been presented to rooms full of doctors at hotels and resorts. "It’s a fundamental change," Dr. Pizzo said Sunday, criticizing the drug industry for poisoning educational programs with marketing messages and doctors for "complicity" in taking speaker fees and expenses-paid trips. He called the grant "a novel rebooting." "The announcement is self-satirizing," said Dr. Adriane Fugh-Berman, a Georgetown University medical professor who has researched and written about industry influence in continuing medical education. "Pfizer’s interest in better ways to manipulate physicians is well-known."

USING A PFIZER GRANT, COURSES AIM TO AVOID BIAS By Duff Wilson The New York Times January 11, 2010

Members of President Obama's Cabinet announced nearly $1 BIL in grants Feb 12 to increase the use of health information technology, pushing a key component of Obama's healthcare overhaul and job creation plans. US Health and Human Services Secretary Kathleen Sebelius and Labor Secretary Hilda Solis announced nearly $1 BIL in federal economic stimulus funds. The money will be used to help make healthcare information technology available to over 100,000 hospitals and primary care physicians by 2014 and train thousands of people for careers in healthcare and information technology. Sebelius announced more than $750 MIL in awards for states and healthcare providers. Solis announced more than $225 MIL in Department of Labor grant awards that will be used to train 15,000 people in job skills needed to support careers in healthcare, information technology and other high growth fields. The White House said grant recipients had identified about 10,000 openings for skilled workers likely to become available within the next two years.

US SETS GRANTS FOR HEALTH TECHNOLOGY, JOB TRAINING By Patricia Zengerle Reuters Health News Feb 12

About one in five US residents -- 57 million Americans -- have had H1N1 swine flu since the pandemic began in April 2009, the CDC estimates. Some 11,690 Americans have died of H1N1 swine flu. That's the midpoint of the CDC's estimate, which ranges from as few as 8,330 deaths to as many as 17,160. The new estimates cover the period from April 2009 through Jan. 16, 2010; they suggest that 2 million Americans caught swine flu since Dec. 12, 2009 -- and that 530 died in that five-week period. While the new estimates do not indicate a new pandemic wave, they do show that people continue to be sickened and even killed by the H1N1 swine flu bug.

ONE IN FIVE AMERICANS HAD H1N1 SWINE FLU Daniel J. DeNoon February 16, 2010 Reuters Health News

Physicians continue to wait for a reprieve from a 21% Medicare pay cut scheduled for March 1 as another legislative solution to the reimbursement crisis fizzled Congress has only 2 weeks to pass legislation that would avert the reduction in Medicare reimbursement. Organized medicine warns that if the cuts go through, physicians will turn away new Medicare patients or even drop out of the system instead of going broke on paltry fees. The average physician depends on Medicare for 31% of his or her revenue. Hardly anyone doubts that Congress will act before March 1 to stave off "Medicare Armageddon." A spokesperson for Sen. Harry Reid told Medscape Medical News that the senator would seek a bipartisan Medicare reimbursement solution as soon as possible. However, the question is, will lawmakers put a temporary bandage on the problem or permanently cure it? The answer may depend on whether comprehensive healthcare reform legislation dies on the vine, experts say. The AMA and other medical societies have demanded a permanent solution to the Medicare reimbursement crisis -specifically, scrapping the so-called sustainable growth rate (SGR) formula that Medicare uses to set physician pay. The formula triggers a pay cut whenever Medicare expenditures on physician services the year before exceed a target based in part on growth in the gross domestic product (GDP). However, the price tag of this SGR fix -more than $200 BIL over 10 years to make up for postponed pay cuts in the past -made the reform bill too expensive for the likes of budget hawks.

DELAY OF MEDICARE PAY CUT STRIPPED FROM JOBS BILL Robert Lowes Februrary 12, 2010 Reuters Health News

One of every 10 Americans was prescribed at least 1 gastrointestinal (GI) medication on an outpatient basis in 2007 compared with 1 of every 15 Americans in 1997. A 60% rise in the number of Americans who were prescribed GI agents accompanied a 170% increase in total expenditures on these medications, which was $18.9 BIL in 2007 compared with $7 BIL in 1997. The average price per GI drug purchase increased during this period from $90 to $120 for a 33% increase. The overall inflation rate for this 10-year stretch was 29%. The percentage of Americans who were prescribed at least 1 GI medication rose across all income and age categories, as well among white non-Hispanics, black non-Hispanics, and Hispanics, according to the Medical Expenditure Panel Survey.

EVERY TENTH AMERICAN WAS PRESCRIBED A GI MEDICATION IN 2007, SAYS FEDERAL AGENCY Robert Lowes February 12, 2010 Reuters Health News

A dietary supplement containing toxic levels of selenium 200 times greater than the concentration listed on the label caused a widespread outbreak of acute selenium poisoning, affecting 201 people from 10 states. Symptoms of selenium poisoning include nausea; vomiting; nail discoloration, brittleness, and loss; hair loss; fatigue; irritability; and foul breath odor. The source of the outbreak was identified as a liquid dietary supplement. It was marketed as being suitable for the "entire family" to provide a balance of nutrients to "maintain energy and sustain health" and was labeled as containing 200 µg of selenium per fluid ounce in the form of sodium selenite, an inorganic form of selenium. When interviewed, patients stated that they had not suspected the supplement had made them ill and never mentioned the fact they were taking it to their physicians. Some increased the dose to try to ameliorate their symptoms.

DIETARY SUPPLEMENT CAUSES WIDESPREAD SELENIUM POISONING Fran Lowry February 8, 2010 Arch Intern Med. 2010;170:256-261, 262-263.Reuters Health News

Three of every 4 nurses said they experienced workplace violence, but only 1 in 6 incidents was formally reported. "There is a consensus in the international literature that workplace violence...directed at nurses is increasing and that nursing is one of the professions most 'at risk'," write Rose Chapman, PhD, RN, from the Curtin University of Technology. Virtually all of the nurses (92%) surveyed reported experiencing verbal abuse, 69% had been physically threatened, and 52% had been physically assaulted in the year before the survey. Violent events were perpetrated regardless of the nurses' age, educational qualifications, years of experience, and sex. The emergency department was the most violent place to work, with nurses reporting an episode involving a weapon once a week. Mental health unit nurses reported episodes with weapons every month, and nurses working in surgical or medical wards reported such incidence more than twice a year.

NURSES ARE FREQUENT TARGETS OF WORKPLACE VIOLENCE Fran Lowry February 4, 2010 J Clin Nurs. 2010;19:479-488. Reuters Health News

Patents on two human genes associated with breast and ovarian cancer should be declared invalid because they stifle the free flow of information and hamper research. The lawsuit by the ACLU, the Association for Molecular Pathology, individual women and others was brought against the US Patent and Trademark Office, Myriad Genetics and the University of Utah Research Foundation, which hold the patents on the BRCA1 and BRCA2 genes.

US RIGHTS GROUP ARGUES AGAINST HUMAN GENE PATENT NEW YORK Reuters Health News Feb 02

"Strong majorities of opinion leaders said that nurses should have more influence in reducing medical errors, improving patient safety, improving quality of care, promoting wellness, expanding preventive care, improving healthcare efficiency, reducing costs, coordinating care throughout the healthcare system, helping the system adapt to an aging population, and increasing access to care," Dr. Hassmiller told Medscape Nursing. Previous Gallup polls have determined that US adults consider nursing to be among the most ethical and honest professions. Although this new survey showed that opinion leaders also regard nurses as one of the most trusted sources of health information, nurses were perceived as having less effect on healthcare reform than government, insurance, and pharmaceutical executives and others.

NURSES SHOULD PLAY GREATER ROLE IN HEALTH POLICY PLANNING, MANAGEMENT Laurie Barclay, MD February 2, 2010 Reuters Health News

Health research is a potential winner in the new US budget proposed Feb. 1, with the National Institutes of Health in line for an extra $1 BIL -- the largest increase for the agency in eight years. President Barack Obama has put a heavy emphasis on medical research since he took office in January 2009, including an easing of restrictions on the use of stem cells imposed by his predecessor George W. Bush. Obama's budget plan for 2011 would provide $25.5 BIL for six months to help prop up Medicaid, the state-federal health insurance plan for the poor, $1.4 BIL for food safety efforts and $3 BIL for AIDS prevention. The plan asks Congress for $954 MIL for smoking prevention programs and $20 MIL for a new Centers for Disease Control and Prevention initiative to prevent chronic diseases such as diabetes and heart disease. The $911 BIL Health and Human Services Department budget doubles funding to $561 MIL for a program aimed at stopping waste and fraud in Medicare, the health insurance plan for the elderly.

HEALTH SPENDING A WINNER IN OBAMA BUDGET By Maggie Fox Reuters Health News Feb 01

Government departments implemented a law requiring that health insurance cover mental and physical illnesses to the same extent. The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 prohibits group health insurance plans from restricting access to care by limiting benefits and requiring higher patient costs for mental health and substance abuse disorders compared with those costs that apply to general medical or surgical benefits. The new rules were jointly issued today by the US Department of Labor, the US Department of Health and Human Services, and the Treasury. "Today's rules will bring needed relief to families faced with meeting the cost of obtaining mental health and substance abuse services," stated US Secretary of Labor Solis. "The benefits will give these Americans access to greatly needed medical treatment, which will better allow them to participate fully in society."

LAW REQUIRING PARITY OF MENTAL AND SUBSTANCE ABUSE HEALTH INSURANCE BENEFITS IMPLEMENTED Emma Hitt, PhD January 29, 2010 Reuters Health News

As February approaches, US House Speaker Nancy Pelosi said she thought Democrats in Congress would still produce healthcare legislation despite recent difficulties, saying no bill was not an option. "I don't see that (no bill) as a possibility; we will have something,". Senate Majority Leader Reid said there was "no rush" to find a new healthcare strategy, and House Majority Leader Steny Hoyer said one option was not to pass a bill. "Let's put it this way. The present (healthcare) system is unsustainable. We can no longer afford it," she told reporters after appearing with representatives of the Special Olympics. Under the most discussed plan, the House would pass the Senate health bill, eliminating the need for another Senate vote, and both chambers would pass House-sought changes to the Senate bill through a process called reconciliation.

PELOSI: NO US HEALTHCARE BILL NOT A POSSIBILITY Reuters Health News ) Jan 27

Raising cost sharing for ambulatory care among elderly patients may have negative health consequences and may increase total healthcare costs, according to a study in the Jan 28 New England Journal of Medicine. "When copayments for ambulatory care are increased, elderly patients may forgo important outpatient care, leading to increased use of hospital care". "Raising cost sharing for ambulatory care among elderly patients may have adverse health consequences and may increase total spending on health care," the study authors write. "The effects of increases in copayments for ambulatory care were magnified among enrollees living in areas of lower income and education and among enrollees who had hypertension, diabetes, or a history of myocardial infarction."

RAISING COPAY FOR ELDERLY AMBULATORY CARE MAY HAVE ADVERSE CONSEQUENCES Laurie Barclay, MD January 27, 2010 N Engl J Med. 2010;362:320-328.Reuters Health News

The duration of hospital stays for full-term newborns should be decided by pediatricians and mothers on a case-by-case basis, using 16 specific criteria regarding the infant, the mother, their home, and their local resources, according to a policy statement published January 25 in Pediatrics. From 1970 through the mid-1990s, the time mothers and infants spent in the hospital became progressively shorter. Early discharge was officially instigated at the end of that period. Subsequent debate about healthcare and safety resulted in federal legislation in the 1990s that guarantees mothers and infants up to 48 hours of hospitalization after vaginal delivery and 96 hours after a cesarean section. The American Academy of Pediatrics supported this study. The study authors report that any financial conflicts have been settled through the academy's board of directors.

SPECIFIC CRITERIA SHOULD DETERMINE HOSPITAL DISCHARGE TIMING ON INDIVIDUAL BASIS Nancy Fowler Larson January 25, 2010 Pediatrics. 2010;125:405-409. Reuters Health News

US House Speaker Nancy Pelosi said Jan 20 she did not think the Senate's version of healthcare reform had enough support to pass the House of Representatives without changes. "In its present form, without any change, I don't think it's possible to pass the Senate bill in the House," she said. Some House Democrats have objected to several provisions in the Senate bill, including a tax on high-cost insurance plans that is opposed by labor unions and a less-restrictive policy on using federal funds to cover abortions. Both bills would extend insurance coverage to more than 30 million uninsured Americans, create exchanges where individuals can shop for insurance plans and bar insurance practices like refusing coverage to people with pre-existing conditions.

PELOSI SAYS US SENATE HEALTH BILL CANNOT PASS HOUSE By Donna Smith, David Morgan, and John Whitesides WASHINGTON Reuters Health News Jan 21

A new position paper from the American College of Physicians provides ethical guidance to physicians for developing mutually supportive patient-physician-caregiver relationships. For more than 30 million patients with acute or chronic illness, family caregivers play a crucial role in optimizing not only their health but also their quality of life. Specific functions performed by family caregivers may include assistance with daily activities, management of complex care regimens, healthcare system navigation, and communication with healthcare professionals. Caregiver susceptibility to injury and disease may be heightened by stress, whether physical, emotional, and/or financial. Additional burdens may result when family caregivers are geographically distant and when health professionals find themselves in the role of family caregivers. By recognizing the importance of the caregiver role, physicians may facilitate a positive caregiving experience, thereby reducing rates of patient hospitalization and institutionalization. The primacy of the patient-physician relationship needs to be balanced with the physician's role in partnering with patients and family caregivers, which could potentially pose ethical challenges.

ETHICAL GUIDELINES ADDRESS PATIENT-PHYSICIAN-CAREGIVER RELATIONSHIPS Laurie Barclay, MD January 20, 2010 J Gen Intern Med. Published online January 9, 2010. ACP Web site.Reuters Health News

Medical societies that have advocated for healthcare reform face the possibility of coming up empty-handed now that the Massachusetts election of Scott Brown to the US Senate has deprived Senate Democrats of a filibuster-proof, 60-vote bloc. The consequences of no bill emerging from Congress, say leaders of organized medicine, would not be pretty -runaway costs, more and more uninsured, and fewer physicians choosing primary care due to inadequate reimbursement. The Republicans' ability to talk a bill to death dramatically alters the Democrats' legislative game plan, which revolves around separate reform bills passed by the House and Senate.

FOUNDERING HEALTHCARE REFORM LEGISLATION, TORPEDOED BY SENATE ELECTION, ALARMS PHYSICIAN ADVOCATES Robert Lowes January 20, 2010 Reuters Health News

When Massachusetts voters elected Republican Scott Brown to the US Senate tonight, they threw a wild card into the poker game called healthcare reform. However, any bill passed by Congress and signed into law by President Obama could be revised afterward more to the House's liking in a process called budget reconciliation. In the Senate, budget reconciliation measures can't be filibustered, which means Senate Democrats need only a simple, 51-vote majority to get their way. In any event, it’s not clear how much of the House bill will make it into the Senate bill in the reconciliation process, whether it’s related to the budget or not. At risk, for example, is the House provision to increase Medicaid reimbursement to physicians to Medicare rates -a $57 BIL boost to physician revenue over 10 years.

GOP SENATE WIN THREATENS HEALTHCARE REFORM LEGISLATION Robert Lowes January 19, 2010 Reuters Health News

Healthcare reforms working their way through the US Congress in first few days of December will help slow rising medical costs but more will have to be done in coming years. White House budget director Peter Orszag said proposals by Democratic lawmakers could still use "further tweaking" to strengthen them and further reduce the cost of US healthcare, but he declined to mention specifics. President Barack Obama's drive for healthcare overhaul, his chief domestic policy goal, has aimed to both increase access to care for Americans and halt the rapid growth in the $2.4 trillion industry. Healthcare costs now make up 16 percent of the US economy and are forecast to reach 20 percent by 2017. Republicans and other critics have said the proposals cost too much and that savings forecast by the CBO either are not realistic or could evaporate over time.

HEALTHCARE REFORMS WORKING THEIR WAY THROUGH THE CONGRESS By Susan Heavey Dec 03 Reuters Health Information 2009

Most Americans would like to see a "public option" in health insurance reform but doubt anything Congress does will lower costs or improve care in the short term. Some 60% of those surveyed said they would like a public option as part of any final healthcare reform legislation, which Republicans and a few Democrats oppose. While 86^ of Democrats support the public option only 57% of Independents and 33% of Republicans do.

REUTERS POLL: MOST IN US WANT PUBLIC HEALTH OPTION Dec 03 Reuters Health Information 2009

California legislated parity coverage for mental healthcare in 2000, and the first 5 years of that program offer a preview of what to expect when federal parity laws take effect next year. The federal program will need to monitor not only plan costs and coverage but also access and quality. They also identify patient education as the biggest barrier to implementing mental health parity laws. Regulators and policymakers should be prepared to 1) establish a system for monitoring health plan performance that includes measures related to access and quality in addition to coverage and costs, 2) assess health plans' exclusion of coverage for specific psychiatric and substance use diagnoses (as mandated in the legislation) and any potential unintended consequences that might result from coverage exclusions, and 3) sponsor an education campaign to raise consumer awareness about insurance coverage under the new parity law.

LESSONS FROM CALIFORNIA ON MENTAL HEALTH PARITY LAWS Janis C. Kelly December 3, 2009 Psychiatric Serv. 2009;60:1589-1594. Abstract

The US Senate made little progress on a broad healthcare overhaul Dec 1, as members battled over cuts in coverage for the elderly and failed to vote on two pending amendments. Republicans condemned more than $400 billion in cuts in Medicare and said they would eventually mean fewer services. "He better get his reasoning straightened out, because this is a huge, big belly-flop flipflop," Senate Democratic leader Harry Reid said of McCain. McCain said his campaign proposals were based on cutting waste and fraud in the Medicare program. "There is no relation between what I tried to do in my campaign and what is being done in this legislation," he said.

US SENATE BATTLES OVER ELDERLY HEALTH BENEFITS Dec 02 Reuters Health Information 2009

In a 61 to 39 vote, the US Senate Dec 3 approved an amendment to its massive healthcare reform bill that would guarantee coverage of much-debated mammograms and other preventive screenings for women without any cost-sharing on their part. The amendment offered by Sen. Mikulski would require both private and public health plans to cover preventive care and screenings specifically for women that are recommended not only by the USPSTF, but also by the Health Resources and Services Administration.

SENATE GUARANTEES COVERAGE OF MAMMOGRAMS, OTHER SCREENINGS IN HEALTHCARE REFORM BILL Robert Lowes December 3, 2009 Reuters Health Information 2009

Millions of unemployed US workers face sharply higher health insurance premiums and loss of coverage as temporary federal subsidies expire. With the US unemployment rate topping 10%, FamiliesUSA is urging Congress to extend a measure that helps laid-off workers maintain employer-sponsored health coverage with a 65% subsidy on their insurance premiums. The subsidies began in March as part of the $787 billion economic stimulus and the nine months of benefits for the first group of recipients expired at the end of Nov. Republicans worried about record federal budget deficits are expected to oppose extending the program. The report said that average monthly family COBRA premiums for the private insurance vary range from $979 in Idaho and $989 in Iowa to $1,246 in Massachusetts and $1,232 in Minnesota.

US UNEMPLOYED FACE HIGHER HEALTHCARE PREMIUMS Dec 01 Reuters Health Information 2009

Stung by the continuing struggle to make a vaccine against the H1N1 flu virus, Health and Human Services Secretary Kathleen Sebelius said her department would review its approach to disaster preparedness. The goal, Sebelius said, will be streamlined regulations that will speed the approval of new technologies that are promoted through government contracts with private companies. Sebelius said about 70 million swine flu vaccine doses are available or have been ordered and administered -- far short of the goal which was to have all priority groups vaccinated by the end of Nov, a total of 160 million people. A large part of the problem has come from difficulties making the vaccine using 1950s era egg-based technology. Companies also want better incentives to make drugs or vaccines on a large scale.

US HEALTH OFFICIALS TO REVIEW DISASTER PLAN By Maggie Fox Dec 01 Reuters Health Information 2009

Low-cost health interventions while on the job can significantly improve employees' health and quality of life. These programs can also dramatically lower health costs. "The current health care system is based on medical providers waiting in silos (medical offices, hospitals) for patients to arrive with illness," lead investigator Dr. RV Milani said. "Treatment is directed towards cure (when possible) or palliation," he noted. "Little to no effort is made toward prevention."

WORK SITE WELLNESS INTERVENTION DECREASES HEALTH CARE COSTS By Michelle Rizzo Dec 01 Am J Cardiol 2009;104:1389-1392.

The US Senate opens debate on a broad healthcare overhaul Dec 1 with senators seeking an elusive compromise on thorny issues like a government-run insurance plan, abortion coverage and holding down costs. The debate on President Barack Obama's top domestic priority, which opened at 3 p.m. EST (2000 GMT), is expected to last three weeks or more. Republicans have vowed to do whatever they can to block or delay the bill. The Senate Democratic plan is designed to rein in costs, expand coverage to about 30 million uninsured Americans and halt industry practices such as denying coverage to those with pre-existing medical conditions.

SENATE TO BEGIN DEBATE ON HEALTHCARE OVERHAUL By Donna Smith and John Whitesides Nov 30 Reuters Health Information 2009

H1N1 influenza continues to wane across the USA, but it has killed more than 30 children since the last count and since March, 198 children have been reported killed by H1N1. Many of the children who died had bacterial infections known to worsen a flu infection. Thirty-one percent of the children who died and who were tested for bacterial infections had one, and nearly a third of these had Staphylococcus aureus. The World Health Organization reports that more than 207 countries and overseas territories have reported laboratory-confirmed cases of H1N1, with more than 7,820 confirmed deaths - numbers the WHO says are the tip of the iceberg.

H1N1 FLU STILL DOWN IN US BUT 198 CHILDREN DEAD By Maggie Fox Nov 30 Reuters Health Information 2009

It's a crime so profitable that even dead people are in on the act. A US Senate committee revealed last year that Medicare had paid as much as $92 million from 2000 to 2007 for medical services or equipment ordered or prescribed by doctors who were dead at the time. Healthcare fraud said to cost US taxpayers hundreds of billions of dollars a year has garnered increased attention amid the congressional debate about overhauling the US healthcare system -- especially since President Barack Obama wants to cover some of the cost of reforms by fighting abuse. A Thomson Reuters report released on Oct. 26 said that in 2007, when the USA spent nearly $2.3 trillion on healthcare fraud was estimated to reach as much as 10 percent of annual healthcare spending.

"CANCER OF FRAUD" PERMEATES US HEALTHCARE SYSTEM By Tom Brown Nov 25 Reuters Health Information 2009

When consumer advertising began for the popular blood-thinner Plavix, Medicaid insurance programs for the poor and disabled spent millions more on the drug, even though the ads did not tempt doctors to write more prescriptions, researchers reported. They said the study suggested that while ads might not directly increase the number of prescriptions, they still affect the cost of publicly funded healthcare because drugmakers appear to build the cost of the ads into their prices. Consequently, payers and policymakers should appropriately still be concerned about direct-to-consumer advertising for publicly funded reimbursement programs such as Medicare and Medicaid.

CONSUMER DRUG ADS DRIVE UP HEALTH COSTS: US STUDY Nov 24 Reuters Health Information 2009

High-cost urban US hospitals may face debt rating downgrades if large cuts to Medicare funding are implemented as part of US health care reform. Research shows there are massive cost differences between hospitals in different regions. A recent report by Dartmouth College revealed costs per Medicare enrollee ranged from $5,300 to $16,000 in 2006. Most of the 17 highest cost hospitals are in urban or densely populated areas, which tend to have a higher cost of living, higher poverty and unemployment levels, diverse populations with diverse health care needs and expensive research arms. The most vulnerable hospitals will be stand-alone hospitals dependent on high cost referral practices and which do not gain many new paying patients.

HEALTH CARE REFORM MAY HURT HOSPITAL CREDIT Nov 23 Reuters Health Information 2009

New electronic record systems installed in thousands of US hospitals have done little to rein in skyrocketing healthcare costs, Harvard University researchers said. A review of roughly 4,000 hospitals from 2003 to 2007 found that while many had moved away from the paper files that still dominate the US healthcare system, administrative costs actually rose, even among the most high-tech institutions. Advocates of such technology have been pushing for greater use of computerized health records to prevent costly errors and allow greater coordination among caregivers and patients. But adoption has been slow, prompting Congress to offer $19 billion in incentives as part of an economic stimulus bill.

NO HOSPITAL SAVINGS WITH ELECTRONIC RECORDS: US STUDY By Susan Heavey Nov 20 Reuters Health Information 2009

When it comes to getting new medicines, Americans are no longer automatically first in line. For many years, the USA has led the world in licensing new drugs, but nowadays it can lag in approving new products or expanding the use of existing ones. For the first time in more than a decade, the number of new molecules launched in Europe in 2008 matched those in the USA, suggesting the US is no longer the region of choice for all initial new drug launches, according to CMR International, a Thomson Reuters subsidiary. The trend coincides with a decline in the overall number of new drugs winning approval in all markets amid raised safety concerns. Finding the balance between risk and reward has always been the name of the game for regulators, but the appetite for risk may be subtly changing on different sides of the Atlantic.

US LOSING GROUND TO EUROPE IN NEW DRUG APPROVALS By Ben Hirschler Nov 20 Reuters Health Information 2009

In addition to asking the leading medical journals and the National Institutes of Health about their policies on medical ghostwriting, Sen Chuck Grassley (R-IA) has now turned his attention to some of nation's top medical schools. Grassley, the ranking member of the Senate Committee on Finance, sent letters to Columbia, Duke, Harvard, Johns Hopkins, Stanford, the University of California, the University of Pennsylvania, the University of Washington, and Washington University, in St Louis, MO, asking for the school's official stance on medical ghostwriting. The letters are part of the committee's attempt to obtain full disclosure about any financial ties that academic physicians have with the pharmaceutical and device industries. The practice involves having review articles, editorials, and research papers drafted by marketing or medical-education companies with prominent or academically affiliated physicians adding their names to the paper late in the process, sometimes with a minimal contribution to the paper.

SEN GRASSLEY QUESTIONS TOP MEDICAL SCHOOLS ABOUT GHOSTWRITING Michael O'Riordan November 20, 2009 Reuters Health Information 2009

Hospital patients who suffer a side effect from treatment are more likely to give high ratings to their quality of care when hospital staff are up front about what went wrong, a new study suggests. When staff did discuss the problem, patients were more likely to be happy with their care -- even when the adverse effect was a preventable one, the study found. "Our findings show that disclosure is associated with patients' perception of higher-quality care, even when they were harmed by an adverse event," lead researcher Dr. Lenny Lopez, of Massachusetts General Hospital in Boston, said in a statement. Using hospital records and patient interviews, the researchers found that almost one-third of adverse events in the study were preventable -- being related to errors such as giving the wrong dose of medication.

PATIENTS HAPPIER WHEN DOCTORS DISCUSS WHAT WENT WRONG Nov 19 Reuters Health Information 2009

In one year at one urban teaching hospital, antibiotic-resistant infections in just 188 patients cost the hospital and society somewhere between $13 and $18 million, researchers say. This study, they add, "gives an indication of the magnitude of the burden imposed by resistance in the USA." "The answer is really going to have to be some high-level policy," perhaps at the national level, addressing microbiological culturing and antibiotic use, as well as ongoing education, said Dr. RR Roberts. The death rate attributable to these infections (after adjusting for possible confounding factors) was 6.5%, as compared with a death rate of 3.0% among patients without antibiotic-resistant infections. This difference amounted to 12 excess deaths caused by antibiotic-resistant infections in the expanded cohort.

ANTIMICROBIAL-RESISTANT INFECTIONS EXACT STAGGERING COSTS By Scott Baltic Nov 18 Clin Infect Dis 2009;49:1175-1186.

A Senate committee passed legislation Nov 17 that would increase government oversight of the US food supply, which has been battered by a series of high-profile recalls that have soured consumer confidence in the food safety system. The bill would expand US FDA oversight of the food supply by giving it the power to order recalls, increase inspection rates and require all facilities to have a food safety plan in place. The Senate Health, Education, Labor and Pensions Committee approved the legislation unanimously by a voice vote. It has been almost 50 years since oversight of the food supply was significantly overhauled, but momentum to reform the system has grown following high-profile outbreaks involving lettuce, peppers, peanuts and spinach since 2006. The Senate legislation would require FDA to inspect all food facilities at least once every four years and high-risk plants no less than once a year. Currently, many facilities can go several years without being inspected.

US SENATE PANEL PASSES FOOD SAFETY REFORM BILL By Christopher Doering Nov 18 Reuters Health Information 2009

Cash-strapped hospitals are stepping up pressure on the prices of medical devices - from knee replacements to diagnostic tests and surgical systems -- as momentum builds toward US healthcare reform. Medical devices represent one of the biggest expenses for hospitals, which are struggling to care for rising numbers of uninsured patients as the weak economy forces more and more Americans out of work. Congress is taking aim at the medical technology industry with a proposed tax on device makers that would generate as much as $40 billion over 10 years to help pay for healthcare reform. Margins on devices are extremely high,especially on cardiac and orthopedic devices.

MEDICAL DEVICE PRICES IN CROSSHAIRS OF REFORM By Susan Kelly and Debra Sherman Nov 12 Reuters Health Information 2009

One of the best ways to control US healthcare spending is to pay doctors, hospitals and other health providers a single set fee for treating all aspects of a surgical procedure or a chronic disease such as diabetes. Although such a "bundled payments" approach does not figure in current US healthcare reform legislation, it would go a long way to controlling costs. Fee-for-service payments, today's dominant mode, encourage higher volume rather than better value. The Congressional Budget Office has estimated that bundled payments could save the US healthcare system about a billion dollars a year but the Rand team said broadening the approach, already used by Medicare in some areas, could save more than that.

BUNDLED PAYMENTS A WAY TO CUT US HEALTH COSTS: STUDY Nov 12 Reuters Health Information 2009

Family practitioners are one group that is at the center of proposed healthcare reforms. But how do family physicians view current reform proposals and what are the ingredients with or without reform -for addressing the primary care physician shortage in the USA? Medscape: What is the position of the AAFP on proposed healthcare reform? Dr. Ted Epperly: We support the House bill (HR-3200) because it expands coverage and increases the primary care workforce. It does this by increasing payments for family physicians by 5% and providing incentives in the form of help with loan repayments and scholarships for those going into primary care. The other important provision of HR-3200 is that it reworks the flawed Medicare Sustainable Growth Rate formula. It also sets up pilot programs for the patient-centered medical home, which is the right model for future care of patients in the USA. We support healthcare for everyone. The type of payment system is up to Congress to decide.

THE FAMILY PRACTITIONER AND HEALTH REFORM: Interview with Ted Epperly, by Barbara Boughton November 11, 2009 Reuters Health Information 2009

The Centers for Medicare and Medicaid Services (CMS) has published final regulations that will dramatically reduce physician reimbursements for medical imaging services beginning in 2010. Many professional organizations and advocacy groups say that this will limit patient access to screening tests that save both money and lives. The Physician Fee Schedule for 2010 is slated to decrease payments to nonhospital practices by 48% for pelvic computed tomography (CT) scans, by 46% for chest/spine magnetic resonance imaging (MRI), and by 27% for cardiovascular-related services. The cuts will affect community-based imaging and restrict access to imaging scans, explained Tim Trysla, executive director of the Access to Medical Imaging Coalition. "This can cause delays in the diagnosis of cancer." In addition to changes in imaging reimbursement, the fee schedule includes a 1% cut to oncology services, part of an overall 6% reduction in reimbursement for cancer care, which will be implemented over the next 4 years.

MEDICARE CUTS TO DIAGNOSTIC IMAGING WILL AFFECT CANCER CARE Roxanne Nelson November 11, 2009 Reuters Health Information 2009

After a landmark win in the House of Representatives Nov 8, President Barack Obama's push for healthcare reform faces a difficult path in the Senate amid divisions in his own Democratic Party on how to proceed. On a 220-215 vote, including the support of one Republican and opposition from 39 Democrats, the House backed a bill late on Saturday that would expand coverage to nearly all Americans and bar insurance practices such as refusing to cover people with pre-existing medical conditions.

HEALTH CARE BILL FACES TOUGH PATH IN SENATE By John Whitesides Nov 09 Reuters Health Information 2009

Doctors have been flocking to White Plains and surrounding Westchester County since the 1970s, drawn in part by an upper-class clientele who demand top-notch medical care and have the means to pay for it. The county has one of the highest median household incomes in the nation (about $77,000 a year in 2007), and the figures soar above six digits in suburbs like Scarsdale and Chappaqua. Scaring up a doctor in Bakersfield, in California's economically battered Central Valley, is a lot harder. In fact, White Plains has more than twice the number of doctors per capita as Bakersfield, where needy patients until recently had to take a 2-hour bus trip to Fresno to see a diabetes treatment specialist. Two decades worth of US healthcare data shows that such regional disparities are increasingly creating a nation of health-care haves and have nots. If it's true that about one in three US health care dollars is wasted, then billions of dollars in costs can be eliminated through improved efficiency, rather than through more government spending that would widen the $1.4 trillion US budget deficit.

ARE DOCTORS WHAT AILS US HEALTHCARE? By Chris Baltimore Nov 06 Reuters Health Information 2009

Even modest improvements in the survival of patients with end-stage renal disease undergoing dialysis may lead to billions of dollars in extra costs that society must be prepared to assume. Within 10 years, the additional costs could exceed $5 million for a relatively small dialysis unit caring for approximately 170 people, Dr. McFarlane explained. Projected onto a large national program, such as the one in the USA, that could translate into an increase of more than $14 billion. Currently, more than 360,000 people in the USA are undergoing dialysis, according to the US Renal Data Service. Medicare spends approximately $73,000 annually per dialysis patient.

SKYROCKETING COSTS OF DIALYSIS MAY REQUIRE DIFFICULT DECISIONS Norra MacReady November 9, 2009 Reuters Health Information 2009

In the face of near-unanimous Republican opposition and a last-ditch effort to change the bill, the US House of Representatives voted 220 to 215 in favor of legislation to overhaul the nation's healthcare system. Thirty-nine of the body's 258 Democratic members -many from conservative districts in the South -joined their GOP House colleagues in opposing the measure, a $1.1 trillion compromise bill that has aroused deep passions on both sides of the aisle, as well as beyond the halls of Congress. President Barack Obama said, "Tonight, in an historic vote, the House of Representatives passed a bill that would finally make real the promise of quality, affordable health care for the American people."

HOUSE PASSES HEALTHCARE REFORM BILL Wayne J. Guglielmo November 7, 2009 Reuters Health Information 2009

Americans are more likely than people in 10 other countries to have trouble getting medical treatment because of insurance restrictions or cost. While the USA spends more than twice as much as other developed countries on healthcare, it lags well behind in key measures of quality. "Our weak primary care system puts patients at risk and results in poor health outcomes and higher costs," said Karen Davis, president of the Commonwealth Fund. The survey provides yet another reminder of the urgent need for reform that makes acceptable, high-quality care a national priority. The majority of US doctors -- some 58 percent -- say their patients often have difficulty paying for medications and other medical care, by far the highest rate in the survey.

US SPENDS MOST, BUT HEALTH QUALITY LAGS By Julie Steenhuysen Nov 05 Reuters Health Information 2009

The AMA supports a massive healthcare reform bill in the US House of Representatives, but the voting can't stop there. To enact meaningful reform, Dr. Rohack warned that the House also must pass a separate bill on Medicare reimbursement that would avert a 21.2% pay cut for physicians scheduled to take effect January 1. Otherwise, Medicare patients may not be able to find a physician willing to treat them. "These are separate bills that must be passed together," said Dr. Rohack.

AMA SUPPORTS LATEST HOUSE REFORM BILL BUT LINKS IT TO MEDICARE PAYMENT BILL Robert Lowes November 5, 2009 Reuters Health Information 2009

US employers tell workers to stay home when they are sick will have to give them paid time off for up to five days under new federal legislation. The emergency law would cover pandemic H1N1 flu or any other infectious disease. "Sick workers advised to stay home by their employers shouldn't have to choose between their livelihood, and their co-workers' or customers' health," Miller said. "This will not only protect employees, but it will save employers money by ensuring that sick employees don't spread infection to co-workers and customers, and will relieve the financial burden on our health system swamped by those suffering from H1N1."

PROPOSED LAW WOULD REQUIRE PAY FOR SICK WORKERS By Maggie Fox Nov 04 Reuters Health Information 2009

Recent changes to Medicaid policy are forcing state mental health systems to be more accountable for the services they provide and are also empowering consumers to have a say in how these services are delivered. "By now, it is generally understood that Medicaid is the nation's primary payer for mental health services, particularly public mental health services," writes JA Buck. The changes have reinforced state Medicaid authority over state mental health agencies, reduced incentives for institutionalization and the building of large state mental hospitals, and promoted the creation of home- and community-based mental health services.

MEDICAID POLICY CHANGES AFFECT DELIVERY OF MENTAL HEALTH SERVICES Fran Lowry November 5, 2009 Psychiatr Serv. 2009;60:1504–1509.

Patients with cancer and other serious illnesses often seek access to investigational drugs when all other treatment options have been exhausted. The US FDA recently published updates to their expanded-access rules in an effort to clarify existing regulations and add new types of access but, the debate over patient access to investigational drugs is expected to continue. The specific details of regulations vary around the world, but they all try to provide a mechanism by which patients with unmet medical needs can access drugs that are in development in a safe and regulated manner.

DEBATE CONTINUES OVER PATIENT ACCESS TO INVESTIGATIONAL DRUGS Roxanne Nelson November 3, 2009 Reuters Health Information 2009

Heavier patients get less respect from doctors, raising concerns about the impact on the quality of care. The patients for whom doctors expressed low respect, on average, had a higher BMI than patients for whom the physicians had high respect, the researchers report. The researchers note that the findings don’t show a cause/effect relationship between BMI and physician respect. Their study also didn’t investigate patients’ health outcomes. Respect is critical because some patients may avoid the health care system altogether. In other research, physician respect has been linked to more information being provided by the physician during a patient visit.

DOCTORS' LACK OF RESPECT WEIGHS ON THE OBESE Bill Hendrick October 29, 2009 Reuters Health Information 2009

The US healthcare system is just as wasteful as President Barack Obama says it is, and proposed reforms could be paid for by fixing some of the most obvious inefficiencies, preventing mistakes and fighting fraud, according to a Thomson Reuters report. The US healthcare system wastes between $505 billion and $850 billion every year one third of total expenditure. "America's healthcare system is indeed hemorrhaging billions of dollars, and the opportunities to slow the fiscal bleeding are substantial," the report reads. For example, American physicians spend nearly eight hours per week on paperwork and employ 1.66 clerical workers per doctor, far more than in Canada.

US HEALTHCARE SYSTEM WASTES UP TO $800 BILLION A YEAR By Maggie Fox Oct 26 Reuters Health Information 2009

Climate change will mean new health problems for the USA, but public health officials play only a limited role in decisions about how to cope with the changing environment. Only five US states -- California, Maryland, New Hampshire, Virginia and Washington -- have plans for dealing with the health implications of climate change, while another 28 states have climate change plans without public health elements and 17 states have no climate plans at all.

US NEEDS MORE HEALTH PREPAREDNESS FOR CLIMATE CHANGE By David Morgan and Richard Cowan Oct 26 Reuters Health Information 2009

Obese children and teenagers hospitalized in 2006 in the USA had to pay about $1200 more in hospital charges and were kept in the hospital longer than matched controls who were not obese. The increasing prevalence of obesity and associated comorbid conditions among children and teenagers in the USA poses a significant challenge to healthcare charges and delivery. "Even though the obesity rate was about 1%, which is underestimate, the key point is that, even with an underestimation, the extra charge is about $1200 per patient and close to about half a day extra in the hospital". Obesity can have a tremendous impact," he said. "In terms of the total [annual] charges, it could be millions of dollars.

OBESITY IN HOSPITALIZED CHILDREN POSES SIGNIFICANT BURDEN Crina Frincu-Mallos, October 27, 2009 Reuters Health Information 2009

Low-income Americans with no more than a high school education appear more likely to get vaccinated against H1N1 swine flu than people with more money and better schooling. Flu fears also ran high among 43.3% of people with household incomes of $25,000 a year or less, compared with just 30% of people with annual incomes of $50,000 or more. Forty percent of poorer Americans said they intended to get vaccinated, versus just over a third of all respondents. The data suggest that less privileged Americans may be more apprehensive about the H1N1 flu because they are more likely to feel the brunt of its economic impact, which can range from days away from work to an expensive stay in the hospital.

IN U.S., LESS EDUCATION MEANS MORE H1N1 CONCERN By David Morgan Oct 23 Reuters Health Information 2009

Drug labels in the USA often omit information showing the severity of side effects or that a medicine is not very effective. Much critical information that the Food and Drug Administration has at the time of approval may fail to make its way into the drug label and relevant journal articles. The labels are written by the manufacturers and the wording is negotiated with the FDA, which gives final approval. "How can I decide if the potential harms of this drug are worth the risk if I don't know how well the drug works, and vice versa?" he asked.

KEY INFORMATION MISSING FROM US DRUG LABELS By Gene Emery Oct 22 Reuters Health Information 2009