Mary Ellen Schneider

As hospitals face increasing pressure to prevent surgical site infections, the American College of Surgeons National Surgical Quality Improvement Program offers one way to rapidly identify potential problems and track improvement efforts.

That was the experience at Huntington Memorial Hospital in Pasadena, Calif., where surgeons were able to significantly reduce the number of vascular surgical site infections by using the NSQIP to guide their quality improvement efforts. The NSQIP, which is operated by the American College of Surgeons (ACS), is a risk-adjusted data collection tool that captures and analyzes clinical outcomes data. The program sends periodic and real-time data to participating hospitals.

Between January 2009 and December 2010, the rate of vascular surgical site infections at the 650-bed community hospital dropped from 4.16% to 0.85% among 478 vascular surgeries performed during the 2-year period. In 2009, 10 vascular surgical site infections (SSis) were diagnosed. Seven were categorized as "superficial" and three were considered "deep." But in 2010, only two superficial vascular SSIs were diagnosed. There were no deep infections identified at the hospital that year. Surgeons from Huntington Memorial Hospital shared their data at the Western Surgical Association annual meeting in Tucson, Ariz.

Huntington Memorial Hospital joined the NSQIP in 2007. Hospital officials reviewed their data in 2008, and found that that the number of vascular surgical site infections was unacceptably high, Dr. Steven Katz, professor of surgery at the University of Southern California in Los Angeles and the director of surgical education at Huntington, said in an interview. The early NSQIP data showed that the observed to expected (O/E) ratio for vascular surgical site infections was 1.97 in 2008. The O/E ratio is a risk-adjusted outcome for a specific surgical site. An O/E ratio of less than 1 means that the site is performing better than expected, but a ratio greater than 1 means an excess of adverse events, according to the ACS.

The hospital convened a multidisciplinary committee with representatives from vascular surgery, anesthesiology, infection control, quality improvement, and nursing. The group then got to work looking for places where their practices fell short of best practices.

As a result, the hospital made a series of changes in perioperative patient management, including changing the surgical preparation solution and handwashing brushes from povidone-iodine to chlorhexidine, increasing the preoperative dose of cefazolin from 1 g to 2 g for patients not on dialysis, and intraoperative redosing of antibiotics in cases where the operative time was 4 hours or more. They also discontinued prophylactic antibiotics within 24 hours of surgery, used supplemental oxygen at an FiO₂ of 80% intraoperatively and immediately after surgery, and routinely used patient warming devices to maintain a core temperature of 37° C. The changes were phased in starting in August 2009, and were fully implemented by the beginning of 2010.

The new protocols reduced infections. Between January 2008 and December 2010, the O/E ratio for vascular SSIs fell from 1.97 to 0.93.

The NSQIP was important to the hospital’s success, said Dr. Katz. The real-time benchmarking reports provided by the program helped to initially identify the problem of high infection rates and later helped to track the success of the interventions, he said. Although the NSQIP doesn’t instruct hospitals on how to make quality improvements, the systems-based data it provides is especially helpful in developing a multidisciplinary approach to tackling the problems, Dr. Katz said.

The NSQIP database is quickly becoming the standard for measuring surgical quality, and the data from Huntington Memorial Hospital lends the program even more credibility, Dr. Richard Keen, chair of surgery at Cook County Hospital in Chicago, said in an interview. The experience at Huntington is "exactly how it’s supposed to work," Dr. Keen said. The NSQIP should help hospitals identify problems they otherwise might not have known about, and help them track whether their interventions have been effective, he said.

But despite recognition by the Joint Commission and others, the NSQIP still isn’t in use in a majority of hospitals around the country. The major stumbling block, Dr. Keen said, is the issue of return on investment. The annual fee for the program is between $10,000 and $24,000, depending on the hospital size, but the larger costs come with the full-time employee needed to work with the data.

But Dr. Keen said he expects to see an "explosion" in participation in the NSQIP in the next few years, driven in part by pressures from payers. The recent moves by Medicare to link payments to quality will make the NSQIP an important tool for hospitals to show that they are making progress in meeting quality goals, he said.

As hospitals face increasing pressure to prevent surgical site infections, the American College of Surgeons National Surgical Quality Improvement Program offers one way to rapidly identify potential problems and track improvement efforts.

That was the experience at Huntington Memorial Hospital in Pasadena, Calif., where surgeons were able to significantly reduce the number of vascular surgical site infections by using the NSQIP to guide their quality improvement efforts. The NSQIP, which is operated by the American College of Surgeons (ACS), is a risk-adjusted data collection tool that captures and analyzes clinical outcomes data. The program sends periodic and real-time data to participating hospitals.

Between January 2009 and December 2010, the rate of vascular surgical site infections at the 650-bed community hospital dropped from 4.16% to 0.85% among 478 vascular surgeries performed during the 2-year period. In 2009, 10 vascular surgical site infections (SSis) were diagnosed. Seven were categorized as "superficial" and three were considered "deep." But in 2010, only two superficial vascular SSIs were diagnosed. There were no deep infections identified at the hospital that year. Surgeons from Huntington Memorial Hospital shared their data at the Western Surgical Association annual meeting in Tucson, Ariz.

Huntington Memorial Hospital joined the NSQIP in 2007. Hospital officials reviewed their data in 2008, and found that that the number of vascular surgical site infections was unacceptably high, Dr. Steven Katz, professor of surgery at the University of Southern California in Los Angeles and the director of surgical education at Huntington, said in an interview. The early NSQIP data showed that the observed to expected (O/E) ratio for vascular surgical site infections was 1.97 in 2008. The O/E ratio is a risk-adjusted outcome for a specific surgical site. An O/E ratio of less than 1 means that the site is performing better than expected, but a ratio greater than 1 means an excess of adverse events, according to the ACS.

The hospital convened a multidisciplinary committee with representatives from vascular surgery, anesthesiology, infection control, quality improvement, and nursing. The group then got to work looking for places where their practices fell short of best practices.

As a result, the hospital made a series of changes in perioperative patient management, including changing the surgical preparation solution and handwashing brushes from povidone-iodine to chlorhexidine, increasing the preoperative dose of cefazolin from 1 g to 2 g for patients not on dialysis, and intraoperative redosing of antibiotics in cases where the operative time was 4 hours or more. They also discontinued prophylactic antibiotics within 24 hours of surgery, used supplemental oxygen at an FiO₂ of 80% intraoperatively and immediately after surgery, and routinely used patient warming devices to maintain a core temperature of 37° C. The changes were phased in starting in August 2009, and were fully implemented by the beginning of 2010.

The new protocols reduced infections. Between January 2008 and December 2010, the O/E ratio for vascular SSIs fell from 1.97 to 0.93.

The NSQIP was important to the hospital’s success, said Dr. Katz. The real-time benchmarking reports provided by the program helped to initially identify the problem of high infection rates and later helped to track the success of the interventions, he said. Although the NSQIP doesn’t instruct hospitals on how to make quality improvements, the systems-based data it provides is especially helpful in developing a multidisciplinary approach to tackling the problems, Dr. Katz said.

The NSQIP database is quickly becoming the standard for measuring surgical quality, and the data from Huntington Memorial Hospital lends the program even more credibility, Dr. Richard Keen, chair of surgery at Cook County Hospital in Chicago, said in an interview. The experience at Huntington is "exactly how it’s supposed to work," Dr. Keen said. The NSQIP should help hospitals identify problems they otherwise might not have known about, and help them track whether their interventions have been effective, he said.

But despite recognition by the Joint Commission and others, the NSQIP still isn’t in use in a majority of hospitals around the country. The major stumbling block, Dr. Keen said, is the issue of return on investment. The annual fee for the program is between $10,000 and $24,000, depending on the hospital size, but the larger costs come with the full-time employee needed to work with the data.

But Dr. Keen said he expects to see an "explosion" in participation in the NSQIP in the next few years, driven in part by pressures from payers. The recent moves by Medicare to link payments to quality will make the NSQIP an important tool for hospitals to show that they are making progress in meeting quality goals, he said.

As hospitals face increasing pressure to prevent surgical site infections, the American College of Surgeons National Surgical Quality Improvement Program offers one way to rapidly identify potential problems and track improvement efforts.

That was the experience at Huntington Memorial Hospital in Pasadena, Calif., where surgeons were able to significantly reduce the number of vascular surgical site infections by using the NSQIP to guide their quality improvement efforts. The NSQIP, which is operated by the American College of Surgeons (ACS), is a risk-adjusted data collection tool that captures and analyzes clinical outcomes data. The program sends periodic and real-time data to participating hospitals.

Between January 2009 and December 2010, the rate of vascular surgical site infections at the 650-bed community hospital dropped from 4.16% to 0.85% among 478 vascular surgeries performed during the 2-year period. In 2009, 10 vascular surgical site infections (SSis) were diagnosed. Seven were categorized as "superficial" and three were considered "deep." But in 2010, only two superficial vascular SSIs were diagnosed. There were no deep infections identified at the hospital that year. Surgeons from Huntington Memorial Hospital shared their data at the Western Surgical Association annual meeting in Tucson, Ariz.

Huntington Memorial Hospital joined the NSQIP in 2007. Hospital officials reviewed their data in 2008, and found that that the number of vascular surgical site infections was unacceptably high, Dr. Steven Katz, professor of surgery at the University of Southern California in Los Angeles and the director of surgical education at Huntington, said in an interview. The early NSQIP data showed that the observed to expected (O/E) ratio for vascular surgical site infections was 1.97 in 2008. The O/E ratio is a risk-adjusted outcome for a specific surgical site. An O/E ratio of less than 1 means that the site is performing better than expected, but a ratio greater than 1 means an excess of adverse events, according to the ACS.

The hospital convened a multidisciplinary committee with representatives from vascular surgery, anesthesiology, infection control, quality improvement, and nursing. The group then got to work looking for places where their practices fell short of best practices.

As a result, the hospital made a series of changes in perioperative patient management, including changing the surgical preparation solution and handwashing brushes from povidone-iodine to chlorhexidine, increasing the preoperative dose of cefazolin from 1 g to 2 g for patients not on dialysis, and intraoperative redosing of antibiotics in cases where the operative time was 4 hours or more. They also discontinued prophylactic antibiotics within 24 hours of surgery, used supplemental oxygen at an FiO₂ of 80% intraoperatively and immediately after surgery, and routinely used patient warming devices to maintain a core temperature of 37° C. The changes were phased in starting in August 2009, and were fully implemented by the beginning of 2010.

The new protocols reduced infections. Between January 2008 and December 2010, the O/E ratio for vascular SSIs fell from 1.97 to 0.93.

The NSQIP was important to the hospital’s success, said Dr. Katz. The real-time benchmarking reports provided by the program helped to initially identify the problem of high infection rates and later helped to track the success of the interventions, he said. Although the NSQIP doesn’t instruct hospitals on how to make quality improvements, the systems-based data it provides is especially helpful in developing a multidisciplinary approach to tackling the problems, Dr. Katz said.

The NSQIP database is quickly becoming the standard for measuring surgical quality, and the data from Huntington Memorial Hospital lends the program even more credibility, Dr. Richard Keen, chair of surgery at Cook County Hospital in Chicago, said in an interview. The experience at Huntington is "exactly how it’s supposed to work," Dr. Keen said. The NSQIP should help hospitals identify problems they otherwise might not have known about, and help them track whether their interventions have been effective, he said.

But despite recognition by the Joint Commission and others, the NSQIP still isn’t in use in a majority of hospitals around the country. The major stumbling block, Dr. Keen said, is the issue of return on investment. The annual fee for the program is between $10,000 and $24,000, depending on the hospital size, but the larger costs come with the full-time employee needed to work with the data.

But Dr. Keen said he expects to see an "explosion" in participation in the NSQIP in the next few years, driven in part by pressures from payers. The recent moves by Medicare to link payments to quality will make the NSQIP an important tool for hospitals to show that they are making progress in meeting quality goals, he said.

Nonprofit employers that do not provide contraception for religious reasons will get an extra year to comply with new government regulations requiring that health plans offer copayment–free coverage for a range of women’s preventive services, including birth control, emergency contraception, and sterilization.

These organizations, which include hospitals and universities with religious affiliations, will now have until Aug. 1, 2013, to comply with the federal rules. The additional year is meant to give these organizations time to deal with any logistical hurdles involved in adding contraceptive coverage, Health and Human Services Secretary Kathleen Sebelius announced Jan. 20. Other health plans must begin complying with the regulations by August 2012.

(c)Tina Sbrigato/iStockphoto.com

The rule also allows certain religious organizations, such as churches, to opt out of the requirements.

The new deadline is part of a final rule announced by the HHS. The department had released an interim final rule last summer setting out the list of preventive services that most new or renewed health plans must cover without out-of-pocket costs for patients.

The additional year for compliance was added based on an HHS review of more than 200,000 comments on the interim rule, covering a full range of opinions.

"I believe this proposal strikes the appropriate balance between respecting religious freedom and increasing access to important preventive services," Ms. Sebelius said in a statement.

The rule will not impact existing conscience laws and regulations, according to the HHS.

Under the Affordable Care Act, most new or renewed health plans must offer recommended preventive services without copayments, coinsurance, or deductibles, beginning Aug. 1. The list of recommended services includes well-woman visits, screening for gestational diabetes, DNA testing for the human papillomavirus in women aged 30 and older, counseling for sexually-transmitted infections, HIV screening and counseling, all contraception methods approved by the Food and Drug Administration, breastfeeding support and supplies, and screening and counseling for domestic violence.

The list of women’s preventive services was developed for the HHS by an expert panel of the Institute of Medicine. The IOM released its recommendations for coverage last July.

Nonprofit employers that do not provide contraception for religious reasons will get an extra year to comply with new government regulations requiring that health plans offer copayment–free coverage for a range of women’s preventive services, including birth control, emergency contraception, and sterilization.

These organizations, which include hospitals and universities with religious affiliations, will now have until Aug. 1, 2013, to comply with the federal rules. The additional year is meant to give these organizations time to deal with any logistical hurdles involved in adding contraceptive coverage, Health and Human Services Secretary Kathleen Sebelius announced Jan. 20. Other health plans must begin complying with the regulations by August 2012.

(c)Tina Sbrigato/iStockphoto.com

The rule also allows certain religious organizations, such as churches, to opt out of the requirements.

The new deadline is part of a final rule announced by the HHS. The department had released an interim final rule last summer setting out the list of preventive services that most new or renewed health plans must cover without out-of-pocket costs for patients.

The additional year for compliance was added based on an HHS review of more than 200,000 comments on the interim rule, covering a full range of opinions.

"I believe this proposal strikes the appropriate balance between respecting religious freedom and increasing access to important preventive services," Ms. Sebelius said in a statement.

The rule will not impact existing conscience laws and regulations, according to the HHS.

Under the Affordable Care Act, most new or renewed health plans must offer recommended preventive services without copayments, coinsurance, or deductibles, beginning Aug. 1. The list of recommended services includes well-woman visits, screening for gestational diabetes, DNA testing for the human papillomavirus in women aged 30 and older, counseling for sexually-transmitted infections, HIV screening and counseling, all contraception methods approved by the Food and Drug Administration, breastfeeding support and supplies, and screening and counseling for domestic violence.

The list of women’s preventive services was developed for the HHS by an expert panel of the Institute of Medicine. The IOM released its recommendations for coverage last July.

Nonprofit employers that do not provide contraception for religious reasons will get an extra year to comply with new government regulations requiring that health plans offer copayment–free coverage for a range of women’s preventive services, including birth control, emergency contraception, and sterilization.

These organizations, which include hospitals and universities with religious affiliations, will now have until Aug. 1, 2013, to comply with the federal rules. The additional year is meant to give these organizations time to deal with any logistical hurdles involved in adding contraceptive coverage, Health and Human Services Secretary Kathleen Sebelius announced Jan. 20. Other health plans must begin complying with the regulations by August 2012.

(c)Tina Sbrigato/iStockphoto.com

The rule also allows certain religious organizations, such as churches, to opt out of the requirements.

The new deadline is part of a final rule announced by the HHS. The department had released an interim final rule last summer setting out the list of preventive services that most new or renewed health plans must cover without out-of-pocket costs for patients.

The additional year for compliance was added based on an HHS review of more than 200,000 comments on the interim rule, covering a full range of opinions.

"I believe this proposal strikes the appropriate balance between respecting religious freedom and increasing access to important preventive services," Ms. Sebelius said in a statement.

The rule will not impact existing conscience laws and regulations, according to the HHS.

Under the Affordable Care Act, most new or renewed health plans must offer recommended preventive services without copayments, coinsurance, or deductibles, beginning Aug. 1. The list of recommended services includes well-woman visits, screening for gestational diabetes, DNA testing for the human papillomavirus in women aged 30 and older, counseling for sexually-transmitted infections, HIV screening and counseling, all contraception methods approved by the Food and Drug Administration, breastfeeding support and supplies, and screening and counseling for domestic violence.

The list of women’s preventive services was developed for the HHS by an expert panel of the Institute of Medicine. The IOM released its recommendations for coverage last July.

After nearly a decade of steady decreases in abortion, the global abortion rate has leveled off, according to new research from the World Health Organization and the Guttmacher Institute.

Between 2003 and 2008, the abortion rate worldwide was almost unchanged, going from 29 abortions per 1,000 women aged 15-44 years to 28 abortions per 1,000 women. The slight drop follows years of consistent decreases in the abortion rate that occurred from 1995 to 2003, when the abortion rate globally fell from 35 to 29 abortions per 1,000 women.

At the same time, the rate of unsafe abortions being performed around the world has increased. The percentage of unsafe abortions rose from 44% in 1995 to 49% in 2008, reported Gilda Sedgh, Sc.D., of the Guttmacher Institute, New York, and her associates. The definition of unsafe abortion used was "a procedure for termination of an unintended pregnancy done either by people lacking the necessary skills or in an environment that does not conform to minimum medical standards, or both," as established by WHO.

The research was based on an analysis of official statistics, published reports, hospital records, and surveys, and it was published on Jan. 19 in the Lancet (Lancet 2012 Jan. 19 [doi: 10.1016/S0140-6736(11)61786-8).

The leveling off of the abortion rate between 2003 and 2008 was probably due in part to unmet contraception needs in developing countries, according to the study authors. The stall in the abortion rate between 2003 and 2008 coincides with a plateau in contraceptive use that had previously been increasing, Dr. Sedgh said in a press conference on Jan. 18.

She emphasized that a greater investment in family planning services will be needed to break the stall in abortion rates and reduce unintended pregnancy rates.

Research does not support the enactment of more restrictive abortion laws, she said, noting that restrictive abortion laws were not associated with lower abortion rates. In fact, the opposite was true. In subregions that had more liberal laws governing abortion, the abortion rate was lower. For example, the abortion rate is 32 per 1,000 women in 2008 in Latin America, where abortion is illegal in most cases, compared with 12 per 1,000 in 2008 in Western Europe, where abortion is generally allowed.

The leveling off of the global abortion rate appears to be driven by a similar stall in abortion rates in developing countries. In 2003 and 2008, the abortion rate in the developing world was 29 abortions per 1,000 women in both years. For example, the rate was 29 in Africa in 2008, following a steady decline from 33 in 2003.

"A growing proportion of all abortions are taking place in developing countries, where they are generally illegal and unsafe," Dr. Sedgh said. "Thirteen percent of all maternal deaths are attributed to unsafe abortion, and virtually all of these deaths occur in the developing world."

In the developed world, excluding Eastern Europe, the abortion rate dropped somewhat – from 19 per 1,000 women in 2003 to 17 in 2008. In North America, that rate dropped from 21 in 2003 to 19 in 2008. The lowest subregional rate worldwide was in Western Europe at 12 abortions per 1,000 women in 2008. In contrast, Eastern Europe had the highest subregional rate at 43 abortions per 1,000 women the same year.

According to the report, the absolute number of abortions was an estimated 45.6 million in 1995, compared with an estimated 41.6 million in 2003 and 43.8 million abortions in 2008. Although these numbers may be related to population growth, the abortion rate per 1,000 women is not, the researchers said. "About 78% of all abortions took place in the developing world in 1995, and increased to 86% in 2008." The proportion of women of reproductive age who live in the developing world rose from 80% to 84% during the same time period. "Since 2003, the number of abortions fell by 0.6 million in the developed world, but increased by 2.8 million in developing countries," they said.

The study was funded by the United Kingdom Department for International Development, the Dutch Ministry of Foreign Affairs, and the John D. and Catherine T. MacArthur Foundation. The authors reported no conflicts of interest.

After nearly a decade of steady decreases in abortion, the global abortion rate has leveled off, according to new research from the World Health Organization and the Guttmacher Institute.

Between 2003 and 2008, the abortion rate worldwide was almost unchanged, going from 29 abortions per 1,000 women aged 15-44 years to 28 abortions per 1,000 women. The slight drop follows years of consistent decreases in the abortion rate that occurred from 1995 to 2003, when the abortion rate globally fell from 35 to 29 abortions per 1,000 women.

At the same time, the rate of unsafe abortions being performed around the world has increased. The percentage of unsafe abortions rose from 44% in 1995 to 49% in 2008, reported Gilda Sedgh, Sc.D., of the Guttmacher Institute, New York, and her associates. The definition of unsafe abortion used was "a procedure for termination of an unintended pregnancy done either by people lacking the necessary skills or in an environment that does not conform to minimum medical standards, or both," as established by WHO.

The research was based on an analysis of official statistics, published reports, hospital records, and surveys, and it was published on Jan. 19 in the Lancet (Lancet 2012 Jan. 19 [doi: 10.1016/S0140-6736(11)61786-8).

The leveling off of the abortion rate between 2003 and 2008 was probably due in part to unmet contraception needs in developing countries, according to the study authors. The stall in the abortion rate between 2003 and 2008 coincides with a plateau in contraceptive use that had previously been increasing, Dr. Sedgh said in a press conference on Jan. 18.

She emphasized that a greater investment in family planning services will be needed to break the stall in abortion rates and reduce unintended pregnancy rates.

Research does not support the enactment of more restrictive abortion laws, she said, noting that restrictive abortion laws were not associated with lower abortion rates. In fact, the opposite was true. In subregions that had more liberal laws governing abortion, the abortion rate was lower. For example, the abortion rate is 32 per 1,000 women in 2008 in Latin America, where abortion is illegal in most cases, compared with 12 per 1,000 in 2008 in Western Europe, where abortion is generally allowed.

The leveling off of the global abortion rate appears to be driven by a similar stall in abortion rates in developing countries. In 2003 and 2008, the abortion rate in the developing world was 29 abortions per 1,000 women in both years. For example, the rate was 29 in Africa in 2008, following a steady decline from 33 in 2003.

"A growing proportion of all abortions are taking place in developing countries, where they are generally illegal and unsafe," Dr. Sedgh said. "Thirteen percent of all maternal deaths are attributed to unsafe abortion, and virtually all of these deaths occur in the developing world."

In the developed world, excluding Eastern Europe, the abortion rate dropped somewhat – from 19 per 1,000 women in 2003 to 17 in 2008. In North America, that rate dropped from 21 in 2003 to 19 in 2008. The lowest subregional rate worldwide was in Western Europe at 12 abortions per 1,000 women in 2008. In contrast, Eastern Europe had the highest subregional rate at 43 abortions per 1,000 women the same year.

According to the report, the absolute number of abortions was an estimated 45.6 million in 1995, compared with an estimated 41.6 million in 2003 and 43.8 million abortions in 2008. Although these numbers may be related to population growth, the abortion rate per 1,000 women is not, the researchers said. "About 78% of all abortions took place in the developing world in 1995, and increased to 86% in 2008." The proportion of women of reproductive age who live in the developing world rose from 80% to 84% during the same time period. "Since 2003, the number of abortions fell by 0.6 million in the developed world, but increased by 2.8 million in developing countries," they said.

The study was funded by the United Kingdom Department for International Development, the Dutch Ministry of Foreign Affairs, and the John D. and Catherine T. MacArthur Foundation. The authors reported no conflicts of interest.

After nearly a decade of steady decreases in abortion, the global abortion rate has leveled off, according to new research from the World Health Organization and the Guttmacher Institute.

Between 2003 and 2008, the abortion rate worldwide was almost unchanged, going from 29 abortions per 1,000 women aged 15-44 years to 28 abortions per 1,000 women. The slight drop follows years of consistent decreases in the abortion rate that occurred from 1995 to 2003, when the abortion rate globally fell from 35 to 29 abortions per 1,000 women.

At the same time, the rate of unsafe abortions being performed around the world has increased. The percentage of unsafe abortions rose from 44% in 1995 to 49% in 2008, reported Gilda Sedgh, Sc.D., of the Guttmacher Institute, New York, and her associates. The definition of unsafe abortion used was "a procedure for termination of an unintended pregnancy done either by people lacking the necessary skills or in an environment that does not conform to minimum medical standards, or both," as established by WHO.

The research was based on an analysis of official statistics, published reports, hospital records, and surveys, and it was published on Jan. 19 in the Lancet (Lancet 2012 Jan. 19 [doi: 10.1016/S0140-6736(11)61786-8).

The leveling off of the abortion rate between 2003 and 2008 was probably due in part to unmet contraception needs in developing countries, according to the study authors. The stall in the abortion rate between 2003 and 2008 coincides with a plateau in contraceptive use that had previously been increasing, Dr. Sedgh said in a press conference on Jan. 18.

She emphasized that a greater investment in family planning services will be needed to break the stall in abortion rates and reduce unintended pregnancy rates.

Research does not support the enactment of more restrictive abortion laws, she said, noting that restrictive abortion laws were not associated with lower abortion rates. In fact, the opposite was true. In subregions that had more liberal laws governing abortion, the abortion rate was lower. For example, the abortion rate is 32 per 1,000 women in 2008 in Latin America, where abortion is illegal in most cases, compared with 12 per 1,000 in 2008 in Western Europe, where abortion is generally allowed.

The leveling off of the global abortion rate appears to be driven by a similar stall in abortion rates in developing countries. In 2003 and 2008, the abortion rate in the developing world was 29 abortions per 1,000 women in both years. For example, the rate was 29 in Africa in 2008, following a steady decline from 33 in 2003.

"A growing proportion of all abortions are taking place in developing countries, where they are generally illegal and unsafe," Dr. Sedgh said. "Thirteen percent of all maternal deaths are attributed to unsafe abortion, and virtually all of these deaths occur in the developing world."

In the developed world, excluding Eastern Europe, the abortion rate dropped somewhat – from 19 per 1,000 women in 2003 to 17 in 2008. In North America, that rate dropped from 21 in 2003 to 19 in 2008. The lowest subregional rate worldwide was in Western Europe at 12 abortions per 1,000 women in 2008. In contrast, Eastern Europe had the highest subregional rate at 43 abortions per 1,000 women the same year.

According to the report, the absolute number of abortions was an estimated 45.6 million in 1995, compared with an estimated 41.6 million in 2003 and 43.8 million abortions in 2008. Although these numbers may be related to population growth, the abortion rate per 1,000 women is not, the researchers said. "About 78% of all abortions took place in the developing world in 1995, and increased to 86% in 2008." The proportion of women of reproductive age who live in the developing world rose from 80% to 84% during the same time period. "Since 2003, the number of abortions fell by 0.6 million in the developed world, but increased by 2.8 million in developing countries," they said.

The study was funded by the United Kingdom Department for International Development, the Dutch Ministry of Foreign Affairs, and the John D. and Catherine T. MacArthur Foundation. The authors reported no conflicts of interest.

Medicare payments for the use of dual energy x-ray absorptiometry are set to drop on March 1 unless Congress acts to extend the current payment rates for the screening procedure.

Physicians performing dual energy x-ray absorptiometry (DXA) testing currently are reimbursed at around $100 per test on average, but those payments are scheduled to drop to about $50 without congressional intervention. Physicians also are concerned that the steep cut could force more office-based physicians to stop offering bone density screening, thereby limiting access for patients.

"We will definitely be changing the way that we do business when it comes to DXA," said Dr. Christopher R. Shuhart, a family physician and medical director for bone health and osteoporosis at Swedish Medical Group in Seattle.

The large multispecialty group is considering a range of options, including whether to limit the number of sites where they offer DXA testing, in part because of the potential Medicare fee cut. They had already been considering changes to their DXA practice for other reasons, Dr. Shuhart said, but the financial pressure that would come with a cut to $50 per test is a significant factor.

"DXA is both clinically valuable and cost effective."

Dr. Shuhart, who also is cochair for facility accreditation at the International Society for Clinical Densitometry (ISCD), said that Swedish Medical Group is in a better position to absorb the DXA cuts than most small private practices because they are part of a large health care system, which allows them to benefit from higher private insurance contract rates that help to offset cuts in Medicare payments.

Congress first cut DXA payments in 2007, when it slashed Medicare payments for imaging services as part of the Deficit Reduction Act of 2005. Although DXA wasn’t one of the high-cost imaging modalities lawmakers had in their crosshairs, it still was included in the law.

Physicians took another payment hit when the Centers for Medicare and Medicaid Services reduced payments for physician work involved in interpreting the results of a DXA test. The cuts were phased in over time, but by the beginning of 2010, the average Medicare payment for DXA had dropped from a high of about $140 to about $62.

Under the Affordable Care Act, DXA payments were restored to 70% of the 2006 level, bringing them back up to nearly $100. But that increase was only for 2 years. At the end of last year, the increase was scheduled to expire, when Congress granted a 2-month reprieve by including DXA in the Temporary Payroll Tax Cut Continuation Act of 2011, which also extended the 2011 Medicare physician fee schedule rates, the payroll tax holiday, and federal unemployment benefits temporarily.

What will happen next with DXA payment is uncertain and depends in large part on the fate of the larger legislative package currently under consideration in Congress.

"It looks like the [Medicare Sustainable Growth Rate formula], DXA, and payroll taxes are wrapped up together for at least the immediate future," said Dr. Jonathan D. Leffert, an endocrinologist in Dallas and chair of the Legislative and Regulatory Committee for the American Association of Clinical Endocrinologists.

Dr. Leffert said that a permanent stabilization of DXA payment rates is not likely right now and that an extension of the current payment rates could range anywhere from 2 months to 22 months. "At this point, it’s pretty much not about the policy, but about the money," he said. Specifically, lawmakers are struggling to find ways to pay for not only the increased DXA payments to physicians but a temporary fix for the 27% Medicare physician fee cut that is also slated to take effect on March 1.

But just getting lawmakers to include DXA in the Temporary Payroll Tax Cut Continuation Act was a big step, said Dr. Andrew J. Laster, a rheumatologist in private practice in Charlotte, N.C., and chair of the public policy committee for the ISCD. There were only about a dozen health provisions that made it into that bill, so it shows that Congress recognizes the value of identifying people with osteoporosis and treating them. "Now at least we are in the room and acknowledged," he said.

"We will definitely be changing the way that we do business when it comes to DXA."

Dr. Laster added that he’s also encouraged by a recent study published in the journal Health Affairs that helps bolster the case for increasing payments for bone density testing (Health Aff. 2011;30:2362-70). Looking at a large population of Medicare beneficiaries, researchers found that as payments for DXA dropped, Medicare claims for the test plateaued. For instance, from 1996 through 2006, before the payment cuts went into effect, DXA testing was growing at a rate of about 6.5%. From 2007 through 2009, however, about 800,000 fewer tests were administered to Medicare beneficiaries than would have been expected based on the earlier growth rate.

The study also showed that DXA testing was linked to fewer fractures. The researchers found that, over a 3-year period, fracture rates were nearly 20% lower in elderly women who had received a DXA test, compared with those who did not.

Alison King, Ph.D., one of the coauthors of the study and a health care consultant, said the results make a strong case for averting the scheduled payment cut for DXA both to improve public health and to save money in the long term. "There are many valuable medical interventions that do not save money," she said. "DXA is both clinically valuable and cost effective."

Dr. Charles King, a rheumatologist in Tupelo, Miss., and chair of the American College of Rheumatology’s Committee on Rheumatologic Care, said that he thinks lawmakers are starting to hear the message about the cost effectiveness of DXA. "We are getting the word out," he said. The problem, he noted, is that Congress has been reticent to provide legislative carve-outs for certain diseases or treatments.

Dr. King advised physicians that if they want to continue to offer DXA they need to view it as a loss leader, but he urged rheumatologists to keep performing it. Rheumatologists must continue to read and interpret these studies because they inadvertently contribute to the development of osteoporosis through the use of corticosteroids and other treatments for rheumatic conditions. "We have to retain ownership of this disease," he said.

Medicare payments for the use of dual energy x-ray absorptiometry are set to drop on March 1 unless Congress acts to extend the current payment rates for the screening procedure.

Physicians performing dual energy x-ray absorptiometry (DXA) testing currently are reimbursed at around $100 per test on average, but those payments are scheduled to drop to about $50 without congressional intervention. Physicians also are concerned that the steep cut could force more office-based physicians to stop offering bone density screening, thereby limiting access for patients.

"We will definitely be changing the way that we do business when it comes to DXA," said Dr. Christopher R. Shuhart, a family physician and medical director for bone health and osteoporosis at Swedish Medical Group in Seattle.

The large multispecialty group is considering a range of options, including whether to limit the number of sites where they offer DXA testing, in part because of the potential Medicare fee cut. They had already been considering changes to their DXA practice for other reasons, Dr. Shuhart said, but the financial pressure that would come with a cut to $50 per test is a significant factor.

"DXA is both clinically valuable and cost effective."

Dr. Shuhart, who also is cochair for facility accreditation at the International Society for Clinical Densitometry (ISCD), said that Swedish Medical Group is in a better position to absorb the DXA cuts than most small private practices because they are part of a large health care system, which allows them to benefit from higher private insurance contract rates that help to offset cuts in Medicare payments.

Congress first cut DXA payments in 2007, when it slashed Medicare payments for imaging services as part of the Deficit Reduction Act of 2005. Although DXA wasn’t one of the high-cost imaging modalities lawmakers had in their crosshairs, it still was included in the law.

Physicians took another payment hit when the Centers for Medicare and Medicaid Services reduced payments for physician work involved in interpreting the results of a DXA test. The cuts were phased in over time, but by the beginning of 2010, the average Medicare payment for DXA had dropped from a high of about $140 to about $62.

Under the Affordable Care Act, DXA payments were restored to 70% of the 2006 level, bringing them back up to nearly $100. But that increase was only for 2 years. At the end of last year, the increase was scheduled to expire, when Congress granted a 2-month reprieve by including DXA in the Temporary Payroll Tax Cut Continuation Act of 2011, which also extended the 2011 Medicare physician fee schedule rates, the payroll tax holiday, and federal unemployment benefits temporarily.

What will happen next with DXA payment is uncertain and depends in large part on the fate of the larger legislative package currently under consideration in Congress.

"It looks like the [Medicare Sustainable Growth Rate formula], DXA, and payroll taxes are wrapped up together for at least the immediate future," said Dr. Jonathan D. Leffert, an endocrinologist in Dallas and chair of the Legislative and Regulatory Committee for the American Association of Clinical Endocrinologists.

Dr. Leffert said that a permanent stabilization of DXA payment rates is not likely right now and that an extension of the current payment rates could range anywhere from 2 months to 22 months. "At this point, it’s pretty much not about the policy, but about the money," he said. Specifically, lawmakers are struggling to find ways to pay for not only the increased DXA payments to physicians but a temporary fix for the 27% Medicare physician fee cut that is also slated to take effect on March 1.

But just getting lawmakers to include DXA in the Temporary Payroll Tax Cut Continuation Act was a big step, said Dr. Andrew J. Laster, a rheumatologist in private practice in Charlotte, N.C., and chair of the public policy committee for the ISCD. There were only about a dozen health provisions that made it into that bill, so it shows that Congress recognizes the value of identifying people with osteoporosis and treating them. "Now at least we are in the room and acknowledged," he said.

"We will definitely be changing the way that we do business when it comes to DXA."

Dr. Laster added that he’s also encouraged by a recent study published in the journal Health Affairs that helps bolster the case for increasing payments for bone density testing (Health Aff. 2011;30:2362-70). Looking at a large population of Medicare beneficiaries, researchers found that as payments for DXA dropped, Medicare claims for the test plateaued. For instance, from 1996 through 2006, before the payment cuts went into effect, DXA testing was growing at a rate of about 6.5%. From 2007 through 2009, however, about 800,000 fewer tests were administered to Medicare beneficiaries than would have been expected based on the earlier growth rate.

The study also showed that DXA testing was linked to fewer fractures. The researchers found that, over a 3-year period, fracture rates were nearly 20% lower in elderly women who had received a DXA test, compared with those who did not.

Alison King, Ph.D., one of the coauthors of the study and a health care consultant, said the results make a strong case for averting the scheduled payment cut for DXA both to improve public health and to save money in the long term. "There are many valuable medical interventions that do not save money," she said. "DXA is both clinically valuable and cost effective."

Dr. Charles King, a rheumatologist in Tupelo, Miss., and chair of the American College of Rheumatology’s Committee on Rheumatologic Care, said that he thinks lawmakers are starting to hear the message about the cost effectiveness of DXA. "We are getting the word out," he said. The problem, he noted, is that Congress has been reticent to provide legislative carve-outs for certain diseases or treatments.

Dr. King advised physicians that if they want to continue to offer DXA they need to view it as a loss leader, but he urged rheumatologists to keep performing it. Rheumatologists must continue to read and interpret these studies because they inadvertently contribute to the development of osteoporosis through the use of corticosteroids and other treatments for rheumatic conditions. "We have to retain ownership of this disease," he said.

Medicare payments for the use of dual energy x-ray absorptiometry are set to drop on March 1 unless Congress acts to extend the current payment rates for the screening procedure.

Physicians performing dual energy x-ray absorptiometry (DXA) testing currently are reimbursed at around $100 per test on average, but those payments are scheduled to drop to about $50 without congressional intervention. Physicians also are concerned that the steep cut could force more office-based physicians to stop offering bone density screening, thereby limiting access for patients.

"We will definitely be changing the way that we do business when it comes to DXA," said Dr. Christopher R. Shuhart, a family physician and medical director for bone health and osteoporosis at Swedish Medical Group in Seattle.

The large multispecialty group is considering a range of options, including whether to limit the number of sites where they offer DXA testing, in part because of the potential Medicare fee cut. They had already been considering changes to their DXA practice for other reasons, Dr. Shuhart said, but the financial pressure that would come with a cut to $50 per test is a significant factor.

"DXA is both clinically valuable and cost effective."

Dr. Shuhart, who also is cochair for facility accreditation at the International Society for Clinical Densitometry (ISCD), said that Swedish Medical Group is in a better position to absorb the DXA cuts than most small private practices because they are part of a large health care system, which allows them to benefit from higher private insurance contract rates that help to offset cuts in Medicare payments.

Congress first cut DXA payments in 2007, when it slashed Medicare payments for imaging services as part of the Deficit Reduction Act of 2005. Although DXA wasn’t one of the high-cost imaging modalities lawmakers had in their crosshairs, it still was included in the law.

Physicians took another payment hit when the Centers for Medicare and Medicaid Services reduced payments for physician work involved in interpreting the results of a DXA test. The cuts were phased in over time, but by the beginning of 2010, the average Medicare payment for DXA had dropped from a high of about $140 to about $62.

Under the Affordable Care Act, DXA payments were restored to 70% of the 2006 level, bringing them back up to nearly $100. But that increase was only for 2 years. At the end of last year, the increase was scheduled to expire, when Congress granted a 2-month reprieve by including DXA in the Temporary Payroll Tax Cut Continuation Act of 2011, which also extended the 2011 Medicare physician fee schedule rates, the payroll tax holiday, and federal unemployment benefits temporarily.

What will happen next with DXA payment is uncertain and depends in large part on the fate of the larger legislative package currently under consideration in Congress.

"It looks like the [Medicare Sustainable Growth Rate formula], DXA, and payroll taxes are wrapped up together for at least the immediate future," said Dr. Jonathan D. Leffert, an endocrinologist in Dallas and chair of the Legislative and Regulatory Committee for the American Association of Clinical Endocrinologists.

Dr. Leffert said that a permanent stabilization of DXA payment rates is not likely right now and that an extension of the current payment rates could range anywhere from 2 months to 22 months. "At this point, it’s pretty much not about the policy, but about the money," he said. Specifically, lawmakers are struggling to find ways to pay for not only the increased DXA payments to physicians but a temporary fix for the 27% Medicare physician fee cut that is also slated to take effect on March 1.

But just getting lawmakers to include DXA in the Temporary Payroll Tax Cut Continuation Act was a big step, said Dr. Andrew J. Laster, a rheumatologist in private practice in Charlotte, N.C., and chair of the public policy committee for the ISCD. There were only about a dozen health provisions that made it into that bill, so it shows that Congress recognizes the value of identifying people with osteoporosis and treating them. "Now at least we are in the room and acknowledged," he said.

"We will definitely be changing the way that we do business when it comes to DXA."

Dr. Laster added that he’s also encouraged by a recent study published in the journal Health Affairs that helps bolster the case for increasing payments for bone density testing (Health Aff. 2011;30:2362-70). Looking at a large population of Medicare beneficiaries, researchers found that as payments for DXA dropped, Medicare claims for the test plateaued. For instance, from 1996 through 2006, before the payment cuts went into effect, DXA testing was growing at a rate of about 6.5%. From 2007 through 2009, however, about 800,000 fewer tests were administered to Medicare beneficiaries than would have been expected based on the earlier growth rate.

The study also showed that DXA testing was linked to fewer fractures. The researchers found that, over a 3-year period, fracture rates were nearly 20% lower in elderly women who had received a DXA test, compared with those who did not.

Alison King, Ph.D., one of the coauthors of the study and a health care consultant, said the results make a strong case for averting the scheduled payment cut for DXA both to improve public health and to save money in the long term. "There are many valuable medical interventions that do not save money," she said. "DXA is both clinically valuable and cost effective."

Dr. Charles King, a rheumatologist in Tupelo, Miss., and chair of the American College of Rheumatology’s Committee on Rheumatologic Care, said that he thinks lawmakers are starting to hear the message about the cost effectiveness of DXA. "We are getting the word out," he said. The problem, he noted, is that Congress has been reticent to provide legislative carve-outs for certain diseases or treatments.

Dr. King advised physicians that if they want to continue to offer DXA they need to view it as a loss leader, but he urged rheumatologists to keep performing it. Rheumatologists must continue to read and interpret these studies because they inadvertently contribute to the development of osteoporosis through the use of corticosteroids and other treatments for rheumatic conditions. "We have to retain ownership of this disease," he said.

Medicare officials are expanding the list of quality measures that hospitals will be judged on as part of a new pay-for-performance program created under the Affordable Care Act.

In a final rule released Nov. 1, detailing Medicare payment rates for hospital outpatient departments, officials at the Centers for Medicare and Medicaid Services announced that they are adding a new clinical process of care measure related to urinary catheters to the Hospital Inpatient Value-Based Purchasing (VBP) Program. The new measure, which will go into effect in October 2013 for fiscal year 2014, will assess whether a urinary catheter inserted during surgery is removed on the first or second postsurgical day. Hospitals will begin reporting data to the CMS on the new measure in 2012.

The new measure will be added to 12 clinical process measures and 1 patient experience measure that were adopted for the first year of the program. The CMS also finalized plans to include three outcome measures related to 30-day mortality for acute myocardial infarction, heart failure, and pneumonia in the program for fiscal year 2014.

At the same time, the CMS is delaying plans to include other measures. The agency had planned to include eight measures on hospital-acquired conditions, two composite measures from the Agency for Healthcare Research and Quality, and a Medicare Spending per Beneficiary measure in the Hospital VBP program in fiscal year 2014. But after receiving public comments noting that performance data had not been publicly available long enough for hospitals to prepare to incorporate the measures, Medicare officials relented.

According to the final rule, the CMS will post hospital performance data on the measures to Medicare’s Hospital Compare website for at least 1 year before requiring hospitals to report data on them.

Under the Hospital VBP program, the CMS will begin making incentive payments to hospitals based on quality on Oct. 1, 2012. The payments are funded by reducing Medicare payments to hospitals by 1% during fiscal year 2013 and 1.25% in fiscal year 2014.

Hospital payments under the program will be based on performance on clinical process-of-care measures, patient satisfaction, and clinical outcomes. In fiscal year 2014, process-of-care measures will be weighted at 45% of the score, patient satisfaction at 30%, and outcomes at 25%. During the first year of the program, process-of-care measures will weighted at 70% and patient satisfaction measures at 30%.

Medicare officials are also moving ahead with plans to require ambulatory surgical centers (ASCs) to report on quality measures next year.

In the final rule, the CMS adopted four clinical outcome measures and one surgical infection control measure that ASCs must report on beginning in October 2012. The final list includes measures related to patient burns; patient falls; wrong site, wrong side, wrong patient, wrong procedure, and wrong implant surgery; rate of ASC admissions requiring a hospital transfer/admission upon discharge; and prophylactic intravenous antibiotic timing. The data reported will be used to determine payments for 2014, according to the final rule.

In 2013, ASCs will also have to report on their use of the safe surgery checklist and report data on their facility volume on selected procedures. That information will be used in setting payments for 2015. Additionally, hospitals will be required to report on influenza vaccination coverage among health care workers starting in 2014, which will affect their 2016 payments.

The more than 1,500-page final rule also outlines the 2012 payments to hospitals and ASCs for outpatient services. The CMS estimates that in 2012, it will spend about $41.1 billion to pay the more than 4,000 general acute care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, long-term acute care hospitals, children’s hospitals, and cancer hospitals under Medicare’s Outpatient Prospective Payment System. And the agency will pay another $3.5 billion to about 5,000 ASCs next year.

The final rule increased payments to hospital outpatient departments by 1.9% in 2012. Under the rule, payments to cancer hospitals will go up by 11.3% due to adjustments required under the Affordable Care Act. ACSs will also see their payments increase by 1.6% in 2012. ☐

Medicare officials are expanding the list of quality measures that hospitals will be judged on as part of a new pay-for-performance program created under the Affordable Care Act.

In a final rule released Nov. 1, detailing Medicare payment rates for hospital outpatient departments, officials at the Centers for Medicare and Medicaid Services announced that they are adding a new clinical process of care measure related to urinary catheters to the Hospital Inpatient Value-Based Purchasing (VBP) Program. The new measure, which will go into effect in October 2013 for fiscal year 2014, will assess whether a urinary catheter inserted during surgery is removed on the first or second postsurgical day. Hospitals will begin reporting data to the CMS on the new measure in 2012.

The new measure will be added to 12 clinical process measures and 1 patient experience measure that were adopted for the first year of the program. The CMS also finalized plans to include three outcome measures related to 30-day mortality for acute myocardial infarction, heart failure, and pneumonia in the program for fiscal year 2014.

At the same time, the CMS is delaying plans to include other measures. The agency had planned to include eight measures on hospital-acquired conditions, two composite measures from the Agency for Healthcare Research and Quality, and a Medicare Spending per Beneficiary measure in the Hospital VBP program in fiscal year 2014. But after receiving public comments noting that performance data had not been publicly available long enough for hospitals to prepare to incorporate the measures, Medicare officials relented.

According to the final rule, the CMS will post hospital performance data on the measures to Medicare’s Hospital Compare website for at least 1 year before requiring hospitals to report data on them.

Under the Hospital VBP program, the CMS will begin making incentive payments to hospitals based on quality on Oct. 1, 2012. The payments are funded by reducing Medicare payments to hospitals by 1% during fiscal year 2013 and 1.25% in fiscal year 2014.

Hospital payments under the program will be based on performance on clinical process-of-care measures, patient satisfaction, and clinical outcomes. In fiscal year 2014, process-of-care measures will be weighted at 45% of the score, patient satisfaction at 30%, and outcomes at 25%. During the first year of the program, process-of-care measures will weighted at 70% and patient satisfaction measures at 30%.

Medicare officials are also moving ahead with plans to require ambulatory surgical centers (ASCs) to report on quality measures next year.

In the final rule, the CMS adopted four clinical outcome measures and one surgical infection control measure that ASCs must report on beginning in October 2012. The final list includes measures related to patient burns; patient falls; wrong site, wrong side, wrong patient, wrong procedure, and wrong implant surgery; rate of ASC admissions requiring a hospital transfer/admission upon discharge; and prophylactic intravenous antibiotic timing. The data reported will be used to determine payments for 2014, according to the final rule.

In 2013, ASCs will also have to report on their use of the safe surgery checklist and report data on their facility volume on selected procedures. That information will be used in setting payments for 2015. Additionally, hospitals will be required to report on influenza vaccination coverage among health care workers starting in 2014, which will affect their 2016 payments.

The more than 1,500-page final rule also outlines the 2012 payments to hospitals and ASCs for outpatient services. The CMS estimates that in 2012, it will spend about $41.1 billion to pay the more than 4,000 general acute care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, long-term acute care hospitals, children’s hospitals, and cancer hospitals under Medicare’s Outpatient Prospective Payment System. And the agency will pay another $3.5 billion to about 5,000 ASCs next year.

The final rule increased payments to hospital outpatient departments by 1.9% in 2012. Under the rule, payments to cancer hospitals will go up by 11.3% due to adjustments required under the Affordable Care Act. ACSs will also see their payments increase by 1.6% in 2012. ☐

Medicare officials are expanding the list of quality measures that hospitals will be judged on as part of a new pay-for-performance program created under the Affordable Care Act.

In a final rule released Nov. 1, detailing Medicare payment rates for hospital outpatient departments, officials at the Centers for Medicare and Medicaid Services announced that they are adding a new clinical process of care measure related to urinary catheters to the Hospital Inpatient Value-Based Purchasing (VBP) Program. The new measure, which will go into effect in October 2013 for fiscal year 2014, will assess whether a urinary catheter inserted during surgery is removed on the first or second postsurgical day. Hospitals will begin reporting data to the CMS on the new measure in 2012.

The new measure will be added to 12 clinical process measures and 1 patient experience measure that were adopted for the first year of the program. The CMS also finalized plans to include three outcome measures related to 30-day mortality for acute myocardial infarction, heart failure, and pneumonia in the program for fiscal year 2014.

At the same time, the CMS is delaying plans to include other measures. The agency had planned to include eight measures on hospital-acquired conditions, two composite measures from the Agency for Healthcare Research and Quality, and a Medicare Spending per Beneficiary measure in the Hospital VBP program in fiscal year 2014. But after receiving public comments noting that performance data had not been publicly available long enough for hospitals to prepare to incorporate the measures, Medicare officials relented.

According to the final rule, the CMS will post hospital performance data on the measures to Medicare’s Hospital Compare website for at least 1 year before requiring hospitals to report data on them.

Under the Hospital VBP program, the CMS will begin making incentive payments to hospitals based on quality on Oct. 1, 2012. The payments are funded by reducing Medicare payments to hospitals by 1% during fiscal year 2013 and 1.25% in fiscal year 2014.

Hospital payments under the program will be based on performance on clinical process-of-care measures, patient satisfaction, and clinical outcomes. In fiscal year 2014, process-of-care measures will be weighted at 45% of the score, patient satisfaction at 30%, and outcomes at 25%. During the first year of the program, process-of-care measures will weighted at 70% and patient satisfaction measures at 30%.

Medicare officials are also moving ahead with plans to require ambulatory surgical centers (ASCs) to report on quality measures next year.

In the final rule, the CMS adopted four clinical outcome measures and one surgical infection control measure that ASCs must report on beginning in October 2012. The final list includes measures related to patient burns; patient falls; wrong site, wrong side, wrong patient, wrong procedure, and wrong implant surgery; rate of ASC admissions requiring a hospital transfer/admission upon discharge; and prophylactic intravenous antibiotic timing. The data reported will be used to determine payments for 2014, according to the final rule.

In 2013, ASCs will also have to report on their use of the safe surgery checklist and report data on their facility volume on selected procedures. That information will be used in setting payments for 2015. Additionally, hospitals will be required to report on influenza vaccination coverage among health care workers starting in 2014, which will affect their 2016 payments.

The more than 1,500-page final rule also outlines the 2012 payments to hospitals and ASCs for outpatient services. The CMS estimates that in 2012, it will spend about $41.1 billion to pay the more than 4,000 general acute care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, long-term acute care hospitals, children’s hospitals, and cancer hospitals under Medicare’s Outpatient Prospective Payment System. And the agency will pay another $3.5 billion to about 5,000 ASCs next year.

The final rule increased payments to hospital outpatient departments by 1.9% in 2012. Under the rule, payments to cancer hospitals will go up by 11.3% due to adjustments required under the Affordable Care Act. ACSs will also see their payments increase by 1.6% in 2012. ☐

Dr. Vivek Murthy, a hospitalist at Brigham and Women’s Hospital in Boston, is a passionate advocate for reforming the health care system. When he’s not seeing patients, teaching, or conducting research, he’s encouraging his colleagues to lobby state and federal lawmakers on health care issues ranging from the need for more loan repayment programs for physicians to the importance of federal funding for preventive health services.

In 2008, he helped start "Doctors for Obama," a group of about 10,000 physicians and medical students who supported then presidential candidate Barack Obama and his health reform platform. A year later, the group was reborn as "Doctors for America," a nonprofit organization that now boasts more than 15,000 members. It has no official ties to President Obama’s reelection campaign or to any political party. During 2009-2010, Doctors for America mobilized physicians to ensure their ideas helped to shape the content of the Affordable Care Act. The group is now launching a campaign to train physicians around the country to educate the public about the impact of the health reform law.

Courtesy White House

In addition to his role as president of Doctors for America, Dr. Murthy serves on the President's Advisory Group on Prevention, Health Promotion, and Integrative and Public Health, a group that provides policy recommendations on chronic disease prevention and management, health promotion, and integrative health care practices. In an interview with Hospitalist News, Dr. Murthy explained why physicians need to be politically active, and how his political activism has changed his interactions with patients.

Hospitalist News: Why did you decide to start Doctors for America?

Dr. Murthy: I decided to start Doctors for America during the 2008 presidential election, when health care was a priority issue. Like many others, I recognized that familiar players, such as insurers and pharma companies, would play a role in sharing the health reform platforms of the candidates and ultimately a health reform bill. However, I was struck by how few physicians were organizing and gathering their ideas to actually make an impact on the candidates’ platforms and, ultimately, on a health reform bill. A few colleagues and I began Doctors for America with a simple belief that physicians should play a leadership role in designing and running our nation’s health care system. That started with enabling physicians to shape and inform what would become the next major health reform law.

HN: Why is it important to you to be politically active?

Dr. Murthy: I haven’t really been politically active for most of my life. I didn’t even follow policy very much. But what became apparent to me a few years ago was that the only way we physicians were going to create a health care system that functioned well for patients and for doctors was if we got involved in helping to build it. It’s not that as physicians we know all the answers; we don’t. But what’s important is that we do have a unique view of the health care system. As individual physicians and also as leaders in our community, we can play a role in helping to give more voice to the perspective of physicians and patients. If these perspectives are missing as our health care system is being redesigned, then we’re not going to have a system that ultimately works.

HN: How does your activism impact or inform your interactions with patients?

Dr. Murthy: My interactions with patients are my greatest source of learning because they help illuminate to me not just what the problems are, but also whether solutions really make sense and are going to work for regular people. I think there are a lot of solutions that sound really good on paper but when it comes down to it, the question is, are they really going to work for patients? Are they going to fit into their day-to-day lives? So having a chance to continue working with patients has been very helpful to me in sparking new ideas and seeing what patients think about proposed solutions.

HN: Do you think more hospitalists should get involved in political activism?

Dr. Murthy: One thing I’ve realized is that most doctors don’t understand just how powerful their voice really is. They don’t realize how much power they have just by virtue of their own experiences and the kind of work they do in society. For example, I was speaking to a congressman’s staffer one day, and he told me that his office gets calls all the time from constituents, but if they get a call from just one doctor, that’s something notable. If 10 doctors call in, that means something major has happened.

The other thing I’ve been struck by is that most people working on Capitol Hill aren’t used to receiving visits from physicians. When Doctors for America has organized efforts to get physicians to come to Washington, D.C., to meet with legislators, members of Congress are often quite surprised. There’s both an incredible opportunity to make an impact, but there’s also an incredible need because we’re at an unfortunate place where there’s a real stalemate in Congress.

The question is, who is going to push both the public and legislators to move in the right direction to fix our health care system? I think that doctors, and hospitalists in particular, are uniquely positioned to be able to do that. The hospitalist movement has been blessed with incredibly bright people who are tackling a broad array of systems problems, including discharge planning, medication safety, and coordination of care. I think the country needs to hear from them.

Take us to your leader. Nominate a hospitalist whose work inspires you. E-mail suggestions to m.schneider@elsevier.com. Read previous columns at ehospitalistnews.com. This column, "Leaders," appears regularly in Hospitalist News, a publication of Elsevier.

Dr. Vivek Murthy, a hospitalist at Brigham and Women’s Hospital in Boston, is a passionate advocate for reforming the health care system. When he’s not seeing patients, teaching, or conducting research, he’s encouraging his colleagues to lobby state and federal lawmakers on health care issues ranging from the need for more loan repayment programs for physicians to the importance of federal funding for preventive health services.

In 2008, he helped start "Doctors for Obama," a group of about 10,000 physicians and medical students who supported then presidential candidate Barack Obama and his health reform platform. A year later, the group was reborn as "Doctors for America," a nonprofit organization that now boasts more than 15,000 members. It has no official ties to President Obama’s reelection campaign or to any political party. During 2009-2010, Doctors for America mobilized physicians to ensure their ideas helped to shape the content of the Affordable Care Act. The group is now launching a campaign to train physicians around the country to educate the public about the impact of the health reform law.

Courtesy White House

In addition to his role as president of Doctors for America, Dr. Murthy serves on the President's Advisory Group on Prevention, Health Promotion, and Integrative and Public Health, a group that provides policy recommendations on chronic disease prevention and management, health promotion, and integrative health care practices. In an interview with Hospitalist News, Dr. Murthy explained why physicians need to be politically active, and how his political activism has changed his interactions with patients.

Hospitalist News: Why did you decide to start Doctors for America?

Dr. Murthy: I decided to start Doctors for America during the 2008 presidential election, when health care was a priority issue. Like many others, I recognized that familiar players, such as insurers and pharma companies, would play a role in sharing the health reform platforms of the candidates and ultimately a health reform bill. However, I was struck by how few physicians were organizing and gathering their ideas to actually make an impact on the candidates’ platforms and, ultimately, on a health reform bill. A few colleagues and I began Doctors for America with a simple belief that physicians should play a leadership role in designing and running our nation’s health care system. That started with enabling physicians to shape and inform what would become the next major health reform law.

HN: Why is it important to you to be politically active?

Dr. Murthy: I haven’t really been politically active for most of my life. I didn’t even follow policy very much. But what became apparent to me a few years ago was that the only way we physicians were going to create a health care system that functioned well for patients and for doctors was if we got involved in helping to build it. It’s not that as physicians we know all the answers; we don’t. But what’s important is that we do have a unique view of the health care system. As individual physicians and also as leaders in our community, we can play a role in helping to give more voice to the perspective of physicians and patients. If these perspectives are missing as our health care system is being redesigned, then we’re not going to have a system that ultimately works.

HN: How does your activism impact or inform your interactions with patients?

Dr. Murthy: My interactions with patients are my greatest source of learning because they help illuminate to me not just what the problems are, but also whether solutions really make sense and are going to work for regular people. I think there are a lot of solutions that sound really good on paper but when it comes down to it, the question is, are they really going to work for patients? Are they going to fit into their day-to-day lives? So having a chance to continue working with patients has been very helpful to me in sparking new ideas and seeing what patients think about proposed solutions.

HN: Do you think more hospitalists should get involved in political activism?

Dr. Murthy: One thing I’ve realized is that most doctors don’t understand just how powerful their voice really is. They don’t realize how much power they have just by virtue of their own experiences and the kind of work they do in society. For example, I was speaking to a congressman’s staffer one day, and he told me that his office gets calls all the time from constituents, but if they get a call from just one doctor, that’s something notable. If 10 doctors call in, that means something major has happened.

The other thing I’ve been struck by is that most people working on Capitol Hill aren’t used to receiving visits from physicians. When Doctors for America has organized efforts to get physicians to come to Washington, D.C., to meet with legislators, members of Congress are often quite surprised. There’s both an incredible opportunity to make an impact, but there’s also an incredible need because we’re at an unfortunate place where there’s a real stalemate in Congress.

The question is, who is going to push both the public and legislators to move in the right direction to fix our health care system? I think that doctors, and hospitalists in particular, are uniquely positioned to be able to do that. The hospitalist movement has been blessed with incredibly bright people who are tackling a broad array of systems problems, including discharge planning, medication safety, and coordination of care. I think the country needs to hear from them.

Take us to your leader. Nominate a hospitalist whose work inspires you. E-mail suggestions to m.schneider@elsevier.com. Read previous columns at ehospitalistnews.com. This column, "Leaders," appears regularly in Hospitalist News, a publication of Elsevier.

Dr. Vivek Murthy, a hospitalist at Brigham and Women’s Hospital in Boston, is a passionate advocate for reforming the health care system. When he’s not seeing patients, teaching, or conducting research, he’s encouraging his colleagues to lobby state and federal lawmakers on health care issues ranging from the need for more loan repayment programs for physicians to the importance of federal funding for preventive health services.

In 2008, he helped start "Doctors for Obama," a group of about 10,000 physicians and medical students who supported then presidential candidate Barack Obama and his health reform platform. A year later, the group was reborn as "Doctors for America," a nonprofit organization that now boasts more than 15,000 members. It has no official ties to President Obama’s reelection campaign or to any political party. During 2009-2010, Doctors for America mobilized physicians to ensure their ideas helped to shape the content of the Affordable Care Act. The group is now launching a campaign to train physicians around the country to educate the public about the impact of the health reform law.

Courtesy White House

In addition to his role as president of Doctors for America, Dr. Murthy serves on the President's Advisory Group on Prevention, Health Promotion, and Integrative and Public Health, a group that provides policy recommendations on chronic disease prevention and management, health promotion, and integrative health care practices. In an interview with Hospitalist News, Dr. Murthy explained why physicians need to be politically active, and how his political activism has changed his interactions with patients.

Hospitalist News: Why did you decide to start Doctors for America?

Dr. Murthy: I decided to start Doctors for America during the 2008 presidential election, when health care was a priority issue. Like many others, I recognized that familiar players, such as insurers and pharma companies, would play a role in sharing the health reform platforms of the candidates and ultimately a health reform bill. However, I was struck by how few physicians were organizing and gathering their ideas to actually make an impact on the candidates’ platforms and, ultimately, on a health reform bill. A few colleagues and I began Doctors for America with a simple belief that physicians should play a leadership role in designing and running our nation’s health care system. That started with enabling physicians to shape and inform what would become the next major health reform law.

HN: Why is it important to you to be politically active?

Dr. Murthy: I haven’t really been politically active for most of my life. I didn’t even follow policy very much. But what became apparent to me a few years ago was that the only way we physicians were going to create a health care system that functioned well for patients and for doctors was if we got involved in helping to build it. It’s not that as physicians we know all the answers; we don’t. But what’s important is that we do have a unique view of the health care system. As individual physicians and also as leaders in our community, we can play a role in helping to give more voice to the perspective of physicians and patients. If these perspectives are missing as our health care system is being redesigned, then we’re not going to have a system that ultimately works.

HN: How does your activism impact or inform your interactions with patients?

Dr. Murthy: My interactions with patients are my greatest source of learning because they help illuminate to me not just what the problems are, but also whether solutions really make sense and are going to work for regular people. I think there are a lot of solutions that sound really good on paper but when it comes down to it, the question is, are they really going to work for patients? Are they going to fit into their day-to-day lives? So having a chance to continue working with patients has been very helpful to me in sparking new ideas and seeing what patients think about proposed solutions.

HN: Do you think more hospitalists should get involved in political activism?

Dr. Murthy: One thing I’ve realized is that most doctors don’t understand just how powerful their voice really is. They don’t realize how much power they have just by virtue of their own experiences and the kind of work they do in society. For example, I was speaking to a congressman’s staffer one day, and he told me that his office gets calls all the time from constituents, but if they get a call from just one doctor, that’s something notable. If 10 doctors call in, that means something major has happened.

The other thing I’ve been struck by is that most people working on Capitol Hill aren’t used to receiving visits from physicians. When Doctors for America has organized efforts to get physicians to come to Washington, D.C., to meet with legislators, members of Congress are often quite surprised. There’s both an incredible opportunity to make an impact, but there’s also an incredible need because we’re at an unfortunate place where there’s a real stalemate in Congress.

The question is, who is going to push both the public and legislators to move in the right direction to fix our health care system? I think that doctors, and hospitalists in particular, are uniquely positioned to be able to do that. The hospitalist movement has been blessed with incredibly bright people who are tackling a broad array of systems problems, including discharge planning, medication safety, and coordination of care. I think the country needs to hear from them.

Take us to your leader. Nominate a hospitalist whose work inspires you. E-mail suggestions to m.schneider@elsevier.com. Read previous columns at ehospitalistnews.com. This column, "Leaders," appears regularly in Hospitalist News, a publication of Elsevier.

Physicians who support a single-payer health system are urging the federal government to reject the Institute of Medicine's recommendations for designing the benefits package to be offered in the state-based health insurance exchanges.

Physicians for a National Health Plan (PNHP) is leading the effort to cast off recommendations issued by the Institute of Medicine (IOM) in October, charging the panel was unduly influenced by the insurance industry. The IOM panel called on the Department of Health and Human Services to base the essential benefits package on the benefits typically offered by small employers. It also urged the agency to consider cost when designing the package of required benefits.

In a Dec. 1 letter to HHS Secretary Kathleen Sebelius, more than 2,400 physicians, nurses, and health advocates criticized the IOM recommendations, saying that they would provide “skimpy” coverage.

“The inadequate coverage the IOM recommends would shift costs from corporate and government payers onto families already burdened by illness,” according to the PNHP letter. “Yet this strategy will not lower costs. Delaying care often creates even higher costs. Steadily rising copayments and deductibles over the past 2 decades have failed to stem skyrocketing medical inflation.”

Dr. Steffie Woolhandler, a cofounder of PNHP and professor of public health at the City University of New York, said that the recommendations from the IOM panel are not what was envisioned by supporters of the Affordable Care Act. Instead, supporters had expected that the essential benefits package would be based on the more generous benefits offered by large employers.

The letter also attacked the IOM panel for including members who have “amassed personal wealth through their involvement with health insurers and other for-profit health care firms.”

Dr. Woolhandler, who served as an IOM fellow in 1990-1991, cited the inclusion of Sam Ho, executive vice president of UnitedHealthcare, and Leonard Schaeffer, former chairman and CEO of WellPoint.

Allowing individuals with financial ties to the insurance industry to serve on the IOM panel is contrary to the IOM's own recommendations, issued in 2009, on minimizing conflicts of interest on panels that issue clinical practice guidelines, Dr. Woolhandler added.

Although Mr. Ho and Mr. Schaeffer have knowledge about the insurance business, there are many qualified experts without conflicts who could have been selected for the panel, she said. “A lot of people know about health insurance benefits,” she said.

The IOM stood by the panel and its recommendations. “The IOM report speaks for itself and details the solid rationale for each of its recommendations for achieving a balance between coverage and cost,” said Christine Stencel, an IOM spokeswoman.

The 18-member panel was chaired by Dr. John R. Ball, former executive vice president of the American Society for Clinical Pathology. The panel also included Dr. Alan Nelson, a health policy expert and retired internist/endocrinologist; Christopher F. Koller, health insurance commissioner for Rhode Island; and several policy experts.

Physicians who support a single-payer health system are urging the federal government to reject the Institute of Medicine's recommendations for designing the benefits package to be offered in the state-based health insurance exchanges.

Physicians for a National Health Plan (PNHP) is leading the effort to cast off recommendations issued by the Institute of Medicine (IOM) in October, charging the panel was unduly influenced by the insurance industry. The IOM panel called on the Department of Health and Human Services to base the essential benefits package on the benefits typically offered by small employers. It also urged the agency to consider cost when designing the package of required benefits.

In a Dec. 1 letter to HHS Secretary Kathleen Sebelius, more than 2,400 physicians, nurses, and health advocates criticized the IOM recommendations, saying that they would provide “skimpy” coverage.

“The inadequate coverage the IOM recommends would shift costs from corporate and government payers onto families already burdened by illness,” according to the PNHP letter. “Yet this strategy will not lower costs. Delaying care often creates even higher costs. Steadily rising copayments and deductibles over the past 2 decades have failed to stem skyrocketing medical inflation.”

Dr. Steffie Woolhandler, a cofounder of PNHP and professor of public health at the City University of New York, said that the recommendations from the IOM panel are not what was envisioned by supporters of the Affordable Care Act. Instead, supporters had expected that the essential benefits package would be based on the more generous benefits offered by large employers.

The letter also attacked the IOM panel for including members who have “amassed personal wealth through their involvement with health insurers and other for-profit health care firms.”

Dr. Woolhandler, who served as an IOM fellow in 1990-1991, cited the inclusion of Sam Ho, executive vice president of UnitedHealthcare, and Leonard Schaeffer, former chairman and CEO of WellPoint.

Allowing individuals with financial ties to the insurance industry to serve on the IOM panel is contrary to the IOM's own recommendations, issued in 2009, on minimizing conflicts of interest on panels that issue clinical practice guidelines, Dr. Woolhandler added.

Although Mr. Ho and Mr. Schaeffer have knowledge about the insurance business, there are many qualified experts without conflicts who could have been selected for the panel, she said. “A lot of people know about health insurance benefits,” she said.

The IOM stood by the panel and its recommendations. “The IOM report speaks for itself and details the solid rationale for each of its recommendations for achieving a balance between coverage and cost,” said Christine Stencel, an IOM spokeswoman.

The 18-member panel was chaired by Dr. John R. Ball, former executive vice president of the American Society for Clinical Pathology. The panel also included Dr. Alan Nelson, a health policy expert and retired internist/endocrinologist; Christopher F. Koller, health insurance commissioner for Rhode Island; and several policy experts.

Physicians who support a single-payer health system are urging the federal government to reject the Institute of Medicine's recommendations for designing the benefits package to be offered in the state-based health insurance exchanges.

Physicians for a National Health Plan (PNHP) is leading the effort to cast off recommendations issued by the Institute of Medicine (IOM) in October, charging the panel was unduly influenced by the insurance industry. The IOM panel called on the Department of Health and Human Services to base the essential benefits package on the benefits typically offered by small employers. It also urged the agency to consider cost when designing the package of required benefits.

In a Dec. 1 letter to HHS Secretary Kathleen Sebelius, more than 2,400 physicians, nurses, and health advocates criticized the IOM recommendations, saying that they would provide “skimpy” coverage.

“The inadequate coverage the IOM recommends would shift costs from corporate and government payers onto families already burdened by illness,” according to the PNHP letter. “Yet this strategy will not lower costs. Delaying care often creates even higher costs. Steadily rising copayments and deductibles over the past 2 decades have failed to stem skyrocketing medical inflation.”

Dr. Steffie Woolhandler, a cofounder of PNHP and professor of public health at the City University of New York, said that the recommendations from the IOM panel are not what was envisioned by supporters of the Affordable Care Act. Instead, supporters had expected that the essential benefits package would be based on the more generous benefits offered by large employers.

The letter also attacked the IOM panel for including members who have “amassed personal wealth through their involvement with health insurers and other for-profit health care firms.”

Dr. Woolhandler, who served as an IOM fellow in 1990-1991, cited the inclusion of Sam Ho, executive vice president of UnitedHealthcare, and Leonard Schaeffer, former chairman and CEO of WellPoint.

Allowing individuals with financial ties to the insurance industry to serve on the IOM panel is contrary to the IOM's own recommendations, issued in 2009, on minimizing conflicts of interest on panels that issue clinical practice guidelines, Dr. Woolhandler added.

Although Mr. Ho and Mr. Schaeffer have knowledge about the insurance business, there are many qualified experts without conflicts who could have been selected for the panel, she said. “A lot of people know about health insurance benefits,” she said.

The IOM stood by the panel and its recommendations. “The IOM report speaks for itself and details the solid rationale for each of its recommendations for achieving a balance between coverage and cost,” said Christine Stencel, an IOM spokeswoman.

The 18-member panel was chaired by Dr. John R. Ball, former executive vice president of the American Society for Clinical Pathology. The panel also included Dr. Alan Nelson, a health policy expert and retired internist/endocrinologist; Christopher F. Koller, health insurance commissioner for Rhode Island; and several policy experts.

Abortion Rate Holds Steady

The number and rate of abortions performed in the United States remained about the same from 2007 to 2008, according to the latest abortion surveillance data collected by the National Center for Chronic Disease Prevention and Health Promotion at the Centers for Disease Control and Prevention. The data, published in Morbidity and Mortality Weekly Report, showed that in 2008 more than 825,500 abortions were reported to CDC. This resulted in an abortion rate of 16 abortions per 1,000 women aged 15-44 years, the same as in 2007. This rate is consistent with the recent leveling off of the abortion rate after years of steady declines, the CDC researchers wrote. However, the abortion ratio, which calculates the number of abortions compared to live births, increased slightly between 2007 and 2008. The 2008 abortion ratio was 234 abortions per 1,000 live births, a 1% increase over 2007. The CDC figures also showed a 17% increase in the number of nonsurgical abortions performed between 2007 and 2008. In 2008, of the abortions performed at 8 weeks gestation or earlier, 22% were nonsurgical.

Psoriasis TX During Pregnancy

Topical treatments such as petroleum jelly should be the first-line treatment of psoriasis in pregnant women, according to recommendations from the National Psoriasis Foundation's (NPF's) medical board. The expert panel recommended that physicians turn to moisturizers and emollients as the first treatments since they have no adverse effects. After that, they suggested the use of low- to moderate-dose topical steroids. If necessary, high-potency topical steroids may be used, but only in the second and third trimesters, the board wrote. As a second-line treatment, physicians may recommend light therapy using narrowband ultraviolet light B (UVB). Broadband UVB can also be used if narrowband is not available. The NPF medical board said TNF inhibitors, as well as the immunosuppressant drug cyclosporine, can be used in the second and third trimesters, but with caution.

Infertility Tax Credit Proposed

Federal legislation would create a tax credit to help infertile couples pay for treatment, including in vitro fertilization. H.R. 3522, the Family Act of 2011, is modeled after a tax credit currently available to offset adoption expenses, and could be used for out-of-pocket expenses associated with infertility treatment as well as for treatments to preserve fertility for cancer patients. “Without this credit, access to all the advances of modern medicine and the ability to bear children, despite physical impediments, become, for average Americans, a luxury defined by the size of their wallets or the digits in their zip code,” the bill's sponsor, Rep. John Lewis (D-Ga.), said in a statement. “That's not right, not fair, or just.” Similar legislation (S. 965) was introduced in the Senate last May. Under both bills, the proposed tax credit would cover 50% of all applicable medical expenses, but total payments through the credit would be capped at $13,360 for a lifetime. The credit would be available to married couples filing jointly with adjusted gross incomes of less than $222,520.

AMA Criticizes Pregnancy Centers

The American Medical Association House of Delegates at its interim meeting adopted a resolution calling on pregnancy counseling centers to be truthful regarding the services they offer. The resolution was sponsored by the California delegation, which said that many “crisis pregnancy centers” operate “with the intent of discouraging women with unwanted pregnancies from seeking abortion.” The centers are often deceptive and have no qualified clinical staff; women who visit them may experience delays in getting true medical services, said the delegation. The House said that any center should be clear on it website or in its advertising as to which services it does or does not provide. Delegates also said that any organization that was providing medical services should abide by licensing requirements and have appropriate qualified licensed personnel.

Keep Circumcision Legal

Reacting to ballot initiatives in California, that state's delegation to the AMA House asked that body approve a resolution opposing any attempts to make circumcision illegal. The resolution said that the medical indications “are compelling enough” and that most laws exclude the prohibition of specific procedures that physicians are qualified to perform, based on their clinical judgment. The AMA House passed the resolution without much debate.

AMA: Let's Talk About Guns

The AMA board approved a California-delegation resolution asking the full AMA to oppose restrictions on physicians discussing firearm safety with their patients, such as in a new Florida law. There, violators could face suspension or revocation of their license or fines of up to $10,000, according to the resolution. In September, a federal judge upheld a motion from physicians to enjoin the law, but the state said it would appeal. There is concern that these types of laws could proliferate, especially because they appear to have the backing of the National Rifle Association.

Abortion Rate Holds Steady

The number and rate of abortions performed in the United States remained about the same from 2007 to 2008, according to the latest abortion surveillance data collected by the National Center for Chronic Disease Prevention and Health Promotion at the Centers for Disease Control and Prevention. The data, published in Morbidity and Mortality Weekly Report, showed that in 2008 more than 825,500 abortions were reported to CDC. This resulted in an abortion rate of 16 abortions per 1,000 women aged 15-44 years, the same as in 2007. This rate is consistent with the recent leveling off of the abortion rate after years of steady declines, the CDC researchers wrote. However, the abortion ratio, which calculates the number of abortions compared to live births, increased slightly between 2007 and 2008. The 2008 abortion ratio was 234 abortions per 1,000 live births, a 1% increase over 2007. The CDC figures also showed a 17% increase in the number of nonsurgical abortions performed between 2007 and 2008. In 2008, of the abortions performed at 8 weeks gestation or earlier, 22% were nonsurgical.

Psoriasis TX During Pregnancy

Topical treatments such as petroleum jelly should be the first-line treatment of psoriasis in pregnant women, according to recommendations from the National Psoriasis Foundation's (NPF's) medical board. The expert panel recommended that physicians turn to moisturizers and emollients as the first treatments since they have no adverse effects. After that, they suggested the use of low- to moderate-dose topical steroids. If necessary, high-potency topical steroids may be used, but only in the second and third trimesters, the board wrote. As a second-line treatment, physicians may recommend light therapy using narrowband ultraviolet light B (UVB). Broadband UVB can also be used if narrowband is not available. The NPF medical board said TNF inhibitors, as well as the immunosuppressant drug cyclosporine, can be used in the second and third trimesters, but with caution.

Infertility Tax Credit Proposed

Federal legislation would create a tax credit to help infertile couples pay for treatment, including in vitro fertilization. H.R. 3522, the Family Act of 2011, is modeled after a tax credit currently available to offset adoption expenses, and could be used for out-of-pocket expenses associated with infertility treatment as well as for treatments to preserve fertility for cancer patients. “Without this credit, access to all the advances of modern medicine and the ability to bear children, despite physical impediments, become, for average Americans, a luxury defined by the size of their wallets or the digits in their zip code,” the bill's sponsor, Rep. John Lewis (D-Ga.), said in a statement. “That's not right, not fair, or just.” Similar legislation (S. 965) was introduced in the Senate last May. Under both bills, the proposed tax credit would cover 50% of all applicable medical expenses, but total payments through the credit would be capped at $13,360 for a lifetime. The credit would be available to married couples filing jointly with adjusted gross incomes of less than $222,520.

AMA Criticizes Pregnancy Centers

The American Medical Association House of Delegates at its interim meeting adopted a resolution calling on pregnancy counseling centers to be truthful regarding the services they offer. The resolution was sponsored by the California delegation, which said that many “crisis pregnancy centers” operate “with the intent of discouraging women with unwanted pregnancies from seeking abortion.” The centers are often deceptive and have no qualified clinical staff; women who visit them may experience delays in getting true medical services, said the delegation. The House said that any center should be clear on it website or in its advertising as to which services it does or does not provide. Delegates also said that any organization that was providing medical services should abide by licensing requirements and have appropriate qualified licensed personnel.

Keep Circumcision Legal

Reacting to ballot initiatives in California, that state's delegation to the AMA House asked that body approve a resolution opposing any attempts to make circumcision illegal. The resolution said that the medical indications “are compelling enough” and that most laws exclude the prohibition of specific procedures that physicians are qualified to perform, based on their clinical judgment. The AMA House passed the resolution without much debate.

AMA: Let's Talk About Guns

The AMA board approved a California-delegation resolution asking the full AMA to oppose restrictions on physicians discussing firearm safety with their patients, such as in a new Florida law. There, violators could face suspension or revocation of their license or fines of up to $10,000, according to the resolution. In September, a federal judge upheld a motion from physicians to enjoin the law, but the state said it would appeal. There is concern that these types of laws could proliferate, especially because they appear to have the backing of the National Rifle Association.

Abortion Rate Holds Steady

The number and rate of abortions performed in the United States remained about the same from 2007 to 2008, according to the latest abortion surveillance data collected by the National Center for Chronic Disease Prevention and Health Promotion at the Centers for Disease Control and Prevention. The data, published in Morbidity and Mortality Weekly Report, showed that in 2008 more than 825,500 abortions were reported to CDC. This resulted in an abortion rate of 16 abortions per 1,000 women aged 15-44 years, the same as in 2007. This rate is consistent with the recent leveling off of the abortion rate after years of steady declines, the CDC researchers wrote. However, the abortion ratio, which calculates the number of abortions compared to live births, increased slightly between 2007 and 2008. The 2008 abortion ratio was 234 abortions per 1,000 live births, a 1% increase over 2007. The CDC figures also showed a 17% increase in the number of nonsurgical abortions performed between 2007 and 2008. In 2008, of the abortions performed at 8 weeks gestation or earlier, 22% were nonsurgical.

Psoriasis TX During Pregnancy

Topical treatments such as petroleum jelly should be the first-line treatment of psoriasis in pregnant women, according to recommendations from the National Psoriasis Foundation's (NPF's) medical board. The expert panel recommended that physicians turn to moisturizers and emollients as the first treatments since they have no adverse effects. After that, they suggested the use of low- to moderate-dose topical steroids. If necessary, high-potency topical steroids may be used, but only in the second and third trimesters, the board wrote. As a second-line treatment, physicians may recommend light therapy using narrowband ultraviolet light B (UVB). Broadband UVB can also be used if narrowband is not available. The NPF medical board said TNF inhibitors, as well as the immunosuppressant drug cyclosporine, can be used in the second and third trimesters, but with caution.

Infertility Tax Credit Proposed

Federal legislation would create a tax credit to help infertile couples pay for treatment, including in vitro fertilization. H.R. 3522, the Family Act of 2011, is modeled after a tax credit currently available to offset adoption expenses, and could be used for out-of-pocket expenses associated with infertility treatment as well as for treatments to preserve fertility for cancer patients. “Without this credit, access to all the advances of modern medicine and the ability to bear children, despite physical impediments, become, for average Americans, a luxury defined by the size of their wallets or the digits in their zip code,” the bill's sponsor, Rep. John Lewis (D-Ga.), said in a statement. “That's not right, not fair, or just.” Similar legislation (S. 965) was introduced in the Senate last May. Under both bills, the proposed tax credit would cover 50% of all applicable medical expenses, but total payments through the credit would be capped at $13,360 for a lifetime. The credit would be available to married couples filing jointly with adjusted gross incomes of less than $222,520.

AMA Criticizes Pregnancy Centers

The American Medical Association House of Delegates at its interim meeting adopted a resolution calling on pregnancy counseling centers to be truthful regarding the services they offer. The resolution was sponsored by the California delegation, which said that many “crisis pregnancy centers” operate “with the intent of discouraging women with unwanted pregnancies from seeking abortion.” The centers are often deceptive and have no qualified clinical staff; women who visit them may experience delays in getting true medical services, said the delegation. The House said that any center should be clear on it website or in its advertising as to which services it does or does not provide. Delegates also said that any organization that was providing medical services should abide by licensing requirements and have appropriate qualified licensed personnel.

Keep Circumcision Legal

Reacting to ballot initiatives in California, that state's delegation to the AMA House asked that body approve a resolution opposing any attempts to make circumcision illegal. The resolution said that the medical indications “are compelling enough” and that most laws exclude the prohibition of specific procedures that physicians are qualified to perform, based on their clinical judgment. The AMA House passed the resolution without much debate.

AMA: Let's Talk About Guns

The AMA board approved a California-delegation resolution asking the full AMA to oppose restrictions on physicians discussing firearm safety with their patients, such as in a new Florida law. There, violators could face suspension or revocation of their license or fines of up to $10,000, according to the resolution. In September, a federal judge upheld a motion from physicians to enjoin the law, but the state said it would appeal. There is concern that these types of laws could proliferate, especially because they appear to have the backing of the National Rifle Association.

Physician payments are in limbo following a vote by the U.S. House of Representatives on Dec. 20 not to approve a 2-month extension of current Medicare payment rates to physicians.

The House voted 229 to 193 to disagree with legislation passed earlier by the Senate, which would have prevented a scheduled 27% Medicare physician fee cut through the end of February. The resolution also requested a House-Senate conference to resolve differences in legislation aimed at averting a steep physician pay cut, extending the Social Security payroll tax holiday, and continuing federally funded unemployment insurance benefits.

But getting agreement from a conference committee before the end of the year appears unlikely, since Democrats in the Senate have said they will not participate in the conference process. They have argued that the conference would be unnecessary if Republicans in the House would agree to the Senate’s proposed 2-month extension.

The American Medical Association blasted Congress for its failure to enact a physician pay fix. "Congress has again failed to fulfill its responsibilities. It is shameful that patients and physicians are the collateral damage; the citizens of this country deserve better," Dr. Peter W. Carmel, the AMA president, said in a statement. "Congress had the entire year to repeal the broken physician payment formula and provide stability for the millions of seniors and military families who rely on Medicare and TRICARE, but has failed to act. It is long past time for members of Congress to act decisively and protect access to care for seniors and military families."

If Congress fails to pass a physician fee fix before the end of the year, doctors won’t immediately feel the impact of the 27% cut. Officials at the Centers for Medicare and Medicaid Services plan to hold Medicare payments for the first 10 business days of January. That gives lawmakers until Jan. 17 to come back in 2012 and vote on a plan. The hold would likely have a limited impact on physician cash flow, since electronic claims are paid no sooner than 14 calendar days after being received by CMS.

But if Congress fails to reach agreement, it wouldn’t be the first time. Physicians had begun to feel the effects of a 21% Medicare pay cut in June 2010, when Congress passed legislation to replace it with a 2.2% pay raise for 6 months. In that case, Congress had allowed the cut to go into effect on June 1, and CMS had held payments until June 18. When there was still no agreement from lawmakers, CMS began paying doctors at the lower rate. Once the cuts were reversed, CMS began reprocessing any claims paid at the lower rate.

While averting the deep Medicare physician fee cut has wide bipartisan approval, the issue has been caught up in controversy over other parts of the legislation. On Dec. 13, the House passed the Middle Class Tax Relief & Job Creation Act (H.R. 3630), which would have replaced the 27% Medicare fee cut with a 1% pay raise for physicians in 2012 and 2013. It also included some controversial provisions, including cuts to preventive health funding in the Affordable Care Act and the rollback of certain environmental regulations.

On Dec. 17, the Senate approved an amended version of the bill, extending the payroll tax holiday and unemployment benefits for 2 months, and averting the Medicare pay cut through the end of February. The bill, which passed 89 to 19, was designed to give lawmakers time to work out a long-term deal, but House Republicans rejected the idea, saying they didn’t want to just delay dealing with the problem.

Physician payments are in limbo following a vote by the U.S. House of Representatives on Dec. 20 not to approve a 2-month extension of current Medicare payment rates to physicians.

The House voted 229 to 193 to disagree with legislation passed earlier by the Senate, which would have prevented a scheduled 27% Medicare physician fee cut through the end of February. The resolution also requested a House-Senate conference to resolve differences in legislation aimed at averting a steep physician pay cut, extending the Social Security payroll tax holiday, and continuing federally funded unemployment insurance benefits.

But getting agreement from a conference committee before the end of the year appears unlikely, since Democrats in the Senate have said they will not participate in the conference process. They have argued that the conference would be unnecessary if Republicans in the House would agree to the Senate’s proposed 2-month extension.

The American Medical Association blasted Congress for its failure to enact a physician pay fix. "Congress has again failed to fulfill its responsibilities. It is shameful that patients and physicians are the collateral damage; the citizens of this country deserve better," Dr. Peter W. Carmel, the AMA president, said in a statement. "Congress had the entire year to repeal the broken physician payment formula and provide stability for the millions of seniors and military families who rely on Medicare and TRICARE, but has failed to act. It is long past time for members of Congress to act decisively and protect access to care for seniors and military families."

If Congress fails to pass a physician fee fix before the end of the year, doctors won’t immediately feel the impact of the 27% cut. Officials at the Centers for Medicare and Medicaid Services plan to hold Medicare payments for the first 10 business days of January. That gives lawmakers until Jan. 17 to come back in 2012 and vote on a plan. The hold would likely have a limited impact on physician cash flow, since electronic claims are paid no sooner than 14 calendar days after being received by CMS.

But if Congress fails to reach agreement, it wouldn’t be the first time. Physicians had begun to feel the effects of a 21% Medicare pay cut in June 2010, when Congress passed legislation to replace it with a 2.2% pay raise for 6 months. In that case, Congress had allowed the cut to go into effect on June 1, and CMS had held payments until June 18. When there was still no agreement from lawmakers, CMS began paying doctors at the lower rate. Once the cuts were reversed, CMS began reprocessing any claims paid at the lower rate.

While averting the deep Medicare physician fee cut has wide bipartisan approval, the issue has been caught up in controversy over other parts of the legislation. On Dec. 13, the House passed the Middle Class Tax Relief & Job Creation Act (H.R. 3630), which would have replaced the 27% Medicare fee cut with a 1% pay raise for physicians in 2012 and 2013. It also included some controversial provisions, including cuts to preventive health funding in the Affordable Care Act and the rollback of certain environmental regulations.

On Dec. 17, the Senate approved an amended version of the bill, extending the payroll tax holiday and unemployment benefits for 2 months, and averting the Medicare pay cut through the end of February. The bill, which passed 89 to 19, was designed to give lawmakers time to work out a long-term deal, but House Republicans rejected the idea, saying they didn’t want to just delay dealing with the problem.

Physician payments are in limbo following a vote by the U.S. House of Representatives on Dec. 20 not to approve a 2-month extension of current Medicare payment rates to physicians.

The House voted 229 to 193 to disagree with legislation passed earlier by the Senate, which would have prevented a scheduled 27% Medicare physician fee cut through the end of February. The resolution also requested a House-Senate conference to resolve differences in legislation aimed at averting a steep physician pay cut, extending the Social Security payroll tax holiday, and continuing federally funded unemployment insurance benefits.

But getting agreement from a conference committee before the end of the year appears unlikely, since Democrats in the Senate have said they will not participate in the conference process. They have argued that the conference would be unnecessary if Republicans in the House would agree to the Senate’s proposed 2-month extension.

The American Medical Association blasted Congress for its failure to enact a physician pay fix. "Congress has again failed to fulfill its responsibilities. It is shameful that patients and physicians are the collateral damage; the citizens of this country deserve better," Dr. Peter W. Carmel, the AMA president, said in a statement. "Congress had the entire year to repeal the broken physician payment formula and provide stability for the millions of seniors and military families who rely on Medicare and TRICARE, but has failed to act. It is long past time for members of Congress to act decisively and protect access to care for seniors and military families."

If Congress fails to pass a physician fee fix before the end of the year, doctors won’t immediately feel the impact of the 27% cut. Officials at the Centers for Medicare and Medicaid Services plan to hold Medicare payments for the first 10 business days of January. That gives lawmakers until Jan. 17 to come back in 2012 and vote on a plan. The hold would likely have a limited impact on physician cash flow, since electronic claims are paid no sooner than 14 calendar days after being received by CMS.

But if Congress fails to reach agreement, it wouldn’t be the first time. Physicians had begun to feel the effects of a 21% Medicare pay cut in June 2010, when Congress passed legislation to replace it with a 2.2% pay raise for 6 months. In that case, Congress had allowed the cut to go into effect on June 1, and CMS had held payments until June 18. When there was still no agreement from lawmakers, CMS began paying doctors at the lower rate. Once the cuts were reversed, CMS began reprocessing any claims paid at the lower rate.

While averting the deep Medicare physician fee cut has wide bipartisan approval, the issue has been caught up in controversy over other parts of the legislation. On Dec. 13, the House passed the Middle Class Tax Relief & Job Creation Act (H.R. 3630), which would have replaced the 27% Medicare fee cut with a 1% pay raise for physicians in 2012 and 2013. It also included some controversial provisions, including cuts to preventive health funding in the Affordable Care Act and the rollback of certain environmental regulations.

On Dec. 17, the Senate approved an amended version of the bill, extending the payroll tax holiday and unemployment benefits for 2 months, and averting the Medicare pay cut through the end of February. The bill, which passed 89 to 19, was designed to give lawmakers time to work out a long-term deal, but House Republicans rejected the idea, saying they didn’t want to just delay dealing with the problem.

The Joint Select Committee on Deficit Reduction failed to produce a plan to cut federal spending, triggering a process slated to cut physician pay and a host of public h

On Nov. 21, just hours before the midnight deadline for the so-called supercommittee to publicly announce a deficit-reduction plan, the cochairs of the committee issued a statement saying that they could not reach a bipartisan agreement.

"Despite our inability to bridge the committee's significant differences, we end this process united in our belief that the nation's fiscal crisis must be addressed and that we cannot leave it to the next generation to solve. We remain hopeful that Congress can build on this committee's work and can find a way to tackle this issue in a way that works for the American people and our economy," according to the statement from Sen. Patty Murray (D-Wash.) and Rep. Jeb Hensarling (R-Tex.).

The bipartisan, bicameral committee of 12 lawmakers was convened last summer as part of the Budget Control Act and tasked with finding about $1.2 trillion in cuts to federal spending over a decade. Under the law, should the supercommittee fail to agree on how to meet that goal, automatic, across-the-board cuts called "sequestration" go into effect starting in 2013.

The cuts would be evenly divided among defense and nondefense spending. Most federal programs are subject to the cuts, except Social Security, Medicaid, the Children's Health Insurance Program, and other low-income programs. The Medicare program is spared some of the deepest cuts since the law calls only for provider cuts, which are capped at 2%.

Physicians' groups expressed disappointment that several weeks of hearings and closed-door meetings had not resulted in a plan. The automatic cuts would endanger everything from military health care, medical research, and disease prevention programs to the training of primary care physicians, Dr. Virginia L. Hood, president of the American College of Physicians, said in a statement.

She urged Congress not to let the sequestration process take effect. Instead, she called on lawmakers to craft a plan to reduce the deficit in a more deliberative way, looking at the cost drivers in health care instead of allowing the across-the-board cuts. The ACP has already provided members of Congress with a list of possible cuts that could produce between $500 billion and $800 billion in savings over the next decade.

For instance, the ACP favors giving the federal government authority to negotiate the prices for drugs paid for by Medicare, a policy change that they estimate would save about $300 billion over 10 years. The federal government also could realize about $62 billion in savings by enacting a medical liability reform plan that includes a $250,000 cap on noneconomic damages, according to the ACP.

But the more pressing concern for doctors is the 27% Medicare physician fee cut that will take effect in a few weeks if Congress doesn't take action to stop it.

Physicians' groups intensely lobbied the supercommittee to make replacing the Sustainable Growth Rate (SGR) formula, used in setting Medicare payments, part of any deficit-reduction plan. Now the task of getting a permanent SGR fix will be much more difficult, said Robert Doherty, ACP's senior vice president for government affairs and public policy.

There had been some interest among the supercommittee members in addressing the SGR, and a large deficit-reduction package was a reasonable place to deal with such an expensive problem, Mr. Doherty said in an interview. As part of a $1.2-trillion package, it was possible to find the necessary $300 billion in offsets to pay for a fix. Finding those offsets would be much harder in a stand-alone bill.

But while Mr. Doherty said the supercommittee's failure represents a "huge lost opportunity" on the SGR, the ACP is not giving up. He said the group favors a proposal from Rep. Allyson Schwartz (D-Pa.) to permanently repeal the SGR. The proposal, known as the Medicare Physician Payment Innovation Act, would stabilize Medicare physician payments for several years before moving to new payment systems.

Specifically, Rep. Schwartz proposes that the Center for Medicare and Medicaid Innovation come up with at least four new payment and delivery models. Starting in 2017, physicians could choose one of those new models or stay in the traditional fee-for-service system, but fee-for-service payments would begin to decline in 2018. At press time, the proposal had not been formally introduced in Congress.

The proposal won the support of the American Academy of Family Physicians, the American Osteopathic Association, the American College of Obstetricians and Gynecologists, and the Society of Hospital Medicine but not that of the American Medical Association.

The AMA praised Rep. Schwartz for her efforts to try to repeal the SGR but stopped short of endorsing the plan, saying that it couldn't sign on to the specific schedule of pay increases and penalties given the workflow changes and investments that would likely be required from physicians.

In the wake of the supercommittee's announcement, physicians' groups called on Congress to act immediately to avert the scheduled 27% Medicare pay cut and to come up with some sort of long-term solution to the annual scrambling to avert SGR-related fee cuts.

"The AMA is deeply concerned that continued instability in the Medicare program, including the looming 27% cut scheduled for Jan. 1, will force many physicians to limit the number of Medicare and TRICARE patients they can care for in their practices," Dr. Peter W. Carmel, president of the AMA, said in a statement . "Congress has ignored the reality that short-term patches have grown the problem immensely. The cost of repealing the formula has grown 525% in the past 5 years and will double again in the next 5 years."

Congressional Action Looming

The U.S. Senate voted on Dec. 17 to put off by 2 months a Medicare physician pay cut due to take effect on Jan. 1. The Senate voted 89-19 to approve the package, just before it left Washington for a holiday recess.

But on Dec. 19, as the House came back into session, many congressmen said they would not support the package, mainly because it only provided 2 months of relief, rather than a year or longer. Similar legislation passed the House Dec. 13, but with a longer horizon: If enacted, that bill would replace the 27% cut with a 1% increase for 2 years.

If the House votes against approving the Senate bill, and the two houses cannot compromise before Jan. 1, physicians will see a 27% reduction in fees, as dictated by the Medicare Sustainable Growth Rate (SGR) formula.

The American Medical Association expressed disgust in a statement issued after the Senate vote.

“Waiting until the last week of the legislative session to address a problem that Congress knew was looming all year is not the way to conduct our nation’s business,” AMA President Peter Carmel said in the statement.

The AMA called on Congress to stop instituting stop-gap fixes and to instead replace the SGR formula. “The 12 temporary patches that Congress has applied have raised the cost of solving the problem by more than 500% over the last few years and eroded patients’ access to care,” said Dr. Carmel. “A permanent solution is the long overdue, fiscally responsible approach.”

Alicia Ault contributed to this report.

The Joint Select Committee on Deficit Reduction failed to produce a plan to cut federal spending, triggering a process slated to cut physician pay and a host of public h

On Nov. 21, just hours before the midnight deadline for the so-called supercommittee to publicly announce a deficit-reduction plan, the cochairs of the committee issued a statement saying that they could not reach a bipartisan agreement.

"Despite our inability to bridge the committee's significant differences, we end this process united in our belief that the nation's fiscal crisis must be addressed and that we cannot leave it to the next generation to solve. We remain hopeful that Congress can build on this committee's work and can find a way to tackle this issue in a way that works for the American people and our economy," according to the statement from Sen. Patty Murray (D-Wash.) and Rep. Jeb Hensarling (R-Tex.).

The bipartisan, bicameral committee of 12 lawmakers was convened last summer as part of the Budget Control Act and tasked with finding about $1.2 trillion in cuts to federal spending over a decade. Under the law, should the supercommittee fail to agree on how to meet that goal, automatic, across-the-board cuts called "sequestration" go into effect starting in 2013.

The cuts would be evenly divided among defense and nondefense spending. Most federal programs are subject to the cuts, except Social Security, Medicaid, the Children's Health Insurance Program, and other low-income programs. The Medicare program is spared some of the deepest cuts since the law calls only for provider cuts, which are capped at 2%.

Physicians' groups expressed disappointment that several weeks of hearings and closed-door meetings had not resulted in a plan. The automatic cuts would endanger everything from military health care, medical research, and disease prevention programs to the training of primary care physicians, Dr. Virginia L. Hood, president of the American College of Physicians, said in a statement.

She urged Congress not to let the sequestration process take effect. Instead, she called on lawmakers to craft a plan to reduce the deficit in a more deliberative way, looking at the cost drivers in health care instead of allowing the across-the-board cuts. The ACP has already provided members of Congress with a list of possible cuts that could produce between $500 billion and $800 billion in savings over the next decade.

For instance, the ACP favors giving the federal government authority to negotiate the prices for drugs paid for by Medicare, a policy change that they estimate would save about $300 billion over 10 years. The federal government also could realize about $62 billion in savings by enacting a medical liability reform plan that includes a $250,000 cap on noneconomic damages, according to the ACP.

But the more pressing concern for doctors is the 27% Medicare physician fee cut that will take effect in a few weeks if Congress doesn't take action to stop it.

Physicians' groups intensely lobbied the supercommittee to make replacing the Sustainable Growth Rate (SGR) formula, used in setting Medicare payments, part of any deficit-reduction plan. Now the task of getting a permanent SGR fix will be much more difficult, said Robert Doherty, ACP's senior vice president for government affairs and public policy.

There had been some interest among the supercommittee members in addressing the SGR, and a large deficit-reduction package was a reasonable place to deal with such an expensive problem, Mr. Doherty said in an interview. As part of a $1.2-trillion package, it was possible to find the necessary $300 billion in offsets to pay for a fix. Finding those offsets would be much harder in a stand-alone bill.

But while Mr. Doherty said the supercommittee's failure represents a "huge lost opportunity" on the SGR, the ACP is not giving up. He said the group favors a proposal from Rep. Allyson Schwartz (D-Pa.) to permanently repeal the SGR. The proposal, known as the Medicare Physician Payment Innovation Act, would stabilize Medicare physician payments for several years before moving to new payment systems.

Specifically, Rep. Schwartz proposes that the Center for Medicare and Medicaid Innovation come up with at least four new payment and delivery models. Starting in 2017, physicians could choose one of those new models or stay in the traditional fee-for-service system, but fee-for-service payments would begin to decline in 2018. At press time, the proposal had not been formally introduced in Congress.

The proposal won the support of the American Academy of Family Physicians, the American Osteopathic Association, the American College of Obstetricians and Gynecologists, and the Society of Hospital Medicine but not that of the American Medical Association.

The AMA praised Rep. Schwartz for her efforts to try to repeal the SGR but stopped short of endorsing the plan, saying that it couldn't sign on to the specific schedule of pay increases and penalties given the workflow changes and investments that would likely be required from physicians.

In the wake of the supercommittee's announcement, physicians' groups called on Congress to act immediately to avert the scheduled 27% Medicare pay cut and to come up with some sort of long-term solution to the annual scrambling to avert SGR-related fee cuts.

"The AMA is deeply concerned that continued instability in the Medicare program, including the looming 27% cut scheduled for Jan. 1, will force many physicians to limit the number of Medicare and TRICARE patients they can care for in their practices," Dr. Peter W. Carmel, president of the AMA, said in a statement . "Congress has ignored the reality that short-term patches have grown the problem immensely. The cost of repealing the formula has grown 525% in the past 5 years and will double again in the next 5 years."

Congressional Action Looming

The U.S. Senate voted on Dec. 17 to put off by 2 months a Medicare physician pay cut due to take effect on Jan. 1. The Senate voted 89-19 to approve the package, just before it left Washington for a holiday recess.

But on Dec. 19, as the House came back into session, many congressmen said they would not support the package, mainly because it only provided 2 months of relief, rather than a year or longer. Similar legislation passed the House Dec. 13, but with a longer horizon: If enacted, that bill would replace the 27% cut with a 1% increase for 2 years.

If the House votes against approving the Senate bill, and the two houses cannot compromise before Jan. 1, physicians will see a 27% reduction in fees, as dictated by the Medicare Sustainable Growth Rate (SGR) formula.

The American Medical Association expressed disgust in a statement issued after the Senate vote.

“Waiting until the last week of the legislative session to address a problem that Congress knew was looming all year is not the way to conduct our nation’s business,” AMA President Peter Carmel said in the statement.

The AMA called on Congress to stop instituting stop-gap fixes and to instead replace the SGR formula. “The 12 temporary patches that Congress has applied have raised the cost of solving the problem by more than 500% over the last few years and eroded patients’ access to care,” said Dr. Carmel. “A permanent solution is the long overdue, fiscally responsible approach.”

Alicia Ault contributed to this report.

The Joint Select Committee on Deficit Reduction failed to produce a plan to cut federal spending, triggering a process slated to cut physician pay and a host of public h

On Nov. 21, just hours before the midnight deadline for the so-called supercommittee to publicly announce a deficit-reduction plan, the cochairs of the committee issued a statement saying that they could not reach a bipartisan agreement.

"Despite our inability to bridge the committee's significant differences, we end this process united in our belief that the nation's fiscal crisis must be addressed and that we cannot leave it to the next generation to solve. We remain hopeful that Congress can build on this committee's work and can find a way to tackle this issue in a way that works for the American people and our economy," according to the statement from Sen. Patty Murray (D-Wash.) and Rep. Jeb Hensarling (R-Tex.).

The bipartisan, bicameral committee of 12 lawmakers was convened last summer as part of the Budget Control Act and tasked with finding about $1.2 trillion in cuts to federal spending over a decade. Under the law, should the supercommittee fail to agree on how to meet that goal, automatic, across-the-board cuts called "sequestration" go into effect starting in 2013.

The cuts would be evenly divided among defense and nondefense spending. Most federal programs are subject to the cuts, except Social Security, Medicaid, the Children's Health Insurance Program, and other low-income programs. The Medicare program is spared some of the deepest cuts since the law calls only for provider cuts, which are capped at 2%.

Physicians' groups expressed disappointment that several weeks of hearings and closed-door meetings had not resulted in a plan. The automatic cuts would endanger everything from military health care, medical research, and disease prevention programs to the training of primary care physicians, Dr. Virginia L. Hood, president of the American College of Physicians, said in a statement.

She urged Congress not to let the sequestration process take effect. Instead, she called on lawmakers to craft a plan to reduce the deficit in a more deliberative way, looking at the cost drivers in health care instead of allowing the across-the-board cuts. The ACP has already provided members of Congress with a list of possible cuts that could produce between $500 billion and $800 billion in savings over the next decade.

For instance, the ACP favors giving the federal government authority to negotiate the prices for drugs paid for by Medicare, a policy change that they estimate would save about $300 billion over 10 years. The federal government also could realize about $62 billion in savings by enacting a medical liability reform plan that includes a $250,000 cap on noneconomic damages, according to the ACP.

But the more pressing concern for doctors is the 27% Medicare physician fee cut that will take effect in a few weeks if Congress doesn't take action to stop it.

Physicians' groups intensely lobbied the supercommittee to make replacing the Sustainable Growth Rate (SGR) formula, used in setting Medicare payments, part of any deficit-reduction plan. Now the task of getting a permanent SGR fix will be much more difficult, said Robert Doherty, ACP's senior vice president for government affairs and public policy.

There had been some interest among the supercommittee members in addressing the SGR, and a large deficit-reduction package was a reasonable place to deal with such an expensive problem, Mr. Doherty said in an interview. As part of a $1.2-trillion package, it was possible to find the necessary $300 billion in offsets to pay for a fix. Finding those offsets would be much harder in a stand-alone bill.

But while Mr. Doherty said the supercommittee's failure represents a "huge lost opportunity" on the SGR, the ACP is not giving up. He said the group favors a proposal from Rep. Allyson Schwartz (D-Pa.) to permanently repeal the SGR. The proposal, known as the Medicare Physician Payment Innovation Act, would stabilize Medicare physician payments for several years before moving to new payment systems.

Specifically, Rep. Schwartz proposes that the Center for Medicare and Medicaid Innovation come up with at least four new payment and delivery models. Starting in 2017, physicians could choose one of those new models or stay in the traditional fee-for-service system, but fee-for-service payments would begin to decline in 2018. At press time, the proposal had not been formally introduced in Congress.

The proposal won the support of the American Academy of Family Physicians, the American Osteopathic Association, the American College of Obstetricians and Gynecologists, and the Society of Hospital Medicine but not that of the American Medical Association.

The AMA praised Rep. Schwartz for her efforts to try to repeal the SGR but stopped short of endorsing the plan, saying that it couldn't sign on to the specific schedule of pay increases and penalties given the workflow changes and investments that would likely be required from physicians.

In the wake of the supercommittee's announcement, physicians' groups called on Congress to act immediately to avert the scheduled 27% Medicare pay cut and to come up with some sort of long-term solution to the annual scrambling to avert SGR-related fee cuts.

"The AMA is deeply concerned that continued instability in the Medicare program, including the looming 27% cut scheduled for Jan. 1, will force many physicians to limit the number of Medicare and TRICARE patients they can care for in their practices," Dr. Peter W. Carmel, president of the AMA, said in a statement . "Congress has ignored the reality that short-term patches have grown the problem immensely. The cost of repealing the formula has grown 525% in the past 5 years and will double again in the next 5 years."

Congressional Action Looming

The U.S. Senate voted on Dec. 17 to put off by 2 months a Medicare physician pay cut due to take effect on Jan. 1. The Senate voted 89-19 to approve the package, just before it left Washington for a holiday recess.

But on Dec. 19, as the House came back into session, many congressmen said they would not support the package, mainly because it only provided 2 months of relief, rather than a year or longer. Similar legislation passed the House Dec. 13, but with a longer horizon: If enacted, that bill would replace the 27% cut with a 1% increase for 2 years.

If the House votes against approving the Senate bill, and the two houses cannot compromise before Jan. 1, physicians will see a 27% reduction in fees, as dictated by the Medicare Sustainable Growth Rate (SGR) formula.

The American Medical Association expressed disgust in a statement issued after the Senate vote.

“Waiting until the last week of the legislative session to address a problem that Congress knew was looming all year is not the way to conduct our nation’s business,” AMA President Peter Carmel said in the statement.

The AMA called on Congress to stop instituting stop-gap fixes and to instead replace the SGR formula. “The 12 temporary patches that Congress has applied have raised the cost of solving the problem by more than 500% over the last few years and eroded patients’ access to care,” said Dr. Carmel. “A permanent solution is the long overdue, fiscally responsible approach.”

Alicia Ault contributed to this report.