Frances Correa

More than three-quarters of surveyed parents said they were concerned about the safety and discomfort of childhood vaccines, with only 23% of respondents saying they had no concerns about childhood vaccination, according to a study conducted by the Centers for Disease Control and Prevention.

Copyright Sean Warren/iStockphoto.com 

Many of those concerns have arisen among parents because of a lack of experience with some of the diseases for which children are vaccinated, CDC researchers explained, as well as a misconception of the potential side effects of vaccines.

Most vaccine-preventable diseases, such as diphtheria and polio, are rarely seen in the United States, said Glen Nowak, one of the study’s main researchers and senior advisor for the CDC’s National Center for Immunization and Respiratory Diseases. However, some vaccine-preventable diseases have been on the rise, Mr. Nowak said in an interview, including whooping cough and measles.

In the CDC study, parental concerns about vaccinating children included worries about the pain of receiving so many shots in a single visit to the doctor’s office (38% of respondents), concerns that children receive too many vaccines in the first 2 years of life (34%), fears that vaccines may cause fevers in children (32%), concerns that vaccines may cause learning disabilities such as autism (30%), and concerns that vaccines’ ingredients are unsafe (26%).

The study was based on data from 2010 HealthStyles e-mail survey of parental vaccine behavior for 4,198 households nationwide. The CDC study limited its analysis to the 476 respondents who reported having one or more children age 6 years or younger.

Parents who don’t vaccinate their children are taking a double risk, he added. "One is that you’re taking the risk that your child won’t get that disease or that illness, and two [is] that if they get that disease or illness, that it won’t turn out to be a very severe case," Mr. Nowak said.

There is a lingering resistance to vaccines that sprang from a 1998 study that linked childhood vaccines and autism, said Mr. Nowak. The study later was found to be fraudulent, and subsequent research has disproved such findings. Nonetheless, nearly a third of survey respondents still said they were concerned that vaccines could cause learning disabilities such as autism.

Dr. Garry Gardner said that although nearly 90% of parents in his practice are comfortable with vaccines, vaccine confidence is still an issue. "There’s still this persistent misconception about [childhood vaccines] and autism that just doesn’t seem to go away," noted Dr. Gardner, a pediatrician practicing in Darien, Ill.

He said once or twice a week he encounters parents who are reluctant to vaccinate their children and many of those parents still believe in the autism/vaccine connection. Further resistance among a small percentage of his patients also comes from a general distrust in traditional medicine and the misconception that too many vaccines could adversely affect a child’s immune system.

More than half of the parents in the CDC study identified their physicians as their most trusted source of information. However, 24% said that the Internet was one of their top three sources of childhood vaccination information.

The researchers cautioned that although hesitance about vaccination may not translate to refusal to vaccinate, physicians should respect and address the concerns associated with childhood vaccination.

No disclosures were provided. All of the researchers worked with the CDC.

More than three-quarters of surveyed parents said they were concerned about the safety and discomfort of childhood vaccines, with only 23% of respondents saying they had no concerns about childhood vaccination, according to a study conducted by the Centers for Disease Control and Prevention.

Copyright Sean Warren/iStockphoto.com 

Many of those concerns have arisen among parents because of a lack of experience with some of the diseases for which children are vaccinated, CDC researchers explained, as well as a misconception of the potential side effects of vaccines.

Most vaccine-preventable diseases, such as diphtheria and polio, are rarely seen in the United States, said Glen Nowak, one of the study’s main researchers and senior advisor for the CDC’s National Center for Immunization and Respiratory Diseases. However, some vaccine-preventable diseases have been on the rise, Mr. Nowak said in an interview, including whooping cough and measles.

In the CDC study, parental concerns about vaccinating children included worries about the pain of receiving so many shots in a single visit to the doctor’s office (38% of respondents), concerns that children receive too many vaccines in the first 2 years of life (34%), fears that vaccines may cause fevers in children (32%), concerns that vaccines may cause learning disabilities such as autism (30%), and concerns that vaccines’ ingredients are unsafe (26%).

The study was based on data from 2010 HealthStyles e-mail survey of parental vaccine behavior for 4,198 households nationwide. The CDC study limited its analysis to the 476 respondents who reported having one or more children age 6 years or younger.

Parents who don’t vaccinate their children are taking a double risk, he added. "One is that you’re taking the risk that your child won’t get that disease or that illness, and two [is] that if they get that disease or illness, that it won’t turn out to be a very severe case," Mr. Nowak said.

There is a lingering resistance to vaccines that sprang from a 1998 study that linked childhood vaccines and autism, said Mr. Nowak. The study later was found to be fraudulent, and subsequent research has disproved such findings. Nonetheless, nearly a third of survey respondents still said they were concerned that vaccines could cause learning disabilities such as autism.

Dr. Garry Gardner said that although nearly 90% of parents in his practice are comfortable with vaccines, vaccine confidence is still an issue. "There’s still this persistent misconception about [childhood vaccines] and autism that just doesn’t seem to go away," noted Dr. Gardner, a pediatrician practicing in Darien, Ill.

He said once or twice a week he encounters parents who are reluctant to vaccinate their children and many of those parents still believe in the autism/vaccine connection. Further resistance among a small percentage of his patients also comes from a general distrust in traditional medicine and the misconception that too many vaccines could adversely affect a child’s immune system.

More than half of the parents in the CDC study identified their physicians as their most trusted source of information. However, 24% said that the Internet was one of their top three sources of childhood vaccination information.

The researchers cautioned that although hesitance about vaccination may not translate to refusal to vaccinate, physicians should respect and address the concerns associated with childhood vaccination.

No disclosures were provided. All of the researchers worked with the CDC.

More than three-quarters of surveyed parents said they were concerned about the safety and discomfort of childhood vaccines, with only 23% of respondents saying they had no concerns about childhood vaccination, according to a study conducted by the Centers for Disease Control and Prevention.

Copyright Sean Warren/iStockphoto.com 

Many of those concerns have arisen among parents because of a lack of experience with some of the diseases for which children are vaccinated, CDC researchers explained, as well as a misconception of the potential side effects of vaccines.

Most vaccine-preventable diseases, such as diphtheria and polio, are rarely seen in the United States, said Glen Nowak, one of the study’s main researchers and senior advisor for the CDC’s National Center for Immunization and Respiratory Diseases. However, some vaccine-preventable diseases have been on the rise, Mr. Nowak said in an interview, including whooping cough and measles.

In the CDC study, parental concerns about vaccinating children included worries about the pain of receiving so many shots in a single visit to the doctor’s office (38% of respondents), concerns that children receive too many vaccines in the first 2 years of life (34%), fears that vaccines may cause fevers in children (32%), concerns that vaccines may cause learning disabilities such as autism (30%), and concerns that vaccines’ ingredients are unsafe (26%).

The study was based on data from 2010 HealthStyles e-mail survey of parental vaccine behavior for 4,198 households nationwide. The CDC study limited its analysis to the 476 respondents who reported having one or more children age 6 years or younger.

Parents who don’t vaccinate their children are taking a double risk, he added. "One is that you’re taking the risk that your child won’t get that disease or that illness, and two [is] that if they get that disease or illness, that it won’t turn out to be a very severe case," Mr. Nowak said.

There is a lingering resistance to vaccines that sprang from a 1998 study that linked childhood vaccines and autism, said Mr. Nowak. The study later was found to be fraudulent, and subsequent research has disproved such findings. Nonetheless, nearly a third of survey respondents still said they were concerned that vaccines could cause learning disabilities such as autism.

Dr. Garry Gardner said that although nearly 90% of parents in his practice are comfortable with vaccines, vaccine confidence is still an issue. "There’s still this persistent misconception about [childhood vaccines] and autism that just doesn’t seem to go away," noted Dr. Gardner, a pediatrician practicing in Darien, Ill.

He said once or twice a week he encounters parents who are reluctant to vaccinate their children and many of those parents still believe in the autism/vaccine connection. Further resistance among a small percentage of his patients also comes from a general distrust in traditional medicine and the misconception that too many vaccines could adversely affect a child’s immune system.

More than half of the parents in the CDC study identified their physicians as their most trusted source of information. However, 24% said that the Internet was one of their top three sources of childhood vaccination information.

The researchers cautioned that although hesitance about vaccination may not translate to refusal to vaccinate, physicians should respect and address the concerns associated with childhood vaccination.

No disclosures were provided. All of the researchers worked with the CDC.

As of July 1, Medicaid will no longer pay heath care providers for preventable, health care–acquired injuries or illnesses.

The final rule, which implements a part of the Affordable Care Act, takes another step forward in reducing unnecessary health care costs, Dr. Donald M. Berwick, administrator for the Center for Medicare and Medicaid Services, said during a June 1 press briefing.

Provider-preventable conditions that will no longer be reimbursed include catheter-associated vascular infections, pressure ulcers, blood incompatibilities, air embolisms, and surgical site infections. Also on the list: providing the wrong surgery, wrong-patient surgery, or wrong surgical site, Dr. Berwick said.

The rule is based on similar measures already implemented under Medicare and independently by many states, Dr. Berwick said.

Currently, 27 states prohibit payment for health care–acquired conditions and 17 do not pay for preventable conditions, according to Cindy Mann, director of CMS’s Center for Medicaid, CHIP, and Survey and Certification.

The Washington State Medicaid program is currently considering ways to increase accountability-based payment systems, according to its chief medical officer, Dr. Jeffery Thompson, who spoke during the press briefing.

Dr. Thompson said the state has determined it could save as much as $100 million, or one-sixth of its budget, by eliminating 30-day hospital readmissions.

Ms. Mann pointed out that examples like these show that avoiding preventable health care costs will improve the quality of care without cutting back on care for those who need it.

Under the provision, states will have the flexibility to expand the list of conditions that will no longer be reimbursed, pending CMS approval. States also will have the option to implement the provisions between July 1, 2011 and July 1, 2012.

As of July 1, Medicaid will no longer pay heath care providers for preventable, health care–acquired injuries or illnesses.

The final rule, which implements a part of the Affordable Care Act, takes another step forward in reducing unnecessary health care costs, Dr. Donald M. Berwick, administrator for the Center for Medicare and Medicaid Services, said during a June 1 press briefing.

Provider-preventable conditions that will no longer be reimbursed include catheter-associated vascular infections, pressure ulcers, blood incompatibilities, air embolisms, and surgical site infections. Also on the list: providing the wrong surgery, wrong-patient surgery, or wrong surgical site, Dr. Berwick said.

The rule is based on similar measures already implemented under Medicare and independently by many states, Dr. Berwick said.

Currently, 27 states prohibit payment for health care–acquired conditions and 17 do not pay for preventable conditions, according to Cindy Mann, director of CMS’s Center for Medicaid, CHIP, and Survey and Certification.

The Washington State Medicaid program is currently considering ways to increase accountability-based payment systems, according to its chief medical officer, Dr. Jeffery Thompson, who spoke during the press briefing.

Dr. Thompson said the state has determined it could save as much as $100 million, or one-sixth of its budget, by eliminating 30-day hospital readmissions.

Ms. Mann pointed out that examples like these show that avoiding preventable health care costs will improve the quality of care without cutting back on care for those who need it.

Under the provision, states will have the flexibility to expand the list of conditions that will no longer be reimbursed, pending CMS approval. States also will have the option to implement the provisions between July 1, 2011 and July 1, 2012.

As of July 1, Medicaid will no longer pay heath care providers for preventable, health care–acquired injuries or illnesses.

The final rule, which implements a part of the Affordable Care Act, takes another step forward in reducing unnecessary health care costs, Dr. Donald M. Berwick, administrator for the Center for Medicare and Medicaid Services, said during a June 1 press briefing.

Provider-preventable conditions that will no longer be reimbursed include catheter-associated vascular infections, pressure ulcers, blood incompatibilities, air embolisms, and surgical site infections. Also on the list: providing the wrong surgery, wrong-patient surgery, or wrong surgical site, Dr. Berwick said.

The rule is based on similar measures already implemented under Medicare and independently by many states, Dr. Berwick said.

Currently, 27 states prohibit payment for health care–acquired conditions and 17 do not pay for preventable conditions, according to Cindy Mann, director of CMS’s Center for Medicaid, CHIP, and Survey and Certification.

The Washington State Medicaid program is currently considering ways to increase accountability-based payment systems, according to its chief medical officer, Dr. Jeffery Thompson, who spoke during the press briefing.

Dr. Thompson said the state has determined it could save as much as $100 million, or one-sixth of its budget, by eliminating 30-day hospital readmissions.

Ms. Mann pointed out that examples like these show that avoiding preventable health care costs will improve the quality of care without cutting back on care for those who need it.

Under the provision, states will have the flexibility to expand the list of conditions that will no longer be reimbursed, pending CMS approval. States also will have the option to implement the provisions between July 1, 2011 and July 1, 2012.

As of July 1, Medicaid will no longer pay heath care providers for preventable, health care–acquired injuries or illnesses.

The final rule, which implements a part of the Affordable Care Act, takes another step forward in reducing unnecessary health care costs, Dr. Donald M. Berwick, administrator for the Center for Medicare and Medicaid Services, said during a June 1 press briefing.

Provider-preventable conditions that will no longer be reimbursed include catheter-associated vascular infections, pressure ulcers, blood incompatibilities, air embolisms, and surgical site infections. Also on the list: providing the wrong surgery, wrong-patient surgery, or wrong surgical site, Dr. Berwick said.

The rule is based on similar measures already implemented under Medicare and independently by many states, Dr. Berwick said.

Currently, 27 states prohibit payment for health care–acquired conditions and 17 do not pay for preventable conditions, according to Cindy Mann, director of CMS’s Center for Medicaid, CHIP, and Survey and Certification.

The Washington State Medicaid program is currently considering ways to increase accountability-based payment systems, according to its chief medical officer, Dr. Jeffery Thompson, who spoke during the press briefing.

Dr. Thompson said the state has determined it could save as much as $100 million, or one-sixth of its budget, by eliminating 30-day hospital readmissions.

Ms. Mann pointed out that examples like these show that avoiding preventable health care costs will improve the quality of care without cutting back on care for those who need it.

Under the provision, states will have the flexibility to expand the list of conditions that will no longer be reimbursed, pending CMS approval. States also will have the option to implement the provisions between July 1, 2011 and July 1, 2012.

As of July 1, Medicaid will no longer pay heath care providers for preventable, health care–acquired injuries or illnesses.

The final rule, which implements a part of the Affordable Care Act, takes another step forward in reducing unnecessary health care costs, Dr. Donald M. Berwick, administrator for the Center for Medicare and Medicaid Services, said during a June 1 press briefing.

Provider-preventable conditions that will no longer be reimbursed include catheter-associated vascular infections, pressure ulcers, blood incompatibilities, air embolisms, and surgical site infections. Also on the list: providing the wrong surgery, wrong-patient surgery, or wrong surgical site, Dr. Berwick said.

The rule is based on similar measures already implemented under Medicare and independently by many states, Dr. Berwick said.

Currently, 27 states prohibit payment for health care–acquired conditions and 17 do not pay for preventable conditions, according to Cindy Mann, director of CMS’s Center for Medicaid, CHIP, and Survey and Certification.

The Washington State Medicaid program is currently considering ways to increase accountability-based payment systems, according to its chief medical officer, Dr. Jeffery Thompson, who spoke during the press briefing.

Dr. Thompson said the state has determined it could save as much as $100 million, or one-sixth of its budget, by eliminating 30-day hospital readmissions.

Ms. Mann pointed out that examples like these show that avoiding preventable health care costs will improve the quality of care without cutting back on care for those who need it.

Under the provision, states will have the flexibility to expand the list of conditions that will no longer be reimbursed, pending CMS approval. States also will have the option to implement the provisions between July 1, 2011 and July 1, 2012.

As of July 1, Medicaid will no longer pay heath care providers for preventable, health care–acquired injuries or illnesses.

The final rule, which implements a part of the Affordable Care Act, takes another step forward in reducing unnecessary health care costs, Dr. Donald M. Berwick, administrator for the Center for Medicare and Medicaid Services, said during a June 1 press briefing.

Provider-preventable conditions that will no longer be reimbursed include catheter-associated vascular infections, pressure ulcers, blood incompatibilities, air embolisms, and surgical site infections. Also on the list: providing the wrong surgery, wrong-patient surgery, or wrong surgical site, Dr. Berwick said.

The rule is based on similar measures already implemented under Medicare and independently by many states, Dr. Berwick said.

Currently, 27 states prohibit payment for health care–acquired conditions and 17 do not pay for preventable conditions, according to Cindy Mann, director of CMS’s Center for Medicaid, CHIP, and Survey and Certification.

The Washington State Medicaid program is currently considering ways to increase accountability-based payment systems, according to its chief medical officer, Dr. Jeffery Thompson, who spoke during the press briefing.

Dr. Thompson said the state has determined it could save as much as $100 million, or one-sixth of its budget, by eliminating 30-day hospital readmissions.

Ms. Mann pointed out that examples like these show that avoiding preventable health care costs will improve the quality of care without cutting back on care for those who need it.

Under the provision, states will have the flexibility to expand the list of conditions that will no longer be reimbursed, pending CMS approval. States also will have the option to implement the provisions between July 1, 2011 and July 1, 2012.

As of July 1, Medicaid will no longer pay heath care providers for preventable, health care–acquired injuries or illnesses.

The final rule, which implements a part of the Affordable Care Act, takes another step forward in reducing unnecessary health care costs, Dr. Donald M. Berwick, administrator for the Center for Medicare and Medicaid Services, said during a June 1 press briefing.

Provider-preventable conditions that will no longer be reimbursed include catheter-associated vascular infections, pressure ulcers, blood incompatibilities, air embolisms, and surgical site infections. Also on the list: providing the wrong surgery, wrong-patient surgery, or wrong surgical site, Dr. Berwick said.

The rule is based on similar measures already implemented under Medicare and independently by many states, Dr. Berwick said.

Currently, 27 states prohibit payment for health care–acquired conditions and 17 do not pay for preventable conditions, according to Cindy Mann, director of CMS’s Center for Medicaid, CHIP, and Survey and Certification.

The Washington State Medicaid program is currently considering ways to increase accountability-based payment systems, according to its chief medical officer, Dr. Jeffery Thompson, who spoke during the press briefing.

Dr. Thompson said the state has determined it could save as much as $100 million, or one-sixth of its budget, by eliminating 30-day hospital readmissions.

Ms. Mann pointed out that examples like these show that avoiding preventable health care costs will improve the quality of care without cutting back on care for those who need it.

Under the provision, states will have the flexibility to expand the list of conditions that will no longer be reimbursed, pending CMS approval. States also will have the option to implement the provisions between July 1, 2011 and July 1, 2012.

As of July 1, Medicaid will no longer pay heath care providers for preventable, health care–acquired injuries or illnesses.

The final rule, which implements a part of the Affordable Care Act, takes another step forward in reducing unnecessary health care costs, Dr. Donald M. Berwick, administrator for the Center for Medicare and Medicaid Services, said during a June 1 press briefing.

Provider-preventable conditions that will no longer be reimbursed include catheter-associated vascular infections, pressure ulcers, blood incompatibilities, air embolisms, and surgical site infections. Also on the list: providing the wrong surgery, wrong-patient surgery, or wrong surgical site, Dr. Berwick said.

The rule is based on similar measures already implemented under Medicare and independently by many states, Dr. Berwick said.

Currently, 27 states prohibit payment for health care–acquired conditions and 17 do not pay for preventable conditions, according to Cindy Mann, director of CMS’s Center for Medicaid, CHIP, and Survey and Certification.

The Washington State Medicaid program is currently considering ways to increase accountability-based payment systems, according to its chief medical officer, Dr. Jeffery Thompson, who spoke during the press briefing.

Dr. Thompson said the state has determined it could save as much as $100 million, or one-sixth of its budget, by eliminating 30-day hospital readmissions.

Ms. Mann pointed out that examples like these show that avoiding preventable health care costs will improve the quality of care without cutting back on care for those who need it.

Under the provision, states will have the flexibility to expand the list of conditions that will no longer be reimbursed, pending CMS approval. States also will have the option to implement the provisions between July 1, 2011 and July 1, 2012.

As of July 1, Medicaid will no longer pay heath care providers for preventable, health care–acquired injuries or illnesses.

The final rule, which implements a part of the Affordable Care Act, takes another step forward in reducing unnecessary health care costs, Dr. Donald M. Berwick, administrator for the Center for Medicare and Medicaid Services, said during a June 1 press briefing.

Provider-preventable conditions that will no longer be reimbursed include catheter-associated vascular infections, pressure ulcers, blood incompatibilities, air embolisms, and surgical site infections. Also on the list: providing the wrong surgery, wrong-patient surgery, or wrong surgical site, Dr. Berwick said.

The rule is based on similar measures already implemented under Medicare and independently by many states, Dr. Berwick said.

Currently, 27 states prohibit payment for health care–acquired conditions and 17 do not pay for preventable conditions, according to Cindy Mann, director of CMS’s Center for Medicaid, CHIP, and Survey and Certification.

The Washington State Medicaid program is currently considering ways to increase accountability-based payment systems, according to its chief medical officer, Dr. Jeffery Thompson, who spoke during the press briefing.

Dr. Thompson said the state has determined it could save as much as $100 million, or one-sixth of its budget, by eliminating 30-day hospital readmissions.

Ms. Mann pointed out that examples like these show that avoiding preventable health care costs will improve the quality of care without cutting back on care for those who need it.

Under the provision, states will have the flexibility to expand the list of conditions that will no longer be reimbursed, pending CMS approval. States also will have the option to implement the provisions between July 1, 2011 and July 1, 2012.

Obesity makes it even less likely that a patient with arthritis is going to exercise, according to findings from two surveys conducted by the Centers for Disease Control and Prevention.

Arthritis is a common comorbidity of obesity. Approximately one-third (35.6%) of adults with self-reported obesity were also affected by physician-diagnosed arthritis, judging from the combined results of the surveys, which were performed in 2007 and 2009.

The combination of arthritis and obesity resulted in a more sedentary lifestyle: 22.7% of obese adults with arthritis were physically inactive, compared with 16.1% with arthritis alone, 13.5% with obesity alone, and 9.4% with neither condition (MMWR 2011;60:614-8).

The state-based, random-digit–dialed telephone survey included a total of 789,460 adults from 50 states, the District of Columbia, Puerto Rico, Guam, and the Virgin Islands. These surveys are part of a series conducted by the CDC to examine the affects of arthritis and comorbid conditions. Previous studies looked at arthritis comorbidity with diabetes and heart disease. CDC researcher Kamil Barbour, Ph.D., said in an interview that results show that patients with chronic conditions are less likely to be physically active if they also have arthritis.

In an editor’s note, the CDC report observed: "Arthritis and obesity are common chronic conditions affecting an estimated 50 million and 72 million U.S. adults, respectively. The findings in this report indicate that these conditions co-occur commonly (one in three adults with obesity also has arthritis) and might hinder the management of both conditions by limiting physical activity. Among adults with both obesity and arthritis, the adjusted likelihood of physical inactivity was 44% higher compared with that of adults with obesity but without arthritis; all state-specific estimates were consistent with these results. These findings suggest that among many persons with obesity, arthritis might be an additional barrier to physical activity."

Dr. Barbour said that numerous barriers involved in arthritis can hinder people’s ability to be active, beyond just being obese. The findings of these surveys should encourage doctors to consider the patient’s full range of difficulties when making recommendations to engage in exercise, he added.

"We want to make [physicians] aware that they should look beyond obesity and any of the current conditions that [patients] may have, and look at the arthritis-specific barriers and kind of tailor their interventions toward addressing these [barriers]."

Dr. Barbour said the CDC will be using this information to augment community physical activity programs through the CDC Arthritis Program. The programs include EnhanceFitness, the Arthritis Foundation Exercise Program, and the Arthritis Foundation Walk With Ease programs, as well as self-management education programs.

Dr. Barbour and the other researchers who conducted and reported the study all work for the CDC.

Obesity makes it even less likely that a patient with arthritis is going to exercise, according to findings from two surveys conducted by the Centers for Disease Control and Prevention.

Arthritis is a common comorbidity of obesity. Approximately one-third (35.6%) of adults with self-reported obesity were also affected by physician-diagnosed arthritis, judging from the combined results of the surveys, which were performed in 2007 and 2009.

The combination of arthritis and obesity resulted in a more sedentary lifestyle: 22.7% of obese adults with arthritis were physically inactive, compared with 16.1% with arthritis alone, 13.5% with obesity alone, and 9.4% with neither condition (MMWR 2011;60:614-8).

The state-based, random-digit–dialed telephone survey included a total of 789,460 adults from 50 states, the District of Columbia, Puerto Rico, Guam, and the Virgin Islands. These surveys are part of a series conducted by the CDC to examine the affects of arthritis and comorbid conditions. Previous studies looked at arthritis comorbidity with diabetes and heart disease. CDC researcher Kamil Barbour, Ph.D., said in an interview that results show that patients with chronic conditions are less likely to be physically active if they also have arthritis.

In an editor’s note, the CDC report observed: "Arthritis and obesity are common chronic conditions affecting an estimated 50 million and 72 million U.S. adults, respectively. The findings in this report indicate that these conditions co-occur commonly (one in three adults with obesity also has arthritis) and might hinder the management of both conditions by limiting physical activity. Among adults with both obesity and arthritis, the adjusted likelihood of physical inactivity was 44% higher compared with that of adults with obesity but without arthritis; all state-specific estimates were consistent with these results. These findings suggest that among many persons with obesity, arthritis might be an additional barrier to physical activity."

Dr. Barbour said that numerous barriers involved in arthritis can hinder people’s ability to be active, beyond just being obese. The findings of these surveys should encourage doctors to consider the patient’s full range of difficulties when making recommendations to engage in exercise, he added.

"We want to make [physicians] aware that they should look beyond obesity and any of the current conditions that [patients] may have, and look at the arthritis-specific barriers and kind of tailor their interventions toward addressing these [barriers]."

Dr. Barbour said the CDC will be using this information to augment community physical activity programs through the CDC Arthritis Program. The programs include EnhanceFitness, the Arthritis Foundation Exercise Program, and the Arthritis Foundation Walk With Ease programs, as well as self-management education programs.

Dr. Barbour and the other researchers who conducted and reported the study all work for the CDC.

Obesity makes it even less likely that a patient with arthritis is going to exercise, according to findings from two surveys conducted by the Centers for Disease Control and Prevention.

Arthritis is a common comorbidity of obesity. Approximately one-third (35.6%) of adults with self-reported obesity were also affected by physician-diagnosed arthritis, judging from the combined results of the surveys, which were performed in 2007 and 2009.

The combination of arthritis and obesity resulted in a more sedentary lifestyle: 22.7% of obese adults with arthritis were physically inactive, compared with 16.1% with arthritis alone, 13.5% with obesity alone, and 9.4% with neither condition (MMWR 2011;60:614-8).

The state-based, random-digit–dialed telephone survey included a total of 789,460 adults from 50 states, the District of Columbia, Puerto Rico, Guam, and the Virgin Islands. These surveys are part of a series conducted by the CDC to examine the affects of arthritis and comorbid conditions. Previous studies looked at arthritis comorbidity with diabetes and heart disease. CDC researcher Kamil Barbour, Ph.D., said in an interview that results show that patients with chronic conditions are less likely to be physically active if they also have arthritis.

In an editor’s note, the CDC report observed: "Arthritis and obesity are common chronic conditions affecting an estimated 50 million and 72 million U.S. adults, respectively. The findings in this report indicate that these conditions co-occur commonly (one in three adults with obesity also has arthritis) and might hinder the management of both conditions by limiting physical activity. Among adults with both obesity and arthritis, the adjusted likelihood of physical inactivity was 44% higher compared with that of adults with obesity but without arthritis; all state-specific estimates were consistent with these results. These findings suggest that among many persons with obesity, arthritis might be an additional barrier to physical activity."

Dr. Barbour said that numerous barriers involved in arthritis can hinder people’s ability to be active, beyond just being obese. The findings of these surveys should encourage doctors to consider the patient’s full range of difficulties when making recommendations to engage in exercise, he added.

"We want to make [physicians] aware that they should look beyond obesity and any of the current conditions that [patients] may have, and look at the arthritis-specific barriers and kind of tailor their interventions toward addressing these [barriers]."

Dr. Barbour said the CDC will be using this information to augment community physical activity programs through the CDC Arthritis Program. The programs include EnhanceFitness, the Arthritis Foundation Exercise Program, and the Arthritis Foundation Walk With Ease programs, as well as self-management education programs.

Dr. Barbour and the other researchers who conducted and reported the study all work for the CDC.

Obesity makes it even less likely that a patient with arthritis is going to exercise, according to findings from two surveys conducted by the Centers for Disease Control and Prevention.

Arthritis is a common comorbidity of obesity. Approximately one-third (35.6%) of adults with self-reported obesity were also affected by physician-diagnosed arthritis, judging from the combined results of the surveys, which were performed in 2007 and 2009.

The combination of arthritis and obesity resulted in a more sedentary lifestyle: 22.7% of obese adults with arthritis were physically inactive, compared with 16.1% with arthritis alone, 13.5% with obesity alone, and 9.4% with neither condition (MMWR 2011;60:614-8).

The state-based, random-digit–dialed telephone survey included a total of 789,460 adults from 50 states, the District of Columbia, Puerto Rico, Guam, and the Virgin Islands. These surveys are part of a series conducted by the CDC to examine the affects of arthritis and comorbid conditions. Previous studies looked at arthritis comorbidity with diabetes and heart disease. CDC researcher Kamil Barbour, Ph.D., said in an interview that results show that patients with chronic conditions are less likely to be physically active if they also have arthritis.

In an editor’s note, the CDC report observed: "Arthritis and obesity are common chronic conditions affecting an estimated 50 million and 72 million U.S. adults, respectively. The findings in this report indicate that these conditions co-occur commonly (one in three adults with obesity also has arthritis) and might hinder the management of both conditions by limiting physical activity. Among adults with both obesity and arthritis, the adjusted likelihood of physical inactivity was 44% higher compared with that of adults with obesity but without arthritis; all state-specific estimates were consistent with these results. These findings suggest that among many persons with obesity, arthritis might be an additional barrier to physical activity."

Dr. Barbour said that numerous barriers involved in arthritis can hinder people’s ability to be active, beyond just being obese. The findings of these surveys should encourage doctors to consider the patient’s full range of difficulties when making recommendations to engage in exercise, he added.

"We want to make [physicians] aware that they should look beyond obesity and any of the current conditions that [patients] may have, and look at the arthritis-specific barriers and kind of tailor their interventions toward addressing these [barriers]."

Dr. Barbour said the CDC will be using this information to augment community physical activity programs through the CDC Arthritis Program. The programs include EnhanceFitness, the Arthritis Foundation Exercise Program, and the Arthritis Foundation Walk With Ease programs, as well as self-management education programs.

Dr. Barbour and the other researchers who conducted and reported the study all work for the CDC.

Obesity makes it even less likely that a patient with arthritis is going to exercise, according to findings from two surveys conducted by the Centers for Disease Control and Prevention.

Arthritis is a common comorbidity of obesity. Approximately one-third (35.6%) of adults with self-reported obesity were also affected by physician-diagnosed arthritis, judging from the combined results of the surveys, which were performed in 2007 and 2009.

The combination of arthritis and obesity resulted in a more sedentary lifestyle: 22.7% of obese adults with arthritis were physically inactive, compared with 16.1% with arthritis alone, 13.5% with obesity alone, and 9.4% with neither condition (MMWR 2011;60:614-8).

The state-based, random-digit–dialed telephone survey included a total of 789,460 adults from 50 states, the District of Columbia, Puerto Rico, Guam, and the Virgin Islands. These surveys are part of a series conducted by the CDC to examine the affects of arthritis and comorbid conditions. Previous studies looked at arthritis comorbidity with diabetes and heart disease. CDC researcher Kamil Barbour, Ph.D., said in an interview that results show that patients with chronic conditions are less likely to be physically active if they also have arthritis.

In an editor’s note, the CDC report observed: "Arthritis and obesity are common chronic conditions affecting an estimated 50 million and 72 million U.S. adults, respectively. The findings in this report indicate that these conditions co-occur commonly (one in three adults with obesity also has arthritis) and might hinder the management of both conditions by limiting physical activity. Among adults with both obesity and arthritis, the adjusted likelihood of physical inactivity was 44% higher compared with that of adults with obesity but without arthritis; all state-specific estimates were consistent with these results. These findings suggest that among many persons with obesity, arthritis might be an additional barrier to physical activity."

Dr. Barbour said that numerous barriers involved in arthritis can hinder people’s ability to be active, beyond just being obese. The findings of these surveys should encourage doctors to consider the patient’s full range of difficulties when making recommendations to engage in exercise, he added.

"We want to make [physicians] aware that they should look beyond obesity and any of the current conditions that [patients] may have, and look at the arthritis-specific barriers and kind of tailor their interventions toward addressing these [barriers]."

Dr. Barbour said the CDC will be using this information to augment community physical activity programs through the CDC Arthritis Program. The programs include EnhanceFitness, the Arthritis Foundation Exercise Program, and the Arthritis Foundation Walk With Ease programs, as well as self-management education programs.

Dr. Barbour and the other researchers who conducted and reported the study all work for the CDC.

Obesity makes it even less likely that a patient with arthritis is going to exercise, according to findings from two surveys conducted by the Centers for Disease Control and Prevention.

Arthritis is a common comorbidity of obesity. Approximately one-third (35.6%) of adults with self-reported obesity were also affected by physician-diagnosed arthritis, judging from the combined results of the surveys, which were performed in 2007 and 2009.

The combination of arthritis and obesity resulted in a more sedentary lifestyle: 22.7% of obese adults with arthritis were physically inactive, compared with 16.1% with arthritis alone, 13.5% with obesity alone, and 9.4% with neither condition (MMWR 2011;60:614-8).

The state-based, random-digit–dialed telephone survey included a total of 789,460 adults from 50 states, the District of Columbia, Puerto Rico, Guam, and the Virgin Islands. These surveys are part of a series conducted by the CDC to examine the affects of arthritis and comorbid conditions. Previous studies looked at arthritis comorbidity with diabetes and heart disease. CDC researcher Kamil Barbour, Ph.D., said in an interview that results show that patients with chronic conditions are less likely to be physically active if they also have arthritis.

In an editor’s note, the CDC report observed: "Arthritis and obesity are common chronic conditions affecting an estimated 50 million and 72 million U.S. adults, respectively. The findings in this report indicate that these conditions co-occur commonly (one in three adults with obesity also has arthritis) and might hinder the management of both conditions by limiting physical activity. Among adults with both obesity and arthritis, the adjusted likelihood of physical inactivity was 44% higher compared with that of adults with obesity but without arthritis; all state-specific estimates were consistent with these results. These findings suggest that among many persons with obesity, arthritis might be an additional barrier to physical activity."

Dr. Barbour said that numerous barriers involved in arthritis can hinder people’s ability to be active, beyond just being obese. The findings of these surveys should encourage doctors to consider the patient’s full range of difficulties when making recommendations to engage in exercise, he added.

"We want to make [physicians] aware that they should look beyond obesity and any of the current conditions that [patients] may have, and look at the arthritis-specific barriers and kind of tailor their interventions toward addressing these [barriers]."

Dr. Barbour said the CDC will be using this information to augment community physical activity programs through the CDC Arthritis Program. The programs include EnhanceFitness, the Arthritis Foundation Exercise Program, and the Arthritis Foundation Walk With Ease programs, as well as self-management education programs.

Dr. Barbour and the other researchers who conducted and reported the study all work for the CDC.

Three new initiatives aim to help physicians make the jump to becoming part of an accountable care organization, officials from the Centers for Medicare and Medicaid services announced May 17.

The Pioneer ACO Model would accelerate the process for ACOs that already have the infrastructure in place to coordinate care for patients. Under this model, private payers would offer provider incentives and would function on a separate contract from the Medicare Shared Savings Program. About 30 integrated health systems are expected to participate in the Pioneer ACO Model project this summer, making a full transition to ACO by September or October, according to Jonathan Blum, director of the Center for Medicare Management, a part of the CMS.

Use of the pioneer model could result in $430 million in Medicare savings over 3 years, according to the CMS Office of the Actuary. The pioneer model will follow the same 65 quality measurements and regulations already assigned to ACOs.

The second initiative is a series of free accelerated development learning sessions to educate providers on becoming an ACO and implementing a coordinated care model. The first of the four learning sessions offered in 2011 will be available June 20–22 in Minneapolis. All materials from the sessions, including webcast sessions, will be publicly available.

Finally, the CMS is requesting public comment on the proposal for providing upfront payments to providers who are interested in becoming ACOs but lack the resources. The accelerated payment program would allow providers who lack the capital to invest in the necessary infrastructure and staffing, Mr. Blum said, adding that the CMS plans to determine how much funding might be provided after evaluating public comments.

These initiatives came as a result of feedback from medical associations during the comment period of the ACO regulations, according to Dr. Donald Berwick, CMS administrator, who added that the challenge to implementing the best model is striking a balance between patient and provider needs. This includes balancing an ACO's need for data with patient privacy, the need for better coordinated care without overburdening providers with regulations, and the need for creating provider incentives without allowing them to avoid methods of care that might threaten those incentives.

Regardless, Mr. Blum said the CMS is devising a model that will greatly improve care. “We think that the ACO model, both the base model but also the Pioneer [model], is one of the best ways for us to improve care and so we're very conscious of the fact that we have to create payment policies and other requirements that provide an attractive model.”

Three new initiatives aim to help physicians make the jump to becoming part of an accountable care organization, officials from the Centers for Medicare and Medicaid services announced May 17.

The Pioneer ACO Model would accelerate the process for ACOs that already have the infrastructure in place to coordinate care for patients. Under this model, private payers would offer provider incentives and would function on a separate contract from the Medicare Shared Savings Program. About 30 integrated health systems are expected to participate in the Pioneer ACO Model project this summer, making a full transition to ACO by September or October, according to Jonathan Blum, director of the Center for Medicare Management, a part of the CMS.

Use of the pioneer model could result in $430 million in Medicare savings over 3 years, according to the CMS Office of the Actuary. The pioneer model will follow the same 65 quality measurements and regulations already assigned to ACOs.

The second initiative is a series of free accelerated development learning sessions to educate providers on becoming an ACO and implementing a coordinated care model. The first of the four learning sessions offered in 2011 will be available June 20–22 in Minneapolis. All materials from the sessions, including webcast sessions, will be publicly available.

Finally, the CMS is requesting public comment on the proposal for providing upfront payments to providers who are interested in becoming ACOs but lack the resources. The accelerated payment program would allow providers who lack the capital to invest in the necessary infrastructure and staffing, Mr. Blum said, adding that the CMS plans to determine how much funding might be provided after evaluating public comments.

These initiatives came as a result of feedback from medical associations during the comment period of the ACO regulations, according to Dr. Donald Berwick, CMS administrator, who added that the challenge to implementing the best model is striking a balance between patient and provider needs. This includes balancing an ACO's need for data with patient privacy, the need for better coordinated care without overburdening providers with regulations, and the need for creating provider incentives without allowing them to avoid methods of care that might threaten those incentives.

Regardless, Mr. Blum said the CMS is devising a model that will greatly improve care. “We think that the ACO model, both the base model but also the Pioneer [model], is one of the best ways for us to improve care and so we're very conscious of the fact that we have to create payment policies and other requirements that provide an attractive model.”

Three new initiatives aim to help physicians make the jump to becoming part of an accountable care organization, officials from the Centers for Medicare and Medicaid services announced May 17.

The Pioneer ACO Model would accelerate the process for ACOs that already have the infrastructure in place to coordinate care for patients. Under this model, private payers would offer provider incentives and would function on a separate contract from the Medicare Shared Savings Program. About 30 integrated health systems are expected to participate in the Pioneer ACO Model project this summer, making a full transition to ACO by September or October, according to Jonathan Blum, director of the Center for Medicare Management, a part of the CMS.

Use of the pioneer model could result in $430 million in Medicare savings over 3 years, according to the CMS Office of the Actuary. The pioneer model will follow the same 65 quality measurements and regulations already assigned to ACOs.

The second initiative is a series of free accelerated development learning sessions to educate providers on becoming an ACO and implementing a coordinated care model. The first of the four learning sessions offered in 2011 will be available June 20–22 in Minneapolis. All materials from the sessions, including webcast sessions, will be publicly available.

Finally, the CMS is requesting public comment on the proposal for providing upfront payments to providers who are interested in becoming ACOs but lack the resources. The accelerated payment program would allow providers who lack the capital to invest in the necessary infrastructure and staffing, Mr. Blum said, adding that the CMS plans to determine how much funding might be provided after evaluating public comments.

These initiatives came as a result of feedback from medical associations during the comment period of the ACO regulations, according to Dr. Donald Berwick, CMS administrator, who added that the challenge to implementing the best model is striking a balance between patient and provider needs. This includes balancing an ACO's need for data with patient privacy, the need for better coordinated care without overburdening providers with regulations, and the need for creating provider incentives without allowing them to avoid methods of care that might threaten those incentives.

Regardless, Mr. Blum said the CMS is devising a model that will greatly improve care. “We think that the ACO model, both the base model but also the Pioneer [model], is one of the best ways for us to improve care and so we're very conscious of the fact that we have to create payment policies and other requirements that provide an attractive model.”

WASHINGTON – A plan to finally replace Medicare's much maligned Sustainable Growth Rate payment formula could be unveiled by this summer, federal lawmakers predicted at a committee hearing.

“Here's the bottom line: If we get to December and we're doing an extension, that's a failure on our part,” Rep. Michael Burgess (R-Tex.) said at the hearing. “We need a permanent solution that's predictable, updatable, and reasonable for this year – and nothing else will do.”

“Whatever virtues the SGR had when it was created 14 years ago, … it's clear that they have vanished,” noted Rep. Henry A. Waxman (D-Calif.). He added that in the past 2 years, Congress has had to pass legislation six times, blocking fee cuts of up to 21% or more.

Approximately 30 medical associations responded to the House subcommittee's request for suggestions and proposals in developing a new system. Speaking Thursday with a five-person panel of experts from medical associations and health policy organizations, House subcommittee members considered alternatives to the current SGR formula, which some participants labeled as anything but sustainable.

While the details of the plans vary, they do show a consensus on several fronts: repealing the SGR, moving away from the traditional fee-for-services payment model, and providing a 4- to 5-year transition period in which providers can experiment with a variety of payment systems.

The expert panel also stressed the importance of avoiding a “one size fits all” solution.

“I think we should also have a realization that what will work in one part of the country will not work in another part of the country, and that's why we have continued to talk about a variety of options,” said Dr. Cecil B. Wilson, president of the American Medical Association. “There is a temptation to feel like we ought to figure out one rule … that solves it all.”

Dr. Wilson pointed to the provisions in the Affordable Care Act that allow for a variety of models of accountable care organizations, embodying the concept of options in the medical system. In that spirit, Dr. Wilson said that the AMA has formed a physician leadership group to evaluate the effectiveness of alternative payment methods.

“The evidence shows that to achieve the savings that Congress is looking for, and to improve the quality of health care delivered to millions of patients in the country, reform must include investment in primary care,” Dr. Roland A. Goertz, president of the American Academy of Family Physicians, noted in written testimony to the committee.

To strengthen primary care's role in Medicare, the AAFP backs payment reforms that would boost primary care reimbursement and support the concept of the patient-centered medical home (PCMH). The AAFP's proposal would create a blended reimbursement system for primary care delivered within a PCMH: fee-for-service payments and pay for performance, plus care management fees for PCMH-related activities that don't involve direct patient care.

To prepare for that new payment system, the AAFP has proposed a 5-year transition period with mandated pay increases for primary care physicians, an increase in the Primary Care Incentive Care payment from 10% to 20%, and a rule that Medicaid payments to primary care physicians will always be at least equal to Medicare payments.

Dr. David Hoyt, executive director of the American College of Surgeons, said the college is analyzing the use of bundled payments for surgery.

Dr. M. Todd Williamson, of the Coalition of State Medical and National Specialty Societies, introduced the option of private contracting, in which patients would be free to apply their benefits to a doctor of their choice, who would be free to opt out on a per-patient basis.

The panelists also asserted their belief that whatever plan chosen should be physician led, with financial support of the government.

“It would be very helpful if physicians could get better financial support in their own payment system to enable them to lead all of those efforts,” said Dr. Mark B. McClellan, director of the Engelberg Center for Health care Reform and former administrator of the Centers for Medicare and Medicaid Services. “Right now, with fee-for-service staying the way it is, they're staying behind.” He added that physicians can be the best sources for innovative and cost-saving mechanisms.

“What will work in one part of the country will not work in another,” Dr. Cecil B. Wilson (center) asserted.

Source Courtesy American Medical Association

WASHINGTON – A plan to finally replace Medicare's much maligned Sustainable Growth Rate payment formula could be unveiled by this summer, federal lawmakers predicted at a committee hearing.

“Here's the bottom line: If we get to December and we're doing an extension, that's a failure on our part,” Rep. Michael Burgess (R-Tex.) said at the hearing. “We need a permanent solution that's predictable, updatable, and reasonable for this year – and nothing else will do.”

“Whatever virtues the SGR had when it was created 14 years ago, … it's clear that they have vanished,” noted Rep. Henry A. Waxman (D-Calif.). He added that in the past 2 years, Congress has had to pass legislation six times, blocking fee cuts of up to 21% or more.

Approximately 30 medical associations responded to the House subcommittee's request for suggestions and proposals in developing a new system. Speaking Thursday with a five-person panel of experts from medical associations and health policy organizations, House subcommittee members considered alternatives to the current SGR formula, which some participants labeled as anything but sustainable.

While the details of the plans vary, they do show a consensus on several fronts: repealing the SGR, moving away from the traditional fee-for-services payment model, and providing a 4- to 5-year transition period in which providers can experiment with a variety of payment systems.

The expert panel also stressed the importance of avoiding a “one size fits all” solution.

“I think we should also have a realization that what will work in one part of the country will not work in another part of the country, and that's why we have continued to talk about a variety of options,” said Dr. Cecil B. Wilson, president of the American Medical Association. “There is a temptation to feel like we ought to figure out one rule … that solves it all.”

Dr. Wilson pointed to the provisions in the Affordable Care Act that allow for a variety of models of accountable care organizations, embodying the concept of options in the medical system. In that spirit, Dr. Wilson said that the AMA has formed a physician leadership group to evaluate the effectiveness of alternative payment methods.

“The evidence shows that to achieve the savings that Congress is looking for, and to improve the quality of health care delivered to millions of patients in the country, reform must include investment in primary care,” Dr. Roland A. Goertz, president of the American Academy of Family Physicians, noted in written testimony to the committee.

To strengthen primary care's role in Medicare, the AAFP backs payment reforms that would boost primary care reimbursement and support the concept of the patient-centered medical home (PCMH). The AAFP's proposal would create a blended reimbursement system for primary care delivered within a PCMH: fee-for-service payments and pay for performance, plus care management fees for PCMH-related activities that don't involve direct patient care.

To prepare for that new payment system, the AAFP has proposed a 5-year transition period with mandated pay increases for primary care physicians, an increase in the Primary Care Incentive Care payment from 10% to 20%, and a rule that Medicaid payments to primary care physicians will always be at least equal to Medicare payments.

Dr. David Hoyt, executive director of the American College of Surgeons, said the college is analyzing the use of bundled payments for surgery.

Dr. M. Todd Williamson, of the Coalition of State Medical and National Specialty Societies, introduced the option of private contracting, in which patients would be free to apply their benefits to a doctor of their choice, who would be free to opt out on a per-patient basis.

The panelists also asserted their belief that whatever plan chosen should be physician led, with financial support of the government.

“It would be very helpful if physicians could get better financial support in their own payment system to enable them to lead all of those efforts,” said Dr. Mark B. McClellan, director of the Engelberg Center for Health care Reform and former administrator of the Centers for Medicare and Medicaid Services. “Right now, with fee-for-service staying the way it is, they're staying behind.” He added that physicians can be the best sources for innovative and cost-saving mechanisms.

“What will work in one part of the country will not work in another,” Dr. Cecil B. Wilson (center) asserted.

Source Courtesy American Medical Association

WASHINGTON – A plan to finally replace Medicare's much maligned Sustainable Growth Rate payment formula could be unveiled by this summer, federal lawmakers predicted at a committee hearing.

“Here's the bottom line: If we get to December and we're doing an extension, that's a failure on our part,” Rep. Michael Burgess (R-Tex.) said at the hearing. “We need a permanent solution that's predictable, updatable, and reasonable for this year – and nothing else will do.”

“Whatever virtues the SGR had when it was created 14 years ago, … it's clear that they have vanished,” noted Rep. Henry A. Waxman (D-Calif.). He added that in the past 2 years, Congress has had to pass legislation six times, blocking fee cuts of up to 21% or more.

Approximately 30 medical associations responded to the House subcommittee's request for suggestions and proposals in developing a new system. Speaking Thursday with a five-person panel of experts from medical associations and health policy organizations, House subcommittee members considered alternatives to the current SGR formula, which some participants labeled as anything but sustainable.

While the details of the plans vary, they do show a consensus on several fronts: repealing the SGR, moving away from the traditional fee-for-services payment model, and providing a 4- to 5-year transition period in which providers can experiment with a variety of payment systems.

The expert panel also stressed the importance of avoiding a “one size fits all” solution.

“I think we should also have a realization that what will work in one part of the country will not work in another part of the country, and that's why we have continued to talk about a variety of options,” said Dr. Cecil B. Wilson, president of the American Medical Association. “There is a temptation to feel like we ought to figure out one rule … that solves it all.”

Dr. Wilson pointed to the provisions in the Affordable Care Act that allow for a variety of models of accountable care organizations, embodying the concept of options in the medical system. In that spirit, Dr. Wilson said that the AMA has formed a physician leadership group to evaluate the effectiveness of alternative payment methods.

“The evidence shows that to achieve the savings that Congress is looking for, and to improve the quality of health care delivered to millions of patients in the country, reform must include investment in primary care,” Dr. Roland A. Goertz, president of the American Academy of Family Physicians, noted in written testimony to the committee.

To strengthen primary care's role in Medicare, the AAFP backs payment reforms that would boost primary care reimbursement and support the concept of the patient-centered medical home (PCMH). The AAFP's proposal would create a blended reimbursement system for primary care delivered within a PCMH: fee-for-service payments and pay for performance, plus care management fees for PCMH-related activities that don't involve direct patient care.

To prepare for that new payment system, the AAFP has proposed a 5-year transition period with mandated pay increases for primary care physicians, an increase in the Primary Care Incentive Care payment from 10% to 20%, and a rule that Medicaid payments to primary care physicians will always be at least equal to Medicare payments.

Dr. David Hoyt, executive director of the American College of Surgeons, said the college is analyzing the use of bundled payments for surgery.

Dr. M. Todd Williamson, of the Coalition of State Medical and National Specialty Societies, introduced the option of private contracting, in which patients would be free to apply their benefits to a doctor of their choice, who would be free to opt out on a per-patient basis.

The panelists also asserted their belief that whatever plan chosen should be physician led, with financial support of the government.

“It would be very helpful if physicians could get better financial support in their own payment system to enable them to lead all of those efforts,” said Dr. Mark B. McClellan, director of the Engelberg Center for Health care Reform and former administrator of the Centers for Medicare and Medicaid Services. “Right now, with fee-for-service staying the way it is, they're staying behind.” He added that physicians can be the best sources for innovative and cost-saving mechanisms.

“What will work in one part of the country will not work in another,” Dr. Cecil B. Wilson (center) asserted.

Source Courtesy American Medical Association

WASHINGTON – At a recent hearing on public reporting of hospital performance data, panelists agreed on the importance of measuring for quality, but not on which measurement standards to use.

Current data used to evaluate performance are limited to too small a number of determining factors, asserted Nancy Foster, vice president for quality and patient safety at the American Hospital Association. Ms. Foster served on the five-person panel at a forum titled “Public Reporting of Quality Outcomes: What's the Best Path Forward?”

In March, the Centers for Medicare and Medicaid Services published data on hospitals' incidents of eight conditions: foreign object remaining after surgery, air embolisms, blood incompatibility, late-stage pressure ulcers, falls and trauma, vascular catheter–associated infections, catheter-associated urinary tract infections, and manifestations of poor glycemic control.

The data present each condition per 1,000 discharges and include national rates of hospital-association conditions. The data were based on claims information submitted by Medicare patients from October 2008 through June 2010.

Ms. Foster maintains that the CMS data are not clinically sound. One example she gave was of hospitals with high reimbursement rates, so-called safety net hospitals that provide care to all individuals regardless of their ability to pay. These facilities, she emphasized, are generally located in communities that lack sufficient health care resources for the populations they serve.

“It shouldn't be a surprise to us that if they can't get their medications following discharge from the hospital, that if they can't get into the right physician office or rehab treatment or whatever else they need, those patients are going to come back to us in larger numbers than in communities where they have adequate access to all those kinds of resources,” Ms. Foster said.

Physicians will sometimes avoid treating patients who are sicker or on Medicaid because they are high risk and could make the hospital's public reports look bad, said Dr. David Share, vice president of Value Partnerships at Blue Cross Blue Shield of Michigan.

“Sometimes the way we measure [quality] actually forces providers to focus on cohorts of patients who aren't going to get the most benefit, but they'll focus there because they're concerned that they won't look good if they don't,” Dr. Share said. He added that lower-quality outcomes could also be based on a poor hospital system, not necessarily individual physician performance, which he said should be measured separately.

Gerald Shea, assistant to the president of governmental affairs for the AFL-CIO, Washington, argued that improvement is also a question of cost, which he said amounts to nearly $250,000 to test and institute a quality measure.

“We've been severely hampered in this enterprise by basically only being able to develop those measures when somebody came forward and said 'we'll pay to develop them.'”

There may be flaws in the current data from public reporting, but Mr. Shea said reports have increased awareness for quality care and encouraged significant changes within hospitals. Since 2000, hospitals have increased their attention on factors including readmission rates, the importance of collegial cooperation, and hospital-association conditions, he said.

The Affordable Care Act will require health exchange plans to publicly report on quality of care based on 65 measures.

“There's a lot of pressure now and a lot of opportunity to use public reporting and transparency as a true level to foster high performance in the country,” said Dr. Anne-Marie Audet, vice president for health systems quality and efficiency at the Commonwealth Fund. Systems continue to focus on ways to create better care and better health at a lower cost.

Thomas Scully, senior counsel at the law office of Alston & Bird in Washington, also served on the panel.

WASHINGTON – At a recent hearing on public reporting of hospital performance data, panelists agreed on the importance of measuring for quality, but not on which measurement standards to use.

Current data used to evaluate performance are limited to too small a number of determining factors, asserted Nancy Foster, vice president for quality and patient safety at the American Hospital Association. Ms. Foster served on the five-person panel at a forum titled “Public Reporting of Quality Outcomes: What's the Best Path Forward?”

In March, the Centers for Medicare and Medicaid Services published data on hospitals' incidents of eight conditions: foreign object remaining after surgery, air embolisms, blood incompatibility, late-stage pressure ulcers, falls and trauma, vascular catheter–associated infections, catheter-associated urinary tract infections, and manifestations of poor glycemic control.

The data present each condition per 1,000 discharges and include national rates of hospital-association conditions. The data were based on claims information submitted by Medicare patients from October 2008 through June 2010.

Ms. Foster maintains that the CMS data are not clinically sound. One example she gave was of hospitals with high reimbursement rates, so-called safety net hospitals that provide care to all individuals regardless of their ability to pay. These facilities, she emphasized, are generally located in communities that lack sufficient health care resources for the populations they serve.

“It shouldn't be a surprise to us that if they can't get their medications following discharge from the hospital, that if they can't get into the right physician office or rehab treatment or whatever else they need, those patients are going to come back to us in larger numbers than in communities where they have adequate access to all those kinds of resources,” Ms. Foster said.

Physicians will sometimes avoid treating patients who are sicker or on Medicaid because they are high risk and could make the hospital's public reports look bad, said Dr. David Share, vice president of Value Partnerships at Blue Cross Blue Shield of Michigan.

“Sometimes the way we measure [quality] actually forces providers to focus on cohorts of patients who aren't going to get the most benefit, but they'll focus there because they're concerned that they won't look good if they don't,” Dr. Share said. He added that lower-quality outcomes could also be based on a poor hospital system, not necessarily individual physician performance, which he said should be measured separately.

Gerald Shea, assistant to the president of governmental affairs for the AFL-CIO, Washington, argued that improvement is also a question of cost, which he said amounts to nearly $250,000 to test and institute a quality measure.

“We've been severely hampered in this enterprise by basically only being able to develop those measures when somebody came forward and said 'we'll pay to develop them.'”

There may be flaws in the current data from public reporting, but Mr. Shea said reports have increased awareness for quality care and encouraged significant changes within hospitals. Since 2000, hospitals have increased their attention on factors including readmission rates, the importance of collegial cooperation, and hospital-association conditions, he said.

The Affordable Care Act will require health exchange plans to publicly report on quality of care based on 65 measures.

“There's a lot of pressure now and a lot of opportunity to use public reporting and transparency as a true level to foster high performance in the country,” said Dr. Anne-Marie Audet, vice president for health systems quality and efficiency at the Commonwealth Fund. Systems continue to focus on ways to create better care and better health at a lower cost.

Thomas Scully, senior counsel at the law office of Alston & Bird in Washington, also served on the panel.

WASHINGTON – At a recent hearing on public reporting of hospital performance data, panelists agreed on the importance of measuring for quality, but not on which measurement standards to use.

Current data used to evaluate performance are limited to too small a number of determining factors, asserted Nancy Foster, vice president for quality and patient safety at the American Hospital Association. Ms. Foster served on the five-person panel at a forum titled “Public Reporting of Quality Outcomes: What's the Best Path Forward?”

In March, the Centers for Medicare and Medicaid Services published data on hospitals' incidents of eight conditions: foreign object remaining after surgery, air embolisms, blood incompatibility, late-stage pressure ulcers, falls and trauma, vascular catheter–associated infections, catheter-associated urinary tract infections, and manifestations of poor glycemic control.

The data present each condition per 1,000 discharges and include national rates of hospital-association conditions. The data were based on claims information submitted by Medicare patients from October 2008 through June 2010.

Ms. Foster maintains that the CMS data are not clinically sound. One example she gave was of hospitals with high reimbursement rates, so-called safety net hospitals that provide care to all individuals regardless of their ability to pay. These facilities, she emphasized, are generally located in communities that lack sufficient health care resources for the populations they serve.

“It shouldn't be a surprise to us that if they can't get their medications following discharge from the hospital, that if they can't get into the right physician office or rehab treatment or whatever else they need, those patients are going to come back to us in larger numbers than in communities where they have adequate access to all those kinds of resources,” Ms. Foster said.

Physicians will sometimes avoid treating patients who are sicker or on Medicaid because they are high risk and could make the hospital's public reports look bad, said Dr. David Share, vice president of Value Partnerships at Blue Cross Blue Shield of Michigan.

“Sometimes the way we measure [quality] actually forces providers to focus on cohorts of patients who aren't going to get the most benefit, but they'll focus there because they're concerned that they won't look good if they don't,” Dr. Share said. He added that lower-quality outcomes could also be based on a poor hospital system, not necessarily individual physician performance, which he said should be measured separately.

Gerald Shea, assistant to the president of governmental affairs for the AFL-CIO, Washington, argued that improvement is also a question of cost, which he said amounts to nearly $250,000 to test and institute a quality measure.

“We've been severely hampered in this enterprise by basically only being able to develop those measures when somebody came forward and said 'we'll pay to develop them.'”

There may be flaws in the current data from public reporting, but Mr. Shea said reports have increased awareness for quality care and encouraged significant changes within hospitals. Since 2000, hospitals have increased their attention on factors including readmission rates, the importance of collegial cooperation, and hospital-association conditions, he said.

The Affordable Care Act will require health exchange plans to publicly report on quality of care based on 65 measures.

“There's a lot of pressure now and a lot of opportunity to use public reporting and transparency as a true level to foster high performance in the country,” said Dr. Anne-Marie Audet, vice president for health systems quality and efficiency at the Commonwealth Fund. Systems continue to focus on ways to create better care and better health at a lower cost.

Thomas Scully, senior counsel at the law office of Alston & Bird in Washington, also served on the panel.

A 40% premium cut and simpler enrollment procedures are two changes the federal government is employing to increase enrollment in the Pre-Existing Condition Insurance Plan, Health and Human Services Secretary Kathleen Sebelius announced.

Launched in July 2010 under the Affordable Care Act (ACA), the Pre-Existing Condition Insurance Plan (PCIP) provides an insurance option for people with preexisting conditions who have been denied coverage and have been without insurance for 6 months or more.

To increase awareness for the program, HHS will offer payment for insurance brokers and agents for successfully connecting eligible enrollees with the PCIP program, said Richard Popper, deputy director of insurance programs in the Office of Consumer Information and Insurance Oversight.

People who are seeking coverage under the PCIP will no longer have to wait to receive a denial letter from their insurance company in order to enroll in the plan.

Instead, they can provide attestation of their condition from their physician, nurse practitioner, or physician assistant.

Patients with preexisting conditions still will be required to be without insurance for 6 months before they are eligible for coverage under the plan, said Mr. Popper. He added that HHS does not have the authority to waive the 6-month waiting period under the current health law.

Ms. Sebelius emphasized HHS's priority to increase PCIP's enrollment. “It's encouraging to see more people who need health insurance the most getting it, but we know that's not enough,” she said.

The measures comply with the ACA provision requiring the PCIP to align premiums and benefits with the private insurance market, Mr. Popper said. However, he said there's still plenty of room for new enrollees.

“We've been enrolling people at an increasing rate, but we know we have the capacity to cover even more people,” Mr. Popper said, adding that funding for the measures will fall under the original $5 billion set aside for the program through the health reform law, as well as existing member premiums.

Despite original HHS estimates that several hundred thousand people would benefit from the PCIP, 18,313 people were enrolled as of early May.

The PCIP is run by the federal government in 23 states and the District of Columbia; remaining states operate their own programs using funding from the ACA.

HHS sent letters to those 27 state programs, encouraging them to consider similar reforms to their programs.

A 40% premium cut and simpler enrollment procedures are two changes the federal government is employing to increase enrollment in the Pre-Existing Condition Insurance Plan, Health and Human Services Secretary Kathleen Sebelius announced.

Launched in July 2010 under the Affordable Care Act (ACA), the Pre-Existing Condition Insurance Plan (PCIP) provides an insurance option for people with preexisting conditions who have been denied coverage and have been without insurance for 6 months or more.

To increase awareness for the program, HHS will offer payment for insurance brokers and agents for successfully connecting eligible enrollees with the PCIP program, said Richard Popper, deputy director of insurance programs in the Office of Consumer Information and Insurance Oversight.

People who are seeking coverage under the PCIP will no longer have to wait to receive a denial letter from their insurance company in order to enroll in the plan.

Instead, they can provide attestation of their condition from their physician, nurse practitioner, or physician assistant.

Patients with preexisting conditions still will be required to be without insurance for 6 months before they are eligible for coverage under the plan, said Mr. Popper. He added that HHS does not have the authority to waive the 6-month waiting period under the current health law.

Ms. Sebelius emphasized HHS's priority to increase PCIP's enrollment. “It's encouraging to see more people who need health insurance the most getting it, but we know that's not enough,” she said.

The measures comply with the ACA provision requiring the PCIP to align premiums and benefits with the private insurance market, Mr. Popper said. However, he said there's still plenty of room for new enrollees.

“We've been enrolling people at an increasing rate, but we know we have the capacity to cover even more people,” Mr. Popper said, adding that funding for the measures will fall under the original $5 billion set aside for the program through the health reform law, as well as existing member premiums.

Despite original HHS estimates that several hundred thousand people would benefit from the PCIP, 18,313 people were enrolled as of early May.

The PCIP is run by the federal government in 23 states and the District of Columbia; remaining states operate their own programs using funding from the ACA.

HHS sent letters to those 27 state programs, encouraging them to consider similar reforms to their programs.

A 40% premium cut and simpler enrollment procedures are two changes the federal government is employing to increase enrollment in the Pre-Existing Condition Insurance Plan, Health and Human Services Secretary Kathleen Sebelius announced.

Launched in July 2010 under the Affordable Care Act (ACA), the Pre-Existing Condition Insurance Plan (PCIP) provides an insurance option for people with preexisting conditions who have been denied coverage and have been without insurance for 6 months or more.

To increase awareness for the program, HHS will offer payment for insurance brokers and agents for successfully connecting eligible enrollees with the PCIP program, said Richard Popper, deputy director of insurance programs in the Office of Consumer Information and Insurance Oversight.

People who are seeking coverage under the PCIP will no longer have to wait to receive a denial letter from their insurance company in order to enroll in the plan.

Instead, they can provide attestation of their condition from their physician, nurse practitioner, or physician assistant.

Patients with preexisting conditions still will be required to be without insurance for 6 months before they are eligible for coverage under the plan, said Mr. Popper. He added that HHS does not have the authority to waive the 6-month waiting period under the current health law.

Ms. Sebelius emphasized HHS's priority to increase PCIP's enrollment. “It's encouraging to see more people who need health insurance the most getting it, but we know that's not enough,” she said.

The measures comply with the ACA provision requiring the PCIP to align premiums and benefits with the private insurance market, Mr. Popper said. However, he said there's still plenty of room for new enrollees.

“We've been enrolling people at an increasing rate, but we know we have the capacity to cover even more people,” Mr. Popper said, adding that funding for the measures will fall under the original $5 billion set aside for the program through the health reform law, as well as existing member premiums.

Despite original HHS estimates that several hundred thousand people would benefit from the PCIP, 18,313 people were enrolled as of early May.

The PCIP is run by the federal government in 23 states and the District of Columbia; remaining states operate their own programs using funding from the ACA.

HHS sent letters to those 27 state programs, encouraging them to consider similar reforms to their programs.