Mary Ellen Schneider

Medicare beneficiaries can now receive co-payment–free screening and counseling for obesity under a new benefit created through the Affordable Care Act.

On Nov. 29, officials at the Centers for Medicare and Medicaid Services announced that they had added intensive behavioral therapy for obesity as a preventive service to be offered to Medicare beneficiaries without cost sharing, effective immediately.

In a memo on the decision, CMS noted that the scientific evidence was adequate to conclude that behavioral therapy in individuals with a body mass index of 30 kg/m² or greater was "reasonable and necessary" to prevent illness or disability.

The benefit includes screening for obesity by measuring body mass index, conducting a dietary assessment, and providing counseling and therapy to promote sustained weight loss. Medicare will cover counseling with a primary care physician or other primary care provider. The coverage includes one face-to-face visit every week for the first month and one face-to-face visit every other week for months 2 though 6. At the 6-month visit, the provider must assess whether the effort is resulting in weight loss. Patients must have lost at least 3 kg (about 6.6 pounds) in the first 6 months to qualify for an additional 6 months of visits.

More than 30% of people over age 65 are estimated to be obese, according to a CMS press release.

"This decision is an important step in aligning Medicare’s portfolio of preventive services with evidence and addressing risk factors for disease," Dr. Patrick Conway, CMS chief medical officer, said in a statement. "We at CMS are carefully and systematically reviewing the best available medical evidence to identify those preventive services that can keep Medicare beneficiaries as healthy as possible for as long as possible."

The obesity screening and counseling benefit is being added to a list of preventive services covered by Medicare without beneficiary cost sharing. That list includes an annual well visit; tobacco cessation counseling; certain immunizations; and screening for bone density, cervical cancer, cholesterol, colorectal cancer, diabetes, breast cancer, HIV, and prostate cancer.

Medicare beneficiaries can now receive co-payment–free screening and counseling for obesity under a new benefit created through the Affordable Care Act.

On Nov. 29, officials at the Centers for Medicare and Medicaid Services announced that they had added intensive behavioral therapy for obesity as a preventive service to be offered to Medicare beneficiaries without cost sharing, effective immediately.

In a memo on the decision, CMS noted that the scientific evidence was adequate to conclude that behavioral therapy in individuals with a body mass index of 30 kg/m² or greater was "reasonable and necessary" to prevent illness or disability.

The benefit includes screening for obesity by measuring body mass index, conducting a dietary assessment, and providing counseling and therapy to promote sustained weight loss. Medicare will cover counseling with a primary care physician or other primary care provider. The coverage includes one face-to-face visit every week for the first month and one face-to-face visit every other week for months 2 though 6. At the 6-month visit, the provider must assess whether the effort is resulting in weight loss. Patients must have lost at least 3 kg (about 6.6 pounds) in the first 6 months to qualify for an additional 6 months of visits.

More than 30% of people over age 65 are estimated to be obese, according to a CMS press release.

"This decision is an important step in aligning Medicare’s portfolio of preventive services with evidence and addressing risk factors for disease," Dr. Patrick Conway, CMS chief medical officer, said in a statement. "We at CMS are carefully and systematically reviewing the best available medical evidence to identify those preventive services that can keep Medicare beneficiaries as healthy as possible for as long as possible."

The obesity screening and counseling benefit is being added to a list of preventive services covered by Medicare without beneficiary cost sharing. That list includes an annual well visit; tobacco cessation counseling; certain immunizations; and screening for bone density, cervical cancer, cholesterol, colorectal cancer, diabetes, breast cancer, HIV, and prostate cancer.

Medicare beneficiaries can now receive co-payment–free screening and counseling for obesity under a new benefit created through the Affordable Care Act.

On Nov. 29, officials at the Centers for Medicare and Medicaid Services announced that they had added intensive behavioral therapy for obesity as a preventive service to be offered to Medicare beneficiaries without cost sharing, effective immediately.

In a memo on the decision, CMS noted that the scientific evidence was adequate to conclude that behavioral therapy in individuals with a body mass index of 30 kg/m² or greater was "reasonable and necessary" to prevent illness or disability.

The benefit includes screening for obesity by measuring body mass index, conducting a dietary assessment, and providing counseling and therapy to promote sustained weight loss. Medicare will cover counseling with a primary care physician or other primary care provider. The coverage includes one face-to-face visit every week for the first month and one face-to-face visit every other week for months 2 though 6. At the 6-month visit, the provider must assess whether the effort is resulting in weight loss. Patients must have lost at least 3 kg (about 6.6 pounds) in the first 6 months to qualify for an additional 6 months of visits.

More than 30% of people over age 65 are estimated to be obese, according to a CMS press release.

"This decision is an important step in aligning Medicare’s portfolio of preventive services with evidence and addressing risk factors for disease," Dr. Patrick Conway, CMS chief medical officer, said in a statement. "We at CMS are carefully and systematically reviewing the best available medical evidence to identify those preventive services that can keep Medicare beneficiaries as healthy as possible for as long as possible."

The obesity screening and counseling benefit is being added to a list of preventive services covered by Medicare without beneficiary cost sharing. That list includes an annual well visit; tobacco cessation counseling; certain immunizations; and screening for bone density, cervical cancer, cholesterol, colorectal cancer, diabetes, breast cancer, HIV, and prostate cancer.

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 health programs beginning in 2013. It also leaves physicians facing a 27% Medicare pay cut in January.

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.

Physicians’ groups expressed disappointment that several weeks of hearings and closed-door meetings had not resulted in a plan.

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."

If Congress does not repeal the SGR and replace it with a new, stable system, it will threaten the financial viability of physician practices and worsen the health security of millions of patients, according to the American Academy of Family Physicians.

"This is no way to address the federal budget deficit," Dr. Glen Stream, AAFP’s president, said in a statement. "At some point, Congress must face up to its responsibility to its constituents. That time is now."

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 health programs beginning in 2013. It also leaves physicians facing a 27% Medicare pay cut in January.

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.

Physicians’ groups expressed disappointment that several weeks of hearings and closed-door meetings had not resulted in a plan.

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."

If Congress does not repeal the SGR and replace it with a new, stable system, it will threaten the financial viability of physician practices and worsen the health security of millions of patients, according to the American Academy of Family Physicians.

"This is no way to address the federal budget deficit," Dr. Glen Stream, AAFP’s president, said in a statement. "At some point, Congress must face up to its responsibility to its constituents. That time is now."

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 health programs beginning in 2013. It also leaves physicians facing a 27% Medicare pay cut in January.

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.

Physicians’ groups expressed disappointment that several weeks of hearings and closed-door meetings had not resulted in a plan.

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."

If Congress does not repeal the SGR and replace it with a new, stable system, it will threaten the financial viability of physician practices and worsen the health security of millions of patients, according to the American Academy of Family Physicians.

"This is no way to address the federal budget deficit," Dr. Glen Stream, AAFP’s president, said in a statement. "At some point, Congress must face up to its responsibility to its constituents. That time is now."

Starting Nov. 21, the National Committee on Quality Assurance will begin to accredit accountable care organizations.

The program offers three levels of accreditation based on the readiness of the ACO. As with the NCQA’s recognition program for patient-centered medical homes, achieving accreditation at each level will be based on accruing a certain number of points by meeting standards and fulfilling some "must-pass" criteria.

NCQA officials said that they decided to establish the new program while ACOs are still in their infancy in order to provide payers and patients with some assurance about the model. The idea is to let everyone know that if a group of providers calls themselves an ACO, then they have adhered to a set of principles and are doing the right things for patients, Margaret E. O’Kane, NCQA president, said during a Nov. 14 press briefing to announce the program.

Accreditation also offers a "roadmap" for groups that aspire to be ACOs, Ms. O’Kane said, by outlining the elements needed to qualify as an ACO. "If you can meet these standards, you can be an ACO," she said.

The NCQA is launching its accreditation program as many physicians and hospitals are still trying to figure out if they could operate as an ACO. On Oct. 20, the Centers for Medicare and Medicaid Services released its final rule spelling out how an ACO should be structured and how providers in the organization would be paid by Medicare. Ms. O’Kane said that NCQA officials tried to align their accreditation standards with the Medicare rules as much as possible.

NCQA will offer accreditation to providers in group practice arrangements, networks of individual practices, hospital-provider partnerships or joint ventures, hospitals and their employed or contracted providers, publicly governed entities that work with providers to arrange care, and partnerships with providers and health plans. ACOs will need to serve at least 5,000 patients to quality for the NCQA program.

"If you can meet these standards, you can be an ACO, said Margaret E. O’Kane, NCQA president.

ACOs that seek accreditation will be evaluated on 65 elements, including four "must-pass" items. The elements fall into the following seven broad categories:

• Program operations. ACOs must have the infrastructure necessary to coordinate providers.

• Access and availability. ACOs must have sufficient numbers and types of providers, as well as timely access to care. NCQA said that the range of providers should include primary care, specialty care, urgent/emergency/inpatient care, community and home-based services, and long-term care.

• Primary care as the foundation. The NCQA accreditation program builds on the standards in its patient-centered medical home recognition program.

• Care management. This requirement includes providing population health programs.

• Care coordination and transitions. The ACO must have a coordinated system for timely information exchange across multiple providers.

• Patient rights and responsibilities. ACOs must have a process for patient complaints, and a way for patients to restrict access to their data.

• Performance reporting. ACOs must measure their performance and publicly report the results.

ACOs that seek NCQA accreditation will also be evaluated using 40 measures of clinical quality, patient experience, and efficiency and utilization.

The program is the product of 2 years of discussions by the NCQA’s ACO Task Force, which includes patients, policy experts, representatives from integrated health systems, and physicians. NCQA also evaluated 2,200 public comments and pilot tested the standards among integrated delivery systems, multispecialty practice groups, and independent practice associations.

Starting Nov. 21, the National Committee on Quality Assurance will begin to accredit accountable care organizations.

The program offers three levels of accreditation based on the readiness of the ACO. As with the NCQA’s recognition program for patient-centered medical homes, achieving accreditation at each level will be based on accruing a certain number of points by meeting standards and fulfilling some "must-pass" criteria.

NCQA officials said that they decided to establish the new program while ACOs are still in their infancy in order to provide payers and patients with some assurance about the model. The idea is to let everyone know that if a group of providers calls themselves an ACO, then they have adhered to a set of principles and are doing the right things for patients, Margaret E. O’Kane, NCQA president, said during a Nov. 14 press briefing to announce the program.

Accreditation also offers a "roadmap" for groups that aspire to be ACOs, Ms. O’Kane said, by outlining the elements needed to qualify as an ACO. "If you can meet these standards, you can be an ACO," she said.

The NCQA is launching its accreditation program as many physicians and hospitals are still trying to figure out if they could operate as an ACO. On Oct. 20, the Centers for Medicare and Medicaid Services released its final rule spelling out how an ACO should be structured and how providers in the organization would be paid by Medicare. Ms. O’Kane said that NCQA officials tried to align their accreditation standards with the Medicare rules as much as possible.

NCQA will offer accreditation to providers in group practice arrangements, networks of individual practices, hospital-provider partnerships or joint ventures, hospitals and their employed or contracted providers, publicly governed entities that work with providers to arrange care, and partnerships with providers and health plans. ACOs will need to serve at least 5,000 patients to quality for the NCQA program.

"If you can meet these standards, you can be an ACO, said Margaret E. O’Kane, NCQA president.

ACOs that seek accreditation will be evaluated on 65 elements, including four "must-pass" items. The elements fall into the following seven broad categories:

• Program operations. ACOs must have the infrastructure necessary to coordinate providers.

• Access and availability. ACOs must have sufficient numbers and types of providers, as well as timely access to care. NCQA said that the range of providers should include primary care, specialty care, urgent/emergency/inpatient care, community and home-based services, and long-term care.

• Primary care as the foundation. The NCQA accreditation program builds on the standards in its patient-centered medical home recognition program.

• Care management. This requirement includes providing population health programs.

• Care coordination and transitions. The ACO must have a coordinated system for timely information exchange across multiple providers.

• Patient rights and responsibilities. ACOs must have a process for patient complaints, and a way for patients to restrict access to their data.

• Performance reporting. ACOs must measure their performance and publicly report the results.

ACOs that seek NCQA accreditation will also be evaluated using 40 measures of clinical quality, patient experience, and efficiency and utilization.

The program is the product of 2 years of discussions by the NCQA’s ACO Task Force, which includes patients, policy experts, representatives from integrated health systems, and physicians. NCQA also evaluated 2,200 public comments and pilot tested the standards among integrated delivery systems, multispecialty practice groups, and independent practice associations.

Starting Nov. 21, the National Committee on Quality Assurance will begin to accredit accountable care organizations.

The program offers three levels of accreditation based on the readiness of the ACO. As with the NCQA’s recognition program for patient-centered medical homes, achieving accreditation at each level will be based on accruing a certain number of points by meeting standards and fulfilling some "must-pass" criteria.

NCQA officials said that they decided to establish the new program while ACOs are still in their infancy in order to provide payers and patients with some assurance about the model. The idea is to let everyone know that if a group of providers calls themselves an ACO, then they have adhered to a set of principles and are doing the right things for patients, Margaret E. O’Kane, NCQA president, said during a Nov. 14 press briefing to announce the program.

Accreditation also offers a "roadmap" for groups that aspire to be ACOs, Ms. O’Kane said, by outlining the elements needed to qualify as an ACO. "If you can meet these standards, you can be an ACO," she said.

The NCQA is launching its accreditation program as many physicians and hospitals are still trying to figure out if they could operate as an ACO. On Oct. 20, the Centers for Medicare and Medicaid Services released its final rule spelling out how an ACO should be structured and how providers in the organization would be paid by Medicare. Ms. O’Kane said that NCQA officials tried to align their accreditation standards with the Medicare rules as much as possible.

NCQA will offer accreditation to providers in group practice arrangements, networks of individual practices, hospital-provider partnerships or joint ventures, hospitals and their employed or contracted providers, publicly governed entities that work with providers to arrange care, and partnerships with providers and health plans. ACOs will need to serve at least 5,000 patients to quality for the NCQA program.

"If you can meet these standards, you can be an ACO, said Margaret E. O’Kane, NCQA president.

ACOs that seek accreditation will be evaluated on 65 elements, including four "must-pass" items. The elements fall into the following seven broad categories:

• Program operations. ACOs must have the infrastructure necessary to coordinate providers.

• Access and availability. ACOs must have sufficient numbers and types of providers, as well as timely access to care. NCQA said that the range of providers should include primary care, specialty care, urgent/emergency/inpatient care, community and home-based services, and long-term care.

• Primary care as the foundation. The NCQA accreditation program builds on the standards in its patient-centered medical home recognition program.

• Care management. This requirement includes providing population health programs.

• Care coordination and transitions. The ACO must have a coordinated system for timely information exchange across multiple providers.

• Patient rights and responsibilities. ACOs must have a process for patient complaints, and a way for patients to restrict access to their data.

• Performance reporting. ACOs must measure their performance and publicly report the results.

ACOs that seek NCQA accreditation will also be evaluated using 40 measures of clinical quality, patient experience, and efficiency and utilization.

The program is the product of 2 years of discussions by the NCQA’s ACO Task Force, which includes patients, policy experts, representatives from integrated health systems, and physicians. NCQA also evaluated 2,200 public comments and pilot tested the standards among integrated delivery systems, multispecialty practice groups, and independent practice associations.

While public health experts agree that combination vaccines are an important tool for getting more children immunized against preventable diseases, physicians who administer those combination products are likely to be paid less, according to a study published online on November 21 and in the December issue of Pediatrics.

On average, physicians who used the combination vaccine Pediarix were paid $23 less by commercial health plans and $13 less from state Medicaid plans, compared with what they would have received if they had individually administered the components of the Pediarix vaccine – diphtheria, tetanus, acellular pertussis, hepatitis B, and inactivated poliovirus vaccines, according to Angela K. Shen, Sc.D., of the National Vaccine Program Office, Department of Health and Human Services, Washington, and her associates (Pediatrics 2011;128:1087-93).

The discrepancy isn’t due to the payment for the vaccines themselves, but in what physicians receive for their work and practice expenses under the immunization administration codes, said study coauthor Dr. Margie C. Andreae, professor of pediatrics at the University of Michigan, Ann Arbor.

"The difference in the payment for combination vaccines versus individual vaccines is really related to the physician work and counseling," she said.

Researchers from the University of Michigan; George Washington University in Washington; SDI Health in Plymouth Meeting, Pa.; the American Academy of Pediatrics; and the National Vaccine Program Office analyzed 110,040 vaccine claims, with 56,503 in the Pediarix arm and 53,537 in the equivalent component vaccine arm.

The claims were captured from SDI Health’s subscription remittance billing service, which is available to private practice office-based physicians. The study sample included claims from June 2007 to July 2009 for patients under age 2 years.

The researchers concluded that the lower payments were a barrier to the use of combination products.

However, Dr. Andreae said many physicians will be able to benefit from a recent payment policy change aimed at making vaccine payments equivalent regardless of whether the vaccine components are administered individually or in combination. In January 2011, the age-specific CPT codes 90465, 90466, 90467, and 90468 were replaced with two new codes – 90460 and 90461 – that pay physicians for the counseling work they do for each component of the vaccine.

According to an American Academy of Pediatrics document explaining how the new codes work, "code 90460 is reported once for the first component of each vaccine or toxoid administered by any route. The reporting of code 90460 includes counseling for the first vaccine component. Code 90461 is additionally reported for the counseling associated with each additional component of any combination vaccine or toxoid."

"The code was designed to recognize the physician work inherent in combination vaccines," Dr. Andreae said in an interview.

While the codes have been widely recognized by commercial payers, so far the Medicaid program is not paying physicians based on the new codes, she said.

Dr. Andreae said she hopes that the new codes will help practices that deal primarily with commercial payers, but the researchers haven’t analyzed the impact of the payment change.

One of the study authors is employed by SDI Health, which has periodic consulting arrangements with vaccine manufacturers mentioned in the study. Dr. Andreae said she had no relevant financial disclosures. This study was conducted under contract with SDI Health to the National Vaccine Program Office.

While public health experts agree that combination vaccines are an important tool for getting more children immunized against preventable diseases, physicians who administer those combination products are likely to be paid less, according to a study published online on November 21 and in the December issue of Pediatrics.

On average, physicians who used the combination vaccine Pediarix were paid $23 less by commercial health plans and $13 less from state Medicaid plans, compared with what they would have received if they had individually administered the components of the Pediarix vaccine – diphtheria, tetanus, acellular pertussis, hepatitis B, and inactivated poliovirus vaccines, according to Angela K. Shen, Sc.D., of the National Vaccine Program Office, Department of Health and Human Services, Washington, and her associates (Pediatrics 2011;128:1087-93).

The discrepancy isn’t due to the payment for the vaccines themselves, but in what physicians receive for their work and practice expenses under the immunization administration codes, said study coauthor Dr. Margie C. Andreae, professor of pediatrics at the University of Michigan, Ann Arbor.

"The difference in the payment for combination vaccines versus individual vaccines is really related to the physician work and counseling," she said.

Researchers from the University of Michigan; George Washington University in Washington; SDI Health in Plymouth Meeting, Pa.; the American Academy of Pediatrics; and the National Vaccine Program Office analyzed 110,040 vaccine claims, with 56,503 in the Pediarix arm and 53,537 in the equivalent component vaccine arm.

The claims were captured from SDI Health’s subscription remittance billing service, which is available to private practice office-based physicians. The study sample included claims from June 2007 to July 2009 for patients under age 2 years.

The researchers concluded that the lower payments were a barrier to the use of combination products.

However, Dr. Andreae said many physicians will be able to benefit from a recent payment policy change aimed at making vaccine payments equivalent regardless of whether the vaccine components are administered individually or in combination. In January 2011, the age-specific CPT codes 90465, 90466, 90467, and 90468 were replaced with two new codes – 90460 and 90461 – that pay physicians for the counseling work they do for each component of the vaccine.

According to an American Academy of Pediatrics document explaining how the new codes work, "code 90460 is reported once for the first component of each vaccine or toxoid administered by any route. The reporting of code 90460 includes counseling for the first vaccine component. Code 90461 is additionally reported for the counseling associated with each additional component of any combination vaccine or toxoid."

"The code was designed to recognize the physician work inherent in combination vaccines," Dr. Andreae said in an interview.

While the codes have been widely recognized by commercial payers, so far the Medicaid program is not paying physicians based on the new codes, she said.

Dr. Andreae said she hopes that the new codes will help practices that deal primarily with commercial payers, but the researchers haven’t analyzed the impact of the payment change.

One of the study authors is employed by SDI Health, which has periodic consulting arrangements with vaccine manufacturers mentioned in the study. Dr. Andreae said she had no relevant financial disclosures. This study was conducted under contract with SDI Health to the National Vaccine Program Office.

While public health experts agree that combination vaccines are an important tool for getting more children immunized against preventable diseases, physicians who administer those combination products are likely to be paid less, according to a study published online on November 21 and in the December issue of Pediatrics.

On average, physicians who used the combination vaccine Pediarix were paid $23 less by commercial health plans and $13 less from state Medicaid plans, compared with what they would have received if they had individually administered the components of the Pediarix vaccine – diphtheria, tetanus, acellular pertussis, hepatitis B, and inactivated poliovirus vaccines, according to Angela K. Shen, Sc.D., of the National Vaccine Program Office, Department of Health and Human Services, Washington, and her associates (Pediatrics 2011;128:1087-93).

The discrepancy isn’t due to the payment for the vaccines themselves, but in what physicians receive for their work and practice expenses under the immunization administration codes, said study coauthor Dr. Margie C. Andreae, professor of pediatrics at the University of Michigan, Ann Arbor.

"The difference in the payment for combination vaccines versus individual vaccines is really related to the physician work and counseling," she said.

Researchers from the University of Michigan; George Washington University in Washington; SDI Health in Plymouth Meeting, Pa.; the American Academy of Pediatrics; and the National Vaccine Program Office analyzed 110,040 vaccine claims, with 56,503 in the Pediarix arm and 53,537 in the equivalent component vaccine arm.

The claims were captured from SDI Health’s subscription remittance billing service, which is available to private practice office-based physicians. The study sample included claims from June 2007 to July 2009 for patients under age 2 years.

The researchers concluded that the lower payments were a barrier to the use of combination products.

However, Dr. Andreae said many physicians will be able to benefit from a recent payment policy change aimed at making vaccine payments equivalent regardless of whether the vaccine components are administered individually or in combination. In January 2011, the age-specific CPT codes 90465, 90466, 90467, and 90468 were replaced with two new codes – 90460 and 90461 – that pay physicians for the counseling work they do for each component of the vaccine.

According to an American Academy of Pediatrics document explaining how the new codes work, "code 90460 is reported once for the first component of each vaccine or toxoid administered by any route. The reporting of code 90460 includes counseling for the first vaccine component. Code 90461 is additionally reported for the counseling associated with each additional component of any combination vaccine or toxoid."

"The code was designed to recognize the physician work inherent in combination vaccines," Dr. Andreae said in an interview.

While the codes have been widely recognized by commercial payers, so far the Medicaid program is not paying physicians based on the new codes, she said.

Dr. Andreae said she hopes that the new codes will help practices that deal primarily with commercial payers, but the researchers haven’t analyzed the impact of the payment change.

One of the study authors is employed by SDI Health, which has periodic consulting arrangements with vaccine manufacturers mentioned in the study. Dr. Andreae said she had no relevant financial disclosures. This study was conducted under contract with SDI Health to the National Vaccine Program Office.

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 were diagnosed. Seven were categorized as "superficial" and three were considered "deep." But in 2010, only two superficial vascular surgical site infections 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, which has an independent general surgery residency program, 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 of greater than 1 means there are 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 (fraction of inspired oxygen) 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 appeared to pay dividends in terms of reducing infections. Between January 2008 and December 2010, the O/E ratio for vascular surgical site infections fell from 1.97 to 0.93.

The NSQIP was important to the hospital’s success, said Dr. Katz, who is the surgical champion for the NSQIP at Huntington. 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. For example, Dr. Keen’s hospital doesn’t participate in the NSQIP, though he’s been pushing the administration to do so for years, he said. The major stumbling block, he said, is the issue of return on investment. The annual fee for the program is between $10,000 and $24,000, depending on the size of the hospital, but the larger costs come with the full-time employee that’s needed to work with the data. "People don’t necessarily see the return," he said.

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 were diagnosed. Seven were categorized as "superficial" and three were considered "deep." But in 2010, only two superficial vascular surgical site infections 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, which has an independent general surgery residency program, 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 of greater than 1 means there are 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 (fraction of inspired oxygen) 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 appeared to pay dividends in terms of reducing infections. Between January 2008 and December 2010, the O/E ratio for vascular surgical site infections fell from 1.97 to 0.93.

The NSQIP was important to the hospital’s success, said Dr. Katz, who is the surgical champion for the NSQIP at Huntington. 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. For example, Dr. Keen’s hospital doesn’t participate in the NSQIP, though he’s been pushing the administration to do so for years, he said. The major stumbling block, he said, is the issue of return on investment. The annual fee for the program is between $10,000 and $24,000, depending on the size of the hospital, but the larger costs come with the full-time employee that’s needed to work with the data. "People don’t necessarily see the return," he said.

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 were diagnosed. Seven were categorized as "superficial" and three were considered "deep." But in 2010, only two superficial vascular surgical site infections 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, which has an independent general surgery residency program, 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 of greater than 1 means there are 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 (fraction of inspired oxygen) 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 appeared to pay dividends in terms of reducing infections. Between January 2008 and December 2010, the O/E ratio for vascular surgical site infections fell from 1.97 to 0.93.

The NSQIP was important to the hospital’s success, said Dr. Katz, who is the surgical champion for the NSQIP at Huntington. 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. For example, Dr. Keen’s hospital doesn’t participate in the NSQIP, though he’s been pushing the administration to do so for years, he said. The major stumbling block, he said, is the issue of return on investment. The annual fee for the program is between $10,000 and $24,000, depending on the size of the hospital, but the larger costs come with the full-time employee that’s needed to work with the data. "People don’t necessarily see the return," he said.

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 physicians and hospitals gear up to implement electronic health records and other health information technology products, the federal government should increase its scrutiny of these products to ensure that they don’t actually contribute to medical errors.

That was the conclusion of an Institute of Medicine panel, which called on the Health and Human Services Department to assess potential safety risks associated with health IT and come up with a plan to minimize those risks. The plan should be published in 2012, with new reports each year, according to the panel’s recommendations.

But if the HHS secretary determines that the industry is falling short of the safety goals, the Food and Drug Administration should be tasked with regulating electronic health records, personal health records, and health information exchanges, the IOM committee recommended. The IOM study was sponsored by HHS.

The report comes as physicians and hospitals strive to qualify for federal incentive payments for the use of health IT products to meet certain quality benchmarks. The program includes bonus payments in the early years, followed later by penalties if they fail to adopt health IT.

"Based on the literature, HIT certainly has clear and demonstrated potential to improve the safety and the quality of patient care, but it also can cause harm. We’ve heard about that," said Dr. Paul C. Tang, a member of the IOM committee and vice president and chief innovation and technology officer at Palo Alto (Calif.) Medical Foundation.

Although evidence demonstrates that health IT systems have helped to improve medication safety in some places, the literature is inconclusive about IT’s safety benefits in other areas, Dr. Tang said. And there are reports of harm associated with the use of these systems, from dosing errors to delays in treatment, according to the report.

But right now it’s difficult to quantify the safety issues because unlike drugs or devices, health IT software is installed and used differently from institution to institution, said Dr. Tang, who also serves as the vice chair on the HIT Policy Committee, which advises the federal government on the development of a nationwide health information infrastructure.

In addition, there is a wide array of different types of health IT products on the market. There are also contractual issues, such as confidentiality clauses, that may make it difficult for users to share safety concerns about the products, according to the IOM report.

The IOM panel made a series of recommendations aimed at improving the information available on the safety risks and benefits associated with health IT use.

For instance, the panel called on HHS to develop a way for health IT users and vendors to report adverse events related to health IT. And the panel members urged Congress to establish an independent federal entity charged with investigating those adverse events. The body could be modeled on the National Transportation Safety Board, Dr. Tang said.

As physicians and hospitals gear up to implement electronic health records and other health information technology products, the federal government should increase its scrutiny of these products to ensure that they don’t actually contribute to medical errors.

That was the conclusion of an Institute of Medicine panel, which called on the Health and Human Services Department to assess potential safety risks associated with health IT and come up with a plan to minimize those risks. The plan should be published in 2012, with new reports each year, according to the panel’s recommendations.

But if the HHS secretary determines that the industry is falling short of the safety goals, the Food and Drug Administration should be tasked with regulating electronic health records, personal health records, and health information exchanges, the IOM committee recommended. The IOM study was sponsored by HHS.

The report comes as physicians and hospitals strive to qualify for federal incentive payments for the use of health IT products to meet certain quality benchmarks. The program includes bonus payments in the early years, followed later by penalties if they fail to adopt health IT.

"Based on the literature, HIT certainly has clear and demonstrated potential to improve the safety and the quality of patient care, but it also can cause harm. We’ve heard about that," said Dr. Paul C. Tang, a member of the IOM committee and vice president and chief innovation and technology officer at Palo Alto (Calif.) Medical Foundation.

Although evidence demonstrates that health IT systems have helped to improve medication safety in some places, the literature is inconclusive about IT’s safety benefits in other areas, Dr. Tang said. And there are reports of harm associated with the use of these systems, from dosing errors to delays in treatment, according to the report.

But right now it’s difficult to quantify the safety issues because unlike drugs or devices, health IT software is installed and used differently from institution to institution, said Dr. Tang, who also serves as the vice chair on the HIT Policy Committee, which advises the federal government on the development of a nationwide health information infrastructure.

In addition, there is a wide array of different types of health IT products on the market. There are also contractual issues, such as confidentiality clauses, that may make it difficult for users to share safety concerns about the products, according to the IOM report.

The IOM panel made a series of recommendations aimed at improving the information available on the safety risks and benefits associated with health IT use.

For instance, the panel called on HHS to develop a way for health IT users and vendors to report adverse events related to health IT. And the panel members urged Congress to establish an independent federal entity charged with investigating those adverse events. The body could be modeled on the National Transportation Safety Board, Dr. Tang said.

As physicians and hospitals gear up to implement electronic health records and other health information technology products, the federal government should increase its scrutiny of these products to ensure that they don’t actually contribute to medical errors.

That was the conclusion of an Institute of Medicine panel, which called on the Health and Human Services Department to assess potential safety risks associated with health IT and come up with a plan to minimize those risks. The plan should be published in 2012, with new reports each year, according to the panel’s recommendations.

But if the HHS secretary determines that the industry is falling short of the safety goals, the Food and Drug Administration should be tasked with regulating electronic health records, personal health records, and health information exchanges, the IOM committee recommended. The IOM study was sponsored by HHS.

The report comes as physicians and hospitals strive to qualify for federal incentive payments for the use of health IT products to meet certain quality benchmarks. The program includes bonus payments in the early years, followed later by penalties if they fail to adopt health IT.

"Based on the literature, HIT certainly has clear and demonstrated potential to improve the safety and the quality of patient care, but it also can cause harm. We’ve heard about that," said Dr. Paul C. Tang, a member of the IOM committee and vice president and chief innovation and technology officer at Palo Alto (Calif.) Medical Foundation.

Although evidence demonstrates that health IT systems have helped to improve medication safety in some places, the literature is inconclusive about IT’s safety benefits in other areas, Dr. Tang said. And there are reports of harm associated with the use of these systems, from dosing errors to delays in treatment, according to the report.

But right now it’s difficult to quantify the safety issues because unlike drugs or devices, health IT software is installed and used differently from institution to institution, said Dr. Tang, who also serves as the vice chair on the HIT Policy Committee, which advises the federal government on the development of a nationwide health information infrastructure.

In addition, there is a wide array of different types of health IT products on the market. There are also contractual issues, such as confidentiality clauses, that may make it difficult for users to share safety concerns about the products, according to the IOM report.

The IOM panel made a series of recommendations aimed at improving the information available on the safety risks and benefits associated with health IT use.

For instance, the panel called on HHS to develop a way for health IT users and vendors to report adverse events related to health IT. And the panel members urged Congress to establish an independent federal entity charged with investigating those adverse events. The body could be modeled on the National Transportation Safety Board, Dr. Tang said.

The U.S. Supreme Court has agreed to hear arguments on the constitutionality of the Affordable Care Act, with a decision likely to come in June.

On Nov. 14, the high court announced that it would consider arguments related to a well-publicized challenge to the health reform law that was originally filed in Florida. The Florida case, which was brought by a coalition of Republican attorneys general and governors from 26 states along with the National Federation of Independent Business, asserted that the individual mandate, which requires all Americans to have health insurance, violates the Constitution. The coalition of states also objected to the law’s broad expansion of Medicaid. They argued that requiring states to invest billions of dollars in an enlarged Medicaid program violated state sovereignty.

The Supreme Court has agreed to hear arguments related to the constitutionality of both the individual mandate and the Medicaid expansion. The justices also said that if the individual mandate is declared unconstitutional, they will then consider whether the law can stand without it or must be struck down completely.

Opponents of the Affordable Care Act cheered the Supreme Court’s decision to accept the case. Greg Abbott, the attorney general for Texas, which is part of the case being considered by the high court, said the court’s decision to accept the case means the law is just one step closer to being tossed out.

But White House officials also think they can win. "We know the Affordable Care Act is constitutional and are confident the Supreme Court will agree," White House communications director Dan Pfeiffer said in a statement.

Families USA, a consumer advocacy group and supporter of the ACA, issued a statement saying it is "surprised and troubled" that the Supreme Court chose to review the expansion of Medicaid. "It is particularly disingenuous for the states bringing this case to object to this expansion of Medicaid as ‘coercive,’ because the Affordable Care Act specifies that between 90% and 100% of the costs of this expansion will be paid for by the federal government," Families USA executive director Ron Pollack said in a statement. "Striking down this Medicaid expansion would jeopardize health care for millions of low-income Americans at a time when they can least afford it."

The first decision in the Florida case came in January when U.S. District Court Judge Roger Vinson ruled that the individual mandate was unconstitutional and voided the entire law. However, he did not agree with the states’ argument that the law’s Medicaid expansion was unconstitutional.

Next, the 11th Circuit Court of Appeals in Atlanta took up the case, agreeing with Judge Vinson that the individual mandate violated the Commerce Clause of the U.S. Constitution. But in a 2-1 ruling on Aug. 12, the appeals court ruled that the individual mandate could be separated from the rest of the Affordable Care Act, allowing that law to stand.

Both the federal government and the plaintiffs in the Florida suit petitioned the Supreme Court to take up the case. Court watchers had expected the justices to consider the Affordable Care Act in its current term since there have been conflicting rulings from the appeals courts on the law. While the 11th Circuit ruled against the individual mandate, other appeals courts have dismissed challenges to the law.

The U.S. Supreme Court has agreed to hear arguments on the constitutionality of the Affordable Care Act, with a decision likely to come in June.

On Nov. 14, the high court announced that it would consider arguments related to a well-publicized challenge to the health reform law that was originally filed in Florida. The Florida case, which was brought by a coalition of Republican attorneys general and governors from 26 states along with the National Federation of Independent Business, asserted that the individual mandate, which requires all Americans to have health insurance, violates the Constitution. The coalition of states also objected to the law’s broad expansion of Medicaid. They argued that requiring states to invest billions of dollars in an enlarged Medicaid program violated state sovereignty.

The Supreme Court has agreed to hear arguments related to the constitutionality of both the individual mandate and the Medicaid expansion. The justices also said that if the individual mandate is declared unconstitutional, they will then consider whether the law can stand without it or must be struck down completely.

Opponents of the Affordable Care Act cheered the Supreme Court’s decision to accept the case. Greg Abbott, the attorney general for Texas, which is part of the case being considered by the high court, said the court’s decision to accept the case means the law is just one step closer to being tossed out.

But White House officials also think they can win. "We know the Affordable Care Act is constitutional and are confident the Supreme Court will agree," White House communications director Dan Pfeiffer said in a statement.

Families USA, a consumer advocacy group and supporter of the ACA, issued a statement saying it is "surprised and troubled" that the Supreme Court chose to review the expansion of Medicaid. "It is particularly disingenuous for the states bringing this case to object to this expansion of Medicaid as ‘coercive,’ because the Affordable Care Act specifies that between 90% and 100% of the costs of this expansion will be paid for by the federal government," Families USA executive director Ron Pollack said in a statement. "Striking down this Medicaid expansion would jeopardize health care for millions of low-income Americans at a time when they can least afford it."

The first decision in the Florida case came in January when U.S. District Court Judge Roger Vinson ruled that the individual mandate was unconstitutional and voided the entire law. However, he did not agree with the states’ argument that the law’s Medicaid expansion was unconstitutional.

Next, the 11th Circuit Court of Appeals in Atlanta took up the case, agreeing with Judge Vinson that the individual mandate violated the Commerce Clause of the U.S. Constitution. But in a 2-1 ruling on Aug. 12, the appeals court ruled that the individual mandate could be separated from the rest of the Affordable Care Act, allowing that law to stand.

Both the federal government and the plaintiffs in the Florida suit petitioned the Supreme Court to take up the case. Court watchers had expected the justices to consider the Affordable Care Act in its current term since there have been conflicting rulings from the appeals courts on the law. While the 11th Circuit ruled against the individual mandate, other appeals courts have dismissed challenges to the law.

The U.S. Supreme Court has agreed to hear arguments on the constitutionality of the Affordable Care Act, with a decision likely to come in June.

On Nov. 14, the high court announced that it would consider arguments related to a well-publicized challenge to the health reform law that was originally filed in Florida. The Florida case, which was brought by a coalition of Republican attorneys general and governors from 26 states along with the National Federation of Independent Business, asserted that the individual mandate, which requires all Americans to have health insurance, violates the Constitution. The coalition of states also objected to the law’s broad expansion of Medicaid. They argued that requiring states to invest billions of dollars in an enlarged Medicaid program violated state sovereignty.

The Supreme Court has agreed to hear arguments related to the constitutionality of both the individual mandate and the Medicaid expansion. The justices also said that if the individual mandate is declared unconstitutional, they will then consider whether the law can stand without it or must be struck down completely.

Opponents of the Affordable Care Act cheered the Supreme Court’s decision to accept the case. Greg Abbott, the attorney general for Texas, which is part of the case being considered by the high court, said the court’s decision to accept the case means the law is just one step closer to being tossed out.

But White House officials also think they can win. "We know the Affordable Care Act is constitutional and are confident the Supreme Court will agree," White House communications director Dan Pfeiffer said in a statement.

Families USA, a consumer advocacy group and supporter of the ACA, issued a statement saying it is "surprised and troubled" that the Supreme Court chose to review the expansion of Medicaid. "It is particularly disingenuous for the states bringing this case to object to this expansion of Medicaid as ‘coercive,’ because the Affordable Care Act specifies that between 90% and 100% of the costs of this expansion will be paid for by the federal government," Families USA executive director Ron Pollack said in a statement. "Striking down this Medicaid expansion would jeopardize health care for millions of low-income Americans at a time when they can least afford it."

The first decision in the Florida case came in January when U.S. District Court Judge Roger Vinson ruled that the individual mandate was unconstitutional and voided the entire law. However, he did not agree with the states’ argument that the law’s Medicaid expansion was unconstitutional.

Next, the 11th Circuit Court of Appeals in Atlanta took up the case, agreeing with Judge Vinson that the individual mandate violated the Commerce Clause of the U.S. Constitution. But in a 2-1 ruling on Aug. 12, the appeals court ruled that the individual mandate could be separated from the rest of the Affordable Care Act, allowing that law to stand.

Both the federal government and the plaintiffs in the Florida suit petitioned the Supreme Court to take up the case. Court watchers had expected the justices to consider the Affordable Care Act in its current term since there have been conflicting rulings from the appeals courts on the law. While the 11th Circuit ruled against the individual mandate, other appeals courts have dismissed challenges to the law.

At the beginning of his career, Matthew K. Nock, Ph.D., a clinical psychologist, wanted to focus on research that could prevent suicide. The problem was that there wasn’t enough known about what motivated people to harm themselves to start testing ways to intervene.

But Dr. Nock, along with his research team at Harvard University, Cambridge, Mass., has been chipping away at some of those unanswered questions over the last several years, finding links between anxiety and suicidal behavior, and developing a predictive tool that could someday help clinicians identify people with suicidal thoughts.

Earlier this year, Dr. Nock, who at age 38 is a professor of psychology at Harvard, was named as one of 22 fellows by the John D. and Catherine T. MacArthur Foundation. The prestigious award was given to a range of people from across the fields of sports, science, and the arts who were selected for their "creativity, originality, and potential to make important contributions in the future."

The award also comes with a $500,000 "no-strings-attached" grant for the next 5 years. Dr. Nock said he plans to put that money right back into his Harvard lab, where he will seed some pilot projects aimed at attaining a better understanding of suicidal behavior.

He is also continuing work on the suicide implicit association test, a brief, computer-based test that he and his research team developed. It uses a person’s reaction time to measure the extent to which they identify with the concepts of death and suicide. The predictive test has had success in the laboratory and in early tests in the emergency department at Massachusetts General Hospital in Boston (Psychol. Sci. 2010;21:511-7).

The researchers found that the test could distinguish between people with psychiatric distress and those who had made a suicide attempt. It also improved the prediction of future suicide attempts better than with clinician prediction, patient prediction, or chart diagnosis. Dr. Nock said he and his colleagues are now trying to replicate the early results and assessing different versions of the test.

"I think we have promising early findings and now we really want to first try to improve on our predictive accuracy," Dr. Nock said.

The next step will be to determine whether the test can be useful in clinical decision making. "We’re hesitant as a research team to make it widely available and get it out into the hands of clinicians until we know we have the best possible tool," Dr. Nock said.

Dr. Nock’s research also has uncovered new linkages between suicidal behavior and anxiety that could help clinicians identify people who are more likely to act on suicidal thoughts.

After analyzing a data set from the World Health Organization with information from 21 countries, Dr. Nock and a team of researchers found that depression is the strongest predictor of suicidal thoughts. While that finding is not a surprise, they also discovered that depression doesn’t predict which people will act on those thoughts. Disorders characterized by anxiety, agitation, and poor impulse control are what drive people to actually go through with their plans for suicide, Dr. Nock said (PLoS One. 2010;5:e10574).

"We think this work is important, because it helps us tease apart how it is that some disorders are differentially associated with different parts of the pathway to suicide," he said.

Both through his analysis of the World Health Organization data and the development of the suicide implicit association test, Dr. Nock has helped to give clinicians and researchers a better sense of who is at risk, said Dr. Morton Silverman, senior adviser to the Suicide Prevention Resource Center in Newton, Mass., and a clinical associate professor of psychiatry at the University of Chicago.

"This is an incredible advance," he said.

And Dr. Nock’s MacArthur Foundation award also has helped to advance the field, Dr. Silverman said. By including Dr. Nock among its fellows this year, the organization has recognized the study of self-injury and suicide as a "legitimate" scientific endeavor, he said.

"It’s been a tremendous boost, I think, to putting the s-word on the kitchen table and making the topic something that deserves attention," Dr. Silverman said.

But along with attention, the field also needs increased funding, Dr. Silverman and Dr. Nock both agreed.

Funding for self-injury and suicide research lags tremendously behind other disease areas like HIV and breast cancer, even though deaths from suicide outpace those other diseases. But Dr. Silverman said he’s optimistic that the field will get some much-needed funding in the future, in part because of a new public-private effort known as the National Action Alliance for Suicide Prevention. The group, which is supported by the federal government, has been meeting for about a year. It is a public-private partnership aimed at addressing suicide and suicide prevention on a national level. The group is currently working on a prioritized research agenda for suicide prevention that is expected to be released in April 2012.

At the beginning of his career, Matthew K. Nock, Ph.D., a clinical psychologist, wanted to focus on research that could prevent suicide. The problem was that there wasn’t enough known about what motivated people to harm themselves to start testing ways to intervene.

But Dr. Nock, along with his research team at Harvard University, Cambridge, Mass., has been chipping away at some of those unanswered questions over the last several years, finding links between anxiety and suicidal behavior, and developing a predictive tool that could someday help clinicians identify people with suicidal thoughts.

Earlier this year, Dr. Nock, who at age 38 is a professor of psychology at Harvard, was named as one of 22 fellows by the John D. and Catherine T. MacArthur Foundation. The prestigious award was given to a range of people from across the fields of sports, science, and the arts who were selected for their "creativity, originality, and potential to make important contributions in the future."

The award also comes with a $500,000 "no-strings-attached" grant for the next 5 years. Dr. Nock said he plans to put that money right back into his Harvard lab, where he will seed some pilot projects aimed at attaining a better understanding of suicidal behavior.

He is also continuing work on the suicide implicit association test, a brief, computer-based test that he and his research team developed. It uses a person’s reaction time to measure the extent to which they identify with the concepts of death and suicide. The predictive test has had success in the laboratory and in early tests in the emergency department at Massachusetts General Hospital in Boston (Psychol. Sci. 2010;21:511-7).

The researchers found that the test could distinguish between people with psychiatric distress and those who had made a suicide attempt. It also improved the prediction of future suicide attempts better than with clinician prediction, patient prediction, or chart diagnosis. Dr. Nock said he and his colleagues are now trying to replicate the early results and assessing different versions of the test.

"I think we have promising early findings and now we really want to first try to improve on our predictive accuracy," Dr. Nock said.

The next step will be to determine whether the test can be useful in clinical decision making. "We’re hesitant as a research team to make it widely available and get it out into the hands of clinicians until we know we have the best possible tool," Dr. Nock said.

Dr. Nock’s research also has uncovered new linkages between suicidal behavior and anxiety that could help clinicians identify people who are more likely to act on suicidal thoughts.

After analyzing a data set from the World Health Organization with information from 21 countries, Dr. Nock and a team of researchers found that depression is the strongest predictor of suicidal thoughts. While that finding is not a surprise, they also discovered that depression doesn’t predict which people will act on those thoughts. Disorders characterized by anxiety, agitation, and poor impulse control are what drive people to actually go through with their plans for suicide, Dr. Nock said (PLoS One. 2010;5:e10574).

"We think this work is important, because it helps us tease apart how it is that some disorders are differentially associated with different parts of the pathway to suicide," he said.

Both through his analysis of the World Health Organization data and the development of the suicide implicit association test, Dr. Nock has helped to give clinicians and researchers a better sense of who is at risk, said Dr. Morton Silverman, senior adviser to the Suicide Prevention Resource Center in Newton, Mass., and a clinical associate professor of psychiatry at the University of Chicago.

"This is an incredible advance," he said.

And Dr. Nock’s MacArthur Foundation award also has helped to advance the field, Dr. Silverman said. By including Dr. Nock among its fellows this year, the organization has recognized the study of self-injury and suicide as a "legitimate" scientific endeavor, he said.

"It’s been a tremendous boost, I think, to putting the s-word on the kitchen table and making the topic something that deserves attention," Dr. Silverman said.

But along with attention, the field also needs increased funding, Dr. Silverman and Dr. Nock both agreed.

Funding for self-injury and suicide research lags tremendously behind other disease areas like HIV and breast cancer, even though deaths from suicide outpace those other diseases. But Dr. Silverman said he’s optimistic that the field will get some much-needed funding in the future, in part because of a new public-private effort known as the National Action Alliance for Suicide Prevention. The group, which is supported by the federal government, has been meeting for about a year. It is a public-private partnership aimed at addressing suicide and suicide prevention on a national level. The group is currently working on a prioritized research agenda for suicide prevention that is expected to be released in April 2012.

At the beginning of his career, Matthew K. Nock, Ph.D., a clinical psychologist, wanted to focus on research that could prevent suicide. The problem was that there wasn’t enough known about what motivated people to harm themselves to start testing ways to intervene.

But Dr. Nock, along with his research team at Harvard University, Cambridge, Mass., has been chipping away at some of those unanswered questions over the last several years, finding links between anxiety and suicidal behavior, and developing a predictive tool that could someday help clinicians identify people with suicidal thoughts.

Earlier this year, Dr. Nock, who at age 38 is a professor of psychology at Harvard, was named as one of 22 fellows by the John D. and Catherine T. MacArthur Foundation. The prestigious award was given to a range of people from across the fields of sports, science, and the arts who were selected for their "creativity, originality, and potential to make important contributions in the future."

The award also comes with a $500,000 "no-strings-attached" grant for the next 5 years. Dr. Nock said he plans to put that money right back into his Harvard lab, where he will seed some pilot projects aimed at attaining a better understanding of suicidal behavior.

He is also continuing work on the suicide implicit association test, a brief, computer-based test that he and his research team developed. It uses a person’s reaction time to measure the extent to which they identify with the concepts of death and suicide. The predictive test has had success in the laboratory and in early tests in the emergency department at Massachusetts General Hospital in Boston (Psychol. Sci. 2010;21:511-7).

The researchers found that the test could distinguish between people with psychiatric distress and those who had made a suicide attempt. It also improved the prediction of future suicide attempts better than with clinician prediction, patient prediction, or chart diagnosis. Dr. Nock said he and his colleagues are now trying to replicate the early results and assessing different versions of the test.

"I think we have promising early findings and now we really want to first try to improve on our predictive accuracy," Dr. Nock said.

The next step will be to determine whether the test can be useful in clinical decision making. "We’re hesitant as a research team to make it widely available and get it out into the hands of clinicians until we know we have the best possible tool," Dr. Nock said.

Dr. Nock’s research also has uncovered new linkages between suicidal behavior and anxiety that could help clinicians identify people who are more likely to act on suicidal thoughts.

After analyzing a data set from the World Health Organization with information from 21 countries, Dr. Nock and a team of researchers found that depression is the strongest predictor of suicidal thoughts. While that finding is not a surprise, they also discovered that depression doesn’t predict which people will act on those thoughts. Disorders characterized by anxiety, agitation, and poor impulse control are what drive people to actually go through with their plans for suicide, Dr. Nock said (PLoS One. 2010;5:e10574).

"We think this work is important, because it helps us tease apart how it is that some disorders are differentially associated with different parts of the pathway to suicide," he said.

Both through his analysis of the World Health Organization data and the development of the suicide implicit association test, Dr. Nock has helped to give clinicians and researchers a better sense of who is at risk, said Dr. Morton Silverman, senior adviser to the Suicide Prevention Resource Center in Newton, Mass., and a clinical associate professor of psychiatry at the University of Chicago.

"This is an incredible advance," he said.

And Dr. Nock’s MacArthur Foundation award also has helped to advance the field, Dr. Silverman said. By including Dr. Nock among its fellows this year, the organization has recognized the study of self-injury and suicide as a "legitimate" scientific endeavor, he said.

"It’s been a tremendous boost, I think, to putting the s-word on the kitchen table and making the topic something that deserves attention," Dr. Silverman said.

But along with attention, the field also needs increased funding, Dr. Silverman and Dr. Nock both agreed.

Funding for self-injury and suicide research lags tremendously behind other disease areas like HIV and breast cancer, even though deaths from suicide outpace those other diseases. But Dr. Silverman said he’s optimistic that the field will get some much-needed funding in the future, in part because of a new public-private effort known as the National Action Alliance for Suicide Prevention. The group, which is supported by the federal government, has been meeting for about a year. It is a public-private partnership aimed at addressing suicide and suicide prevention on a national level. The group is currently working on a prioritized research agenda for suicide prevention that is expected to be released in April 2012.

Many hospitals may be unprepared for a new Medicare requirement to lower readmissions, and could face resulting financial penalties, according to a new report from the Dartmouth Atlas Project.

Over a 5-year period, hospitals made little progress in reducing readmissions among Medicare beneficiaries 65 years and older. The Dartmouth Atlas researchers found that surgical 30-day readmission rates were 12.7% in both 2004 and 2009, and medical 30-day readmission rates rose from 15.9% in 2004 to 16.1% in 2009. Trends were similar for specific conditions. For example, rates were relatively unchanged for congestive heart failure (20.9% vs. 21.2%) and pneumonia (15.1% vs. 15.3%). However, U.S. hospitals showed some improvement in acute myocardial infarctions, reducing 30-day readmissions from 19.4% in 2004 to 18.5% in 2009.

"For a long-standing and well-recognized problem, not much progress has been made," Dr. David C. Goodman, the study’s lead author and director of the Center for Health Policy Research at the Dartmouth Institute for Health Policy and Clinical Practice, said during a press conference to release the findings.

The researchers analyzed data for fee-for-service Medicare beneficiaries aged 65 years and older who lived in 306 Dartmouth Atlas hospital referral regions and had both Part A and Part B Medicare coverage.

The Affordable Care Act calls on the Centers for Medicare and Medicaid Services to start measuring 30-day hospital readmission rates and to penalize poor performers. In October 2012, hospitals with high readmission rates will face penalties of 1% of their total Medicare billings, increasing to 2% the following year.

Part of the solution to reducing hospital readmissions is good discharge planning, Dr. Goodman said. "This sounds simple but oftendoesn’t happen."

That planning should include having the care team in the hospital develop a care plan and communicate that plan to the patient and their family. It also means ensuring that the patient has all the necessary prescriptions, understands what medications to take and when, and can get their prescriptions. And health care providers in the hospital should also help patients set up follow-up appointments with their primary care physician, Dr. Goodman said.

But aside from discharge planning, there are also "hidden" factors such as how local patterns of hospital use affect readmission rates. Dr. Goodman and his colleagues found that communities and health care systems with higher underlying admission rates also tended to have higher rates of hospital readmission.

The researchers reported no financial conflicts.

Many hospitals may be unprepared for a new Medicare requirement to lower readmissions, and could face resulting financial penalties, according to a new report from the Dartmouth Atlas Project.

Over a 5-year period, hospitals made little progress in reducing readmissions among Medicare beneficiaries 65 years and older. The Dartmouth Atlas researchers found that surgical 30-day readmission rates were 12.7% in both 2004 and 2009, and medical 30-day readmission rates rose from 15.9% in 2004 to 16.1% in 2009. Trends were similar for specific conditions. For example, rates were relatively unchanged for congestive heart failure (20.9% vs. 21.2%) and pneumonia (15.1% vs. 15.3%). However, U.S. hospitals showed some improvement in acute myocardial infarctions, reducing 30-day readmissions from 19.4% in 2004 to 18.5% in 2009.

"For a long-standing and well-recognized problem, not much progress has been made," Dr. David C. Goodman, the study’s lead author and director of the Center for Health Policy Research at the Dartmouth Institute for Health Policy and Clinical Practice, said during a press conference to release the findings.

The researchers analyzed data for fee-for-service Medicare beneficiaries aged 65 years and older who lived in 306 Dartmouth Atlas hospital referral regions and had both Part A and Part B Medicare coverage.

The Affordable Care Act calls on the Centers for Medicare and Medicaid Services to start measuring 30-day hospital readmission rates and to penalize poor performers. In October 2012, hospitals with high readmission rates will face penalties of 1% of their total Medicare billings, increasing to 2% the following year.

Part of the solution to reducing hospital readmissions is good discharge planning, Dr. Goodman said. "This sounds simple but oftendoesn’t happen."

That planning should include having the care team in the hospital develop a care plan and communicate that plan to the patient and their family. It also means ensuring that the patient has all the necessary prescriptions, understands what medications to take and when, and can get their prescriptions. And health care providers in the hospital should also help patients set up follow-up appointments with their primary care physician, Dr. Goodman said.

But aside from discharge planning, there are also "hidden" factors such as how local patterns of hospital use affect readmission rates. Dr. Goodman and his colleagues found that communities and health care systems with higher underlying admission rates also tended to have higher rates of hospital readmission.

The researchers reported no financial conflicts.

Many hospitals may be unprepared for a new Medicare requirement to lower readmissions, and could face resulting financial penalties, according to a new report from the Dartmouth Atlas Project.

Over a 5-year period, hospitals made little progress in reducing readmissions among Medicare beneficiaries 65 years and older. The Dartmouth Atlas researchers found that surgical 30-day readmission rates were 12.7% in both 2004 and 2009, and medical 30-day readmission rates rose from 15.9% in 2004 to 16.1% in 2009. Trends were similar for specific conditions. For example, rates were relatively unchanged for congestive heart failure (20.9% vs. 21.2%) and pneumonia (15.1% vs. 15.3%). However, U.S. hospitals showed some improvement in acute myocardial infarctions, reducing 30-day readmissions from 19.4% in 2004 to 18.5% in 2009.

"For a long-standing and well-recognized problem, not much progress has been made," Dr. David C. Goodman, the study’s lead author and director of the Center for Health Policy Research at the Dartmouth Institute for Health Policy and Clinical Practice, said during a press conference to release the findings.

The researchers analyzed data for fee-for-service Medicare beneficiaries aged 65 years and older who lived in 306 Dartmouth Atlas hospital referral regions and had both Part A and Part B Medicare coverage.

The Affordable Care Act calls on the Centers for Medicare and Medicaid Services to start measuring 30-day hospital readmission rates and to penalize poor performers. In October 2012, hospitals with high readmission rates will face penalties of 1% of their total Medicare billings, increasing to 2% the following year.

Part of the solution to reducing hospital readmissions is good discharge planning, Dr. Goodman said. "This sounds simple but oftendoesn’t happen."

That planning should include having the care team in the hospital develop a care plan and communicate that plan to the patient and their family. It also means ensuring that the patient has all the necessary prescriptions, understands what medications to take and when, and can get their prescriptions. And health care providers in the hospital should also help patients set up follow-up appointments with their primary care physician, Dr. Goodman said.

But aside from discharge planning, there are also "hidden" factors such as how local patterns of hospital use affect readmission rates. Dr. Goodman and his colleagues found that communities and health care systems with higher underlying admission rates also tended to have higher rates of hospital readmission.

The researchers reported no financial conflicts.

LAS VEGAS – Traditional internal medicine, family medicine, and pediatric hospitalists have joined hospitalists from obstetrics, neurology, orthopedics, surgery, and even dermatology to learn about each other and where the new specialty fields may be headed in the future.

About 65 people, mostly physicians, gathered in a nondescript meeting room in a Las Vegas hotel in November to explore the lessons learned from the first 15 years of hospital medicine and to hear how specialists are adapting the hospitalist model to their own fields.

Although there is a common focus on quality and safety across all the groups, there are also plenty of differences in the models, too, said Dr. John Nelson, a cofounder and past president of the Society of Hospital Medicine (SHM) and one of the organizers of the meeting.

For example, while traditional medicine hospitalists tend to have a high volume of cases, some of the other specialties see a smaller number of patients. And while medicine hospitalists do little to no outpatient work, that’s different in surgery where hospitalists must conduct outpatient follow-up for all of their cases to avoid complications.

There are also differences in income. Traditional medicine hospitalists can generally earn more as hospitalists than similarly trained colleagues working in the outpatient setting. But the opposite is generally true for other specialties like neurology, orthopedics, and surgery. In specialty areas, hospitalists tend to earn less than their outpatient counterparts. In part that’s a trade-off for better hours, Dr. Nelson said.

One of the reasons that the Society of Hospital Medicine decided to convene the meeting was to find out more about the similarities and differences between specialty hospitalists and traditional hospitalists and to see where there are areas for collaboration, said Dr. Larry Wellikson, CEO of the SHM.

Dr. Wellikson said that the SHM is sensitive to concerns that specialty hospitalists don’t fit the traditional hospitalist model and that’s why the society is taking its time and feeling out the relationship it will have with these new hospitalists. "We’re right in the exploratory phase," he said. "We’re sort of dating."

There’s clearly the potential for the new specialty hospitalists to become allies for traditional medicine hospitalists in dealing with systems problems in the hospital, Dr. Wellikson said. For example, orthopedic hospitalists might help traditional hospitalists work with the emergency department to move patients out of the ED.

While many of the specialty hospitalist models are only a few years old, they are already being embraced at Hoag, a regional not-for-profit health care system in Orange County, Calif. Dr. Richard Afable, Hoag’s president and CEO, said his health system has six hospitalist programs in place and is considering adding more. "From my view, it’s a standard of care," Dr. Afable said.

At Hoag, millions of dollars have been invested in hospitalist programs, but Dr. Afable said it’s been well worth it. In the traditional medicine hospitalist program, the return on investment is about seven to one, with most of the value coming from reduced length of stay. But even without the return on investment, Dr. Afable said they’d still have hospitalists.

"It’s a necessary expense to run a great hospital," he said.

Dr. Jack S. Weiss, the regional chief medical officer–West for United Healthcare, said the move to specialization in hospital medicine is a "natural evolution on several counts." But he said he also has some concerns about the movement, and he’s not convinced that specialization alone will be a "game changer" in terms of achieving improved care while lowering overall costs. One worry, Dr. Weiss said, is that specialization in hospital medicine will have the same results as specialization in the outpatient world. Specifically, the concern is that generalists would get lower reimbursement and that the hospital would lose the generalist perspective, he said.

LAS VEGAS – Traditional internal medicine, family medicine, and pediatric hospitalists have joined hospitalists from obstetrics, neurology, orthopedics, surgery, and even dermatology to learn about each other and where the new specialty fields may be headed in the future.

About 65 people, mostly physicians, gathered in a nondescript meeting room in a Las Vegas hotel in November to explore the lessons learned from the first 15 years of hospital medicine and to hear how specialists are adapting the hospitalist model to their own fields.

Although there is a common focus on quality and safety across all the groups, there are also plenty of differences in the models, too, said Dr. John Nelson, a cofounder and past president of the Society of Hospital Medicine (SHM) and one of the organizers of the meeting.

For example, while traditional medicine hospitalists tend to have a high volume of cases, some of the other specialties see a smaller number of patients. And while medicine hospitalists do little to no outpatient work, that’s different in surgery where hospitalists must conduct outpatient follow-up for all of their cases to avoid complications.

There are also differences in income. Traditional medicine hospitalists can generally earn more as hospitalists than similarly trained colleagues working in the outpatient setting. But the opposite is generally true for other specialties like neurology, orthopedics, and surgery. In specialty areas, hospitalists tend to earn less than their outpatient counterparts. In part that’s a trade-off for better hours, Dr. Nelson said.

One of the reasons that the Society of Hospital Medicine decided to convene the meeting was to find out more about the similarities and differences between specialty hospitalists and traditional hospitalists and to see where there are areas for collaboration, said Dr. Larry Wellikson, CEO of the SHM.

Dr. Wellikson said that the SHM is sensitive to concerns that specialty hospitalists don’t fit the traditional hospitalist model and that’s why the society is taking its time and feeling out the relationship it will have with these new hospitalists. "We’re right in the exploratory phase," he said. "We’re sort of dating."

There’s clearly the potential for the new specialty hospitalists to become allies for traditional medicine hospitalists in dealing with systems problems in the hospital, Dr. Wellikson said. For example, orthopedic hospitalists might help traditional hospitalists work with the emergency department to move patients out of the ED.

While many of the specialty hospitalist models are only a few years old, they are already being embraced at Hoag, a regional not-for-profit health care system in Orange County, Calif. Dr. Richard Afable, Hoag’s president and CEO, said his health system has six hospitalist programs in place and is considering adding more. "From my view, it’s a standard of care," Dr. Afable said.

At Hoag, millions of dollars have been invested in hospitalist programs, but Dr. Afable said it’s been well worth it. In the traditional medicine hospitalist program, the return on investment is about seven to one, with most of the value coming from reduced length of stay. But even without the return on investment, Dr. Afable said they’d still have hospitalists.

"It’s a necessary expense to run a great hospital," he said.

Dr. Jack S. Weiss, the regional chief medical officer–West for United Healthcare, said the move to specialization in hospital medicine is a "natural evolution on several counts." But he said he also has some concerns about the movement, and he’s not convinced that specialization alone will be a "game changer" in terms of achieving improved care while lowering overall costs. One worry, Dr. Weiss said, is that specialization in hospital medicine will have the same results as specialization in the outpatient world. Specifically, the concern is that generalists would get lower reimbursement and that the hospital would lose the generalist perspective, he said.

LAS VEGAS – Traditional internal medicine, family medicine, and pediatric hospitalists have joined hospitalists from obstetrics, neurology, orthopedics, surgery, and even dermatology to learn about each other and where the new specialty fields may be headed in the future.

About 65 people, mostly physicians, gathered in a nondescript meeting room in a Las Vegas hotel in November to explore the lessons learned from the first 15 years of hospital medicine and to hear how specialists are adapting the hospitalist model to their own fields.

Although there is a common focus on quality and safety across all the groups, there are also plenty of differences in the models, too, said Dr. John Nelson, a cofounder and past president of the Society of Hospital Medicine (SHM) and one of the organizers of the meeting.

For example, while traditional medicine hospitalists tend to have a high volume of cases, some of the other specialties see a smaller number of patients. And while medicine hospitalists do little to no outpatient work, that’s different in surgery where hospitalists must conduct outpatient follow-up for all of their cases to avoid complications.

There are also differences in income. Traditional medicine hospitalists can generally earn more as hospitalists than similarly trained colleagues working in the outpatient setting. But the opposite is generally true for other specialties like neurology, orthopedics, and surgery. In specialty areas, hospitalists tend to earn less than their outpatient counterparts. In part that’s a trade-off for better hours, Dr. Nelson said.

One of the reasons that the Society of Hospital Medicine decided to convene the meeting was to find out more about the similarities and differences between specialty hospitalists and traditional hospitalists and to see where there are areas for collaboration, said Dr. Larry Wellikson, CEO of the SHM.

Dr. Wellikson said that the SHM is sensitive to concerns that specialty hospitalists don’t fit the traditional hospitalist model and that’s why the society is taking its time and feeling out the relationship it will have with these new hospitalists. "We’re right in the exploratory phase," he said. "We’re sort of dating."

There’s clearly the potential for the new specialty hospitalists to become allies for traditional medicine hospitalists in dealing with systems problems in the hospital, Dr. Wellikson said. For example, orthopedic hospitalists might help traditional hospitalists work with the emergency department to move patients out of the ED.

While many of the specialty hospitalist models are only a few years old, they are already being embraced at Hoag, a regional not-for-profit health care system in Orange County, Calif. Dr. Richard Afable, Hoag’s president and CEO, said his health system has six hospitalist programs in place and is considering adding more. "From my view, it’s a standard of care," Dr. Afable said.

At Hoag, millions of dollars have been invested in hospitalist programs, but Dr. Afable said it’s been well worth it. In the traditional medicine hospitalist program, the return on investment is about seven to one, with most of the value coming from reduced length of stay. But even without the return on investment, Dr. Afable said they’d still have hospitalists.

"It’s a necessary expense to run a great hospital," he said.

Dr. Jack S. Weiss, the regional chief medical officer–West for United Healthcare, said the move to specialization in hospital medicine is a "natural evolution on several counts." But he said he also has some concerns about the movement, and he’s not convinced that specialization alone will be a "game changer" in terms of achieving improved care while lowering overall costs. One worry, Dr. Weiss said, is that specialization in hospital medicine will have the same results as specialization in the outpatient world. Specifically, the concern is that generalists would get lower reimbursement and that the hospital would lose the generalist perspective, he said.