The historic healthcare reform legislation that Congress passed in March makes 19 references to the term "medical home," and for good reason. Reformers are betting that the medical home, with its physician-led team delivering and coordinating holistic patient care in the exam room and online, is just what the country needs to improve quality and lower costs. At the same time, giving primary care physicians extra pay for operating medical homes and operating them well promises to deliver these clinicians from fee-for-service medicine and its piecemeal, perverse, and punishing incentives. Creating such nirvanas, however, is easier said than done, especially when physicians attempt to reform their practices in an unreformed system with inadequate compensation. Working "feverishly," the 36 participating family practices registered modest improvements in quality-of-care measures but backslid in terms of how patients rated them. The demonstration project is the first of its kind on a national scale. The authors of the summary article in the collection concede that it is possible for practices to become medical homes, but that this transformation "requires tremendous effort and motivation," and that most practices would need outside help, as well as adequate compensation, to make the switch.

LACK OF ADEQUATE PAY REDUCES EFFECTIVENESS OF MEDICAL HOME Medscape Medical News Robert Lowes June 7, 2010

The failure of Congress to permanently solve the Medicare reimbursement crisis is making it harder for seniors to make an appointment with a physician. The online survey of 9000 physicians revealed that 17% -and 31% of those in primary care -are limiting the number of Medicare patients they treat, with most of them explaining that Medicare rates are too low and that the threat of future cuts "makes Medicare an unreliable payer". At the end of May, the House passed a Democrat-sponsored bill that would postpone a scheduled 21%+ reduction in Medicare reimbursement from June 1 to January 1, 2012, and give physicians small raises in the meantime. However, Senate Democrats opted not to try to pass the legislation in their chamber that day, saying they did not have enough time to do so before the Memorial Day break. As a result of Senate inaction, the draconian pay cut took effect on June 1, although the Center for Medicare and Medicaid Services is holding June claims through June 14, in the hope that Congress will avert the reduction retroactively.

PHYSICIANS SEEING FEWER MEDICARE PATIENTS BECAUSE OF LOW PAY AND THREAT OF CUT From Medscape Medical News Robert Lowes June 3, 2010

Italy is taking new steps to rein in healthcare spending and reduce the country's drugs bill by imposing a cut in generic drug prices and curbs on reimbursement for more expensive medicines. Italy joins a growing list of European countries that have acted to cut drug prices as part of austerity measures to tackle runaway budget deficits. From 2011, reimbursement of generics will be limited to the cheapest version of a medicine within four therapeutic categories, with the lowest price established by a tender system. The introduction of a tender system for purchases of generics follows similar action by Germany, where tendering has led to reduced prices.

ITALY JOINS EUROPE-WIDE MOVE TO CUT DRUG COSTS Jun 02 -Reuters Health Information

The hospital at the center of a whistleblower lawsuit may be stripped of Medicaid and Medicare reimbursement in the aftermath of a Department of Justice investigation that left Christ Hospital on the hook for a $110-million settlement. Christ Hospital admitted no guilt in the settlement, signed May 21, but sought to avoid the "multibillion" dollar award being sought by the government. Cardiologist Dr Harry Fry initially filed his suit with the Cincinnati District Court under the False Claims Act, alleging that cardiologists at the hospital were given time in an outpatient testing unit based solely on the number of CABG or cath-lab revenues they generated for the hospital the previous year. Many of those procedures were billed to Medicare/Medicaid, making it a federal offense.

CARDIOLOGIST WHISTLEBLOWER GETS $23.5M; CHRIST HOSPITAL MAY LOSE FEDERAL REIMBURSEMENTS Shelley Wood June 2, 2010 Heartwire

Pressured by an aging population and the need to rein in budget deficits, Canada's provinces are taking tough measures to curb healthcare costs, a trend that could erode the principles of the popular state-funded system. Ontario, Canada's most populous province, kicked off a fierce battle with drug companies and pharmacies when it said earlier this year it would halve generic drug prices and eliminate "incentive fees" to generic drug manufacturers. And a few provinces are also experimenting with private funding for procedures such as hip, knee and cataract surgery. It's likely just a start as the provinces, responsible for delivering healthcare, cope with the demands of a retiring baby-boom generation. Official figures show that senior citizens will make up 25% of the population by 2036. Healthcare in Canada is delivered through a publicly funded system, which covers all "medically necessary" hospital and physician care and curbs the role of private medicine. It ate up about 40% of provincial budgets, or some C$183 billion ($174 billion) last year.

SOARING COSTS FORCE CANADA TO REASSESS HEALTH MODEL By Claire Sibonney May 31 Reuters Health Information

More children's medicines -- four products sold under the PediaCare brand name -- have been recalled. All four of the over-the-counter medications were made in Johnson & Johnson's troubled McNeil plant in Pennsylvania. Numerous problems at the plant, including drugs containing incorrect dosages and unsafe manufacturing conditions, led to the April 30 recall of popular child and infant versions of Tylenol, Motrin, Benadryl, and Zyrtec. The products recalled over the Memorial Day weekend are sold by Blacksmith Brands. Although no injuries have been reported from use of these products, the manufacturer warns parents to stop using the drugs and to throw away any product they may have purchased.

PEDIACARE CHILDREN'S DRUGS RECALLED WebMD Health News Daniel J. DeNoon June 2, 2010

With Congress failing to stop a 21% cut in Medicare reimbursement for physicians that takes effect on June 1, organized medicine is dialling up its rhetoric from disapproval to disgust. Physicians have been chiding lawmakers for months for putting a series of short-term band-aids on the Medicare reimbursement crisis instead of curing it for good. However, all that remonstration did not seem to make any difference. Members of the House and Senate left Washington, DC, May 28 without averting the pay cut -the third time they have done so this year. Physicians are voicing the same criticisms of Congress as before, except they are voicing them with more vehemence. "America's physicians are outraged that Congress has deserted patients by failing to address this year's Medicare cut before the June 1 deadline," Dr. Rohack said in a written statement. "I don't go on vacation when I have patients to take care of," Lori Heim, MD, president of the American Academy of Family Physicians.

ORGANIZED MEDICINE BLASTS CONGRESS FOR FAILING TO STOP MEDICARE PAY CUT Medscape Medical News Robert Lowes May 28, 2010

Revitalizing efforts to increase diversity in the medical workforce addressed in the institute's report are important to improve underrepresented patients' access to care, quality of care, and outcomes of care. Some elements are to incorporated diversity as a part of the medical schools' mission and goals in achieving excellence, spearheading approaches focused on action in modifying various policy areas, such as outreach and recruitment, admissions, retention, curriculum reform, student financial aid, campus environment, educational and healthcare partnerships, and cross-cultural education and training and including mentorship into the educational and professional process to support students throughout their medical careers.

REPORT IDENTIFIES WAYS TO INCREASE DIVERSITY IN US MEDICAL SCHOOLS Medscape Medical News Brande Nicole Martin May 27, 2010

Now that US healthcare reform is becoming a reality, states are sorting out how they will pay for two of the plan's major components that will rest largely on their shoulders at the same time they are pulling out of a long economic downturn Under the healthcare reforms championed by President Barack Obama, states will generally see their Medicaid costs rise mildly, while they are in line for more federal dollars. The plan made more people eligible for Medicaid, which should have driven states' costs higher. Congress, though, included a caveat for the federal government to reimburse the costs of all new enrollees by 100%. The Kaiser study found that through 2019, the year when the US government will pull back and reimburse 93% of the costs of those participants, federal spending on Medicaid will increase by at least $443.5 billion. On the other hand, states will see an increase of only $21.1 billion. Other increased federal funding streams will draw down the amounts states have to put into Medicaid, as well, Kaiser found. That means that under conservative estimates, Maine's Medicaid spending will decrease 1.5% and Colorado's will slip 0.5%, according to the study. Massachusetts and Vermont, which established their own health plans, will spend 2.1% and 0.6% less, respectively.

HEALTHCARE REFORM COSTS SHIFT TO CASH-STRAPPED STATES By Lisa Lambert May 26 Reuters Health Information

State regulators fined health insurers $236 MIL from December 1997 through December 2009, usually because of how these companies treated -or rather, mistreated -healthcare providers. Roughly 7 of every 10 fines involved the failure to pay provider claims on a timely basis. However, the number of these fines declined dramatically in recent years, suggesting that state prompt-pay laws and lawsuits filed against health insurers over claims processing are speeding up physician pay as intended. Organized medicine has fought with health insurers over slow pay for years. One major battleground was a federal class-action lawsuit that the AMA and other medical societies brought against the nation's leading managed care companies over various aspects of claims processing. Six of the insurers settled and promised, among other things, to pay clean electronic claims within 15 business or calendar days, depending on the insurer, and 5 insurers promised to pay clean paper claims within 30 calendar days. The AMA won a similar settlement from the Blue Cross Blue Shield Association and 30 of its subsidiaries and plans in 2007.

SLOW PAYMENT OF PROVIDER CLAIMS ACCOUNTS FOR MOST HEALTH INSURER FINES SINCE 1997 Robert Lowes May 25, 2010 Medscape Medical News

British grocer Asda has said it will sell all privately prescribed cancer drugs on a not-for-profit basis, in a move that steps up competition with pharmacy chains and highlights a debate over access to medicines. The decision by Britain's second-biggest supermarket chain, which is owned by US retailer Wal-Mart, comes two months after it said it would sell fertility drugs at cost price. "Cancer is the UK's second biggest killer, affecting nearly 300,000 people per year and for many the cost of treatment is well above what they can afford," Asda said. Its commitment means that it will sell lung cancer drug Iressa for 2,167.71 pounds ($3,109), at least 400 pounds cheaper than pharmacies like Lloyds, Boots and Superdrug.

UK GROCERY CHAIN WILL SELL CANCER DRUGS AT NO PROFIT By Mark Potter and Ben Hirschler May 20 From Reuters Health Information

Physicians would receive a Medicare reimbursement increase of 1.3% through the remainder of 2010 and another increase of 1% in 2011 -well below the inflation rate -under a bill before Congress that would avert a scheduled 21.3% Medicare pay cut. The size of the proposed Medicare pay raises is no small thing for physicians, who depend on the government program, on average, for about 30% of their revenue. For internists, that slice of the revenue pie is 44%. The bill, unveiled May 20 by Congressional Democrats, is titled the American Jobs and Closing Tax Loopholes Act. In addition to calling for modest increases in Medicare reimbursement through 2011, it also sets the stage for possible raises in 2012 and 2013 under a complicated formula that favors primary care physicians. In addition, Medicare reimbursement cannot be reduced in 2012 or 2013. However, in 2014, Medicare would revert to its current method of setting physician reimbursement; namely, the controversial sustained growth rate (SGR) formula, which triggered the 21.3% pay cut scheduled to take effect on June 1.

PROPOSED MEDICARE PAY RAISES LAG BEHIND INFLATION RATE Robert Lowes May 21, 2010 From Medscape Medical News

The chair of an expert committee of the WHO said that his group will review confidential agreements between the agency and private businesses to determine how much influence, these firms had on WHO's handling of the H1N1 influenza pandemic. WHO convened the committee earlier this year to draw lessons from how WHO and the international community responded to the H1N1 pandemic. The review committee also will assess a binding agreement among WHO member states called the International Health Regulations, which was drafted to help WHO prevent and respond to acute public health risks with the potential to cross borders. The expert review committee will examine WHO's criteria for declaring a pandemic, which have been criticized as flawed and misleading. WHO officials acknowledge that their criteria take into account how widely a virus is circulating but do not factor in its severity, which could be measured by morbidity or mortality.

WHO PANEL WILL EXPLORE POSSIBLE INDUSTRY INFLUENCE ON PANDEMIC INFLUENZA DECISIONS Robert Lowes ay 19, 2010 From Medscape Medical News N Engl J Med. Published online May 19, 2010.

A national group representing small businesses has signed onto a federal lawsuit filed by officials from 20 states that challenges the constitutionality of the new healthcare reform law, particularly its mandate for individuals to obtain insurance coverage. In a press release, the NFIB stated that it seeks to increase healthcare coverage for more Americans, but not at the expense of constitutional freedoms, which it accuses the Patient Protection and Affordable Care Act (PPACA) of doing. "The individual and employer mandates, onslaughts of new taxes, and onerous paperwork requirements in this unconstitutional law will devastate small businesses," the NFIB stated. It added that the individual mandate is "the first time the government is telling individuals they have to do something simply because they are alive."

BUSINESS GROUP JOINS MASSIVE SUIT AGAINST HEALTHCARE REFORM Robert Lowes May 18, 2010 From Medscape Medical News

Pay-for-performance metrics might provide financial incentives for surgeons to discriminate against obese patients, a large retrospective study of national insurance claims suggests. Pay for performance is a "government policy that promotes patient selection and discrimination," said Martin A. Makary, MD. "The policy incentivizes doctors to pass on, stall, or delay treatment of obese patients, many of whom are minorities." "Physicians in an inner-city setting who treat patients with lower socioeconomic status who are at higher risk could be penalized for treating these patients," he added. "These methods can affect any procedure that has substantial complication rates if higher-risk patients are treated. The fear is that centers will stop treating higher-risk patients," he explained.

PAY-FOR-PERFORMANCE MODELS INHERENTLY DISCRIMINATORY Alice Goodman May 13, 2010 From Medscape Medical News

Nearly 1000 registered nurses rallied today outside the US Capitol in support of legislation that would set adequate ratios of nurse-to-patient staffing in the nation's hospitals to ensure good care and prevent nurse burnout. Virtually everyone agrees that hospitals need more nurses on duty, but when it comes to a solution, the 1000 voices in Washington, DC, during National Nurses Week were not speaking for their entire profession. These nurses were members of the 150,000-strong National Nurses United (NNU), a union formed from a recent merger. In contrast, ANA stands opposed to lawmakers regulating how many nurses work a given shift, which has already happened in California. The ANA would rather see Congress follow in the footsteps of other state legislatures and pass a law requiring hospitals to develop customized staffing plans with strong input from nurses. The NNU is touting a study published last month reporting that mandatory staffing levels in California have helped reduce mortality rates among general surgery patients while improving nurse job satisfaction.

NURSES RALLY RENEWS DEBATE OVER MANDATORY STAFFING RATIOS Robert Lowes May 12, 2010 From Medscape Medical News

Total medical costs of cancer care have nearly doubled during the past 20 years, despite a shift away from inpatient care. In 1987, the total medical cost of cancer (in 2007 American dollars) was $24.7 BIL, but by 2001 to 2005, the cost increased by 98%, to $48.1 BIL. Drug and other treatment costs were not the primary reason for the increase in cancer care spending. "It was mainly due to the number of new cancer cases and the number of cancer patients who are living longer," she told Medscape Oncology. Dr. Tangka and her coauthors found that the number of cancer cases had risen proportionately more than medical expenditures, indicating that increasing cancer costs have primarily been driven by an increased number of cases and not by the cost per treated cancer case.

CANCER COSTS HAVE NEARLY DOUBLED IN LESS THAN 20 YEARS Roxanne Nelson May 11, 2010 from Medscape Medical News

Uninsured, critically ill US patients may receive fewer critical care services and may fare worse than their peers with health insurance. One in 3 Americans younger than 65 years lacks health insurance during some portion of each year, and that the high cost of intensive care (nearly 1% of the US gross domestic product) may result in these patients failing to receive needed services, resulting in increased risk for morbidity and mortality. The goal was to evaluate whether differences in critical care access, delivery, and outcomes are associated with health insurance status, based on a systematic review of the medical and nonmedical literature. Compared with the insured, uninsured patients were less likely to receive critical care services and would have 8.5% fewer procedures than insured patients once admitted. They were also more likely than insured patients to have delays in hospital discharge and to undergo withdrawal of life support. Patients who are critically ill with lesser degrees of insurance coverage receive fewer critical care services compared with those who have more insurance.

LACK OF HEALTH INSURANCE LINKED TO WORSE CRITICAL CARE OUTCOMES Laurie Barclay, MD May 4, 2010 From Medscape Medical News Am J Respir Crit Care Med. 2010;181:1003-1011. Abstract

US health insurers are avoiding the controversial but rare practice of canceling coverage when a customer gets sick, but it is unclear how regulators will enforce the ban. Sweeping healthcare reforms passed in March give companies such as WellPoint and UnitedHealth Group until September to implement several big changes, including an end to terminating policies, known as rescission. The federal law will standardize the rules and allow insurance companies to cancel coverage only if they can prove fraud or intentional misrepresentation. Companies had already been limited in their ability to cancel healthcare coverage, but rules have varied state by state. "What's significant is the direct federal oversight and not having to wait for the states to enforce," said Gary Claxton of KFF.

HEALTH INSURERS END CANCELLATIONS; ENFORCEMENT KEY By Susan Heavey and Lewis Krauskopf Apr 30 From Reuters Health Information

With an average of 23 phone calls, 18 patients and 20 lab reports to deal with each day, Dr. Baron of Philadelphia is pretty busy. His practice of five primary care physicians looks after more than 8,400 patients, and he says the challenges they face every day in providing that care and getting paid for it lie at the very heart of healthcare reform in the USA. Dr. Baron provides a snapshot of his busy practice in this week's New England Journal of Medicine and says unless the system changes, doctors will continue to shy away from primary and general care and newly insured patients will have nowhere to turn. Dr. Baron said his practice, like many US practices, is paid via a patchwork of Medicaid, Medicare, and private insurance. Currently doctors are usually reimbursed only for a patient visit, how about an annual fee per patient, he asks.

DAILY STRUGGLE: US SYSTEM STRAINS PRIMARY DOCTORS Apr 29 - From Reuters Health Information N Engl J Med 2010;362:1632-1636.

UnitedHealth Group Inc April 27 said it would immediately stop terminating healthcare coverage for policyholders after they become sick to comply with new healthcare law months ahead of schedule. The move follows pressure from Democrats and the Obama administration to implement healthcare reforms ahead of the Sept. 23 deadline. WellPoint had already said it would end the practice, known as rescission, on May 1. The new law also prohibits insurers from refusing to cover people with pre-existing conditions and capping lifetime payouts.

UNITEDHEALTH MOVES EARLY TO END DROPPED POLICIES By Susan Heavey Apr 28 From Reuters Health Information

To learn more about how nurses can facilitate the transition to new healthcare policy, Medscape Nurses interviewed presenter Rebecca M. Patton, president of the American Nurses Association (ANA). Medscape: How will the new healthcare reform legislation affect the practice of nursing? Anyone who's been following the healthcare trades and blogs knows that there's a battle going on at both the national and state levels involving the removal of unnecessary practice restrictions on APRNs. This is vitally important when you consider that APRNs are more than well equipped to deliver the high-quality primary and preventive care that millions of additional Americans will now be able to receive under the provisions of the healthcare reform bill. Allowing APRNs to practice to the full extent of their education, training, and capabilities is a clear and obvious solution to the patient access and primary care challenges that have been staring us all square in the face for some time now. Recognizing the integral role that APRNs play in the delivery of patient-centered primary care helps bring the focus of our healthcare system back where it belongs -on the patient and the community.

HEALTHCARE REFORM LEGISLATION EFFECTS ON NURSING: An Expert Interview With Rebecca M. Patton Laurie Barclay, MD April 27, 2010 From Medscape Medical News

US DHHS Sec. Sebelius has called on health insurer WellPoint to stop dropping coverage for patients recently diagnosed with breast cancer, calling the practice "deplorable." In a letter dated April 22 to Angela Braly, WellPoint's chief executive, Sebelius said she was "surprised and disappointed" to learn from a Reuters report that the company has specifically targeted women with breast cancer for aggressive investigation with intent to cancel their policies. "As you know, the practice described in this article will soon be illegal," Sebelius wrote. "The Affordable Care Act specifically prohibits insurance companies from rescinding policies, except in cases of fraud or intentional misrepresentation of material fact."

US TO WELLPOINT: STOP DROPPING BREAST CANCER PATIENTS By Toni Clarke Apr 23 From Reuters Health Information

Imagine, for a moment, the sound of ringing telephones in physician offices in 2014, the first year most Americans are required to carry health insurance under historic healthcare reform legislation enacted last month. Millions of previously uninsured and undertreated individuals have just purchased policies, many with the help of tax credits, and now they are trying to make appointments with internists and family physicians to treat their migraine headaches, high blood pressure, and constipation. However, receptionists and schedulers who answer their calls do not have encouraging words. "The first appointment we can give you is 2 months out," they say over and over. "We’re just swamped." The new reform law, PPACA, attempts to avoid access scenarios like this by increasing the number of primary care physicians, who are already in short supply. The nation currently needs an additional 17,000 physicians in primary care shortage areas where 65 million Americans live, according to the US DHHS. American Medical Colleges were predicting a shortfall of 46,000 full-time equivalent primary care physicians by the year 2025 even before the PPACA was enacted.

SOLVING PRIMARY CARE SHORTAGE REQUIRES MORE THAN NEW HEALTHCARE REFORM LAW Robert Lowes April 26, 2010 From Medscape Medical News