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House Hears SGR Alternatives, Vows Action
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 Thursday.
"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 of the House Energy and Commerce Committee’s Subcommittee on Health. "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.
One Size Won’t Fit All. 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 B. 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.
"Private contracting is a key principle of American freedom and liberty," Dr. Williamson said. "[It] will help the federal government achieve fiscal stability while fulfilling its promise to Medicare beneficiaries."
Harold D. Miller, executive director of the Center for Healthcare Quality and Payment Reform, suggested an episode-of-care payment plan through which hospitals and physicians jointly charge one price for all services included in a hospitalization. The model would also include a warranty stating that any infections or complications would be treated at no additional cost. Also, a physician practice would receive one payment for all patient needs associated with chronic diseases or other conditions.
Rep. Burgess, who is also a doctor, said organizations should focus on ways to address patients with chronic conditions, adding that 80% of Medicare funding is spent by 20% of beneficiaries with chronic illnesses.
Is IPAB the New SGR? Rep. Fred Upton (R-Mich.) raised concerns about the Independent Payment Advisory Board (IPAB), created by the Affordable Care Act. The board sets expenditure targets, on which it bases spending cuts. In 2018, targets will be based on the gross domestic product. "Sounds a lot like SGR, which we’re trying to get rid of," Mr. Upton said. "Since hospitals are exempt from IPAB cuts through the rest of the decade, it seems that the IPAB has the potential to undermine any serious efforts at physician payment reform."
Some panelists agreed.
"It’s not impossible that [the IPAB] could serve a function," Dr. Wilson said, "but as presently constituted, we see it [as] basically another target for physicians to meet – potential double jeopardy, with an SGR as well as the pronouncements from this body."
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." Dr. McClellan added that physicians can be the best sources for innovative and cost-saving mechanisms.
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 Thursday.
"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 of the House Energy and Commerce Committee’s Subcommittee on Health. "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.
One Size Won’t Fit All. 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 B. 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.
"Private contracting is a key principle of American freedom and liberty," Dr. Williamson said. "[It] will help the federal government achieve fiscal stability while fulfilling its promise to Medicare beneficiaries."
Harold D. Miller, executive director of the Center for Healthcare Quality and Payment Reform, suggested an episode-of-care payment plan through which hospitals and physicians jointly charge one price for all services included in a hospitalization. The model would also include a warranty stating that any infections or complications would be treated at no additional cost. Also, a physician practice would receive one payment for all patient needs associated with chronic diseases or other conditions.
Rep. Burgess, who is also a doctor, said organizations should focus on ways to address patients with chronic conditions, adding that 80% of Medicare funding is spent by 20% of beneficiaries with chronic illnesses.
Is IPAB the New SGR? Rep. Fred Upton (R-Mich.) raised concerns about the Independent Payment Advisory Board (IPAB), created by the Affordable Care Act. The board sets expenditure targets, on which it bases spending cuts. In 2018, targets will be based on the gross domestic product. "Sounds a lot like SGR, which we’re trying to get rid of," Mr. Upton said. "Since hospitals are exempt from IPAB cuts through the rest of the decade, it seems that the IPAB has the potential to undermine any serious efforts at physician payment reform."
Some panelists agreed.
"It’s not impossible that [the IPAB] could serve a function," Dr. Wilson said, "but as presently constituted, we see it [as] basically another target for physicians to meet – potential double jeopardy, with an SGR as well as the pronouncements from this body."
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." Dr. McClellan added that physicians can be the best sources for innovative and cost-saving mechanisms.
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 Thursday.
"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 of the House Energy and Commerce Committee’s Subcommittee on Health. "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.
One Size Won’t Fit All. 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 B. 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.
"Private contracting is a key principle of American freedom and liberty," Dr. Williamson said. "[It] will help the federal government achieve fiscal stability while fulfilling its promise to Medicare beneficiaries."
Harold D. Miller, executive director of the Center for Healthcare Quality and Payment Reform, suggested an episode-of-care payment plan through which hospitals and physicians jointly charge one price for all services included in a hospitalization. The model would also include a warranty stating that any infections or complications would be treated at no additional cost. Also, a physician practice would receive one payment for all patient needs associated with chronic diseases or other conditions.
Rep. Burgess, who is also a doctor, said organizations should focus on ways to address patients with chronic conditions, adding that 80% of Medicare funding is spent by 20% of beneficiaries with chronic illnesses.
Is IPAB the New SGR? Rep. Fred Upton (R-Mich.) raised concerns about the Independent Payment Advisory Board (IPAB), created by the Affordable Care Act. The board sets expenditure targets, on which it bases spending cuts. In 2018, targets will be based on the gross domestic product. "Sounds a lot like SGR, which we’re trying to get rid of," Mr. Upton said. "Since hospitals are exempt from IPAB cuts through the rest of the decade, it seems that the IPAB has the potential to undermine any serious efforts at physician payment reform."
Some panelists agreed.
"It’s not impossible that [the IPAB] could serve a function," Dr. Wilson said, "but as presently constituted, we see it [as] basically another target for physicians to meet – potential double jeopardy, with an SGR as well as the pronouncements from this body."
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." Dr. McClellan added that physicians can be the best sources for innovative and cost-saving mechanisms.
FROM A HEARING OF THE HOUSE ENERGY AND COMMERCE COMMITTEE'S SUBCOMMITTEE ON HEALTH
House Hears SGR Alternatives, Vows Action
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 on May 5.
"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 of the House Energy and Commerce Committee’s Subcommittee on Health. "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.
One Size Won’t Fit All. 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 B. 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.
"Private contracting is a key principle of American freedom and liberty," Dr. Williamson said. "[It] will help the federal government achieve fiscal stability while fulfilling its promise to Medicare beneficiaries."
Harold D. Miller, executive director of the Center for Healthcare Quality and Payment Reform, suggested an episode-of-care payment plan through which hospitals and physicians jointly charge one price for all services included in a hospitalization. The model would also include a warranty stating that any infections or complications would be treated at no additional cost. Also, a physician practice would receive one payment for all patient needs associated with chronic diseases or other conditions.
Rep. Burgess, who is also a doctor, said organizations should focus on ways to address patients with chronic conditions, adding that 80% of Medicare funding is spent by 20% of beneficiaries with chronic illnesses.
Is IPAB the New SGR? Rep. Fred Upton (R-Mich.) raised concerns about the Independent Payment Advisory Board (IPAB), created by the Affordable Care Act. The board sets expenditure targets, on which it bases spending cuts. In 2018, targets will be based on the gross domestic product. "Sounds a lot like SGR, which we’re trying to get rid of," Mr. Upton said. "Since hospitals are exempt from IPAB cuts through the rest of the decade, it seems that the IPAB has the potential to undermine any serious efforts at physician payment reform."
Some panelists agreed.
"It’s not impossible that [the IPAB] could serve a function," Dr. Wilson said, "but as presently constituted, we see it [as] basically another target for physicians to meet – potential double jeopardy, with an SGR as well as the pronouncements from this body."
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." Dr. McClellan added that physicians can be the best sources for innovative and cost-saving mechanisms.
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 on May 5.
"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 of the House Energy and Commerce Committee’s Subcommittee on Health. "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.
One Size Won’t Fit All. 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 B. 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.
"Private contracting is a key principle of American freedom and liberty," Dr. Williamson said. "[It] will help the federal government achieve fiscal stability while fulfilling its promise to Medicare beneficiaries."
Harold D. Miller, executive director of the Center for Healthcare Quality and Payment Reform, suggested an episode-of-care payment plan through which hospitals and physicians jointly charge one price for all services included in a hospitalization. The model would also include a warranty stating that any infections or complications would be treated at no additional cost. Also, a physician practice would receive one payment for all patient needs associated with chronic diseases or other conditions.
Rep. Burgess, who is also a doctor, said organizations should focus on ways to address patients with chronic conditions, adding that 80% of Medicare funding is spent by 20% of beneficiaries with chronic illnesses.
Is IPAB the New SGR? Rep. Fred Upton (R-Mich.) raised concerns about the Independent Payment Advisory Board (IPAB), created by the Affordable Care Act. The board sets expenditure targets, on which it bases spending cuts. In 2018, targets will be based on the gross domestic product. "Sounds a lot like SGR, which we’re trying to get rid of," Mr. Upton said. "Since hospitals are exempt from IPAB cuts through the rest of the decade, it seems that the IPAB has the potential to undermine any serious efforts at physician payment reform."
Some panelists agreed.
"It’s not impossible that [the IPAB] could serve a function," Dr. Wilson said, "but as presently constituted, we see it [as] basically another target for physicians to meet – potential double jeopardy, with an SGR as well as the pronouncements from this body."
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." Dr. McClellan added that physicians can be the best sources for innovative and cost-saving mechanisms.
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 on May 5.
"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 of the House Energy and Commerce Committee’s Subcommittee on Health. "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.
One Size Won’t Fit All. 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 B. 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.
"Private contracting is a key principle of American freedom and liberty," Dr. Williamson said. "[It] will help the federal government achieve fiscal stability while fulfilling its promise to Medicare beneficiaries."
Harold D. Miller, executive director of the Center for Healthcare Quality and Payment Reform, suggested an episode-of-care payment plan through which hospitals and physicians jointly charge one price for all services included in a hospitalization. The model would also include a warranty stating that any infections or complications would be treated at no additional cost. Also, a physician practice would receive one payment for all patient needs associated with chronic diseases or other conditions.
Rep. Burgess, who is also a doctor, said organizations should focus on ways to address patients with chronic conditions, adding that 80% of Medicare funding is spent by 20% of beneficiaries with chronic illnesses.
Is IPAB the New SGR? Rep. Fred Upton (R-Mich.) raised concerns about the Independent Payment Advisory Board (IPAB), created by the Affordable Care Act. The board sets expenditure targets, on which it bases spending cuts. In 2018, targets will be based on the gross domestic product. "Sounds a lot like SGR, which we’re trying to get rid of," Mr. Upton said. "Since hospitals are exempt from IPAB cuts through the rest of the decade, it seems that the IPAB has the potential to undermine any serious efforts at physician payment reform."
Some panelists agreed.
"It’s not impossible that [the IPAB] could serve a function," Dr. Wilson said, "but as presently constituted, we see it [as] basically another target for physicians to meet – potential double jeopardy, with an SGR as well as the pronouncements from this body."
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." Dr. McClellan added that physicians can be the best sources for innovative and cost-saving mechanisms.
FROM A HEARING OF THE HOUSE ENERGY AND COMMERCE COMMITTEE'S SUBCOMMITTEE ON HEALTH
House Hears SGR Alternatives, Vows Action
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 May 5.
"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 of the House Energy and Commerce Committee's Subcommittee on Health. "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.
One Size Won't Fit All. 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.
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.
"Private contracting is a key principle of American freedom and liberty," Dr. Williamson said. "[It] will help the federal government achieve fiscal stability while fulfilling its promise to Medicare beneficiaries."
Harold D. Miller, executive director of the Center for Healthcare Quality and Payment Reform, suggested an episode-of-care payment plan through which hospitals and physicians jointly charge one price for all services included in a hospitalization. The model would also include a warranty stating that any infections or complications would be treated at no additional cost. Also, a physician practice would receive one payment for all patient needs associated with chronic diseases or other conditions.
Rep. Burgess, who is also a doctor, said organizations should focus on ways to address patients with chronic conditions, adding that 80% of Medicare funding is spent by 20% of beneficiaries with chronic illnesses.
Is IPAB the New SGR? Rep. Fred Upton (R-Mich.) raised concerns about the Independent Payment Advisory Board (IPAB), created by the Affordable Care Act. The board sets expenditure targets, on which it bases spending cuts. In 2018, targets will be based on the gross domestic product. "Sounds a lot like SGR, which we're trying to get rid of," Mr. Upton said. "Since hospitals are exempt from IPAB cuts through the rest of the decade, it seems that the IPAB has the potential to undermine any serious efforts at physician payment reform."
Some panelists agreed.
"It's not impossible that [the IPAB] could serve a function," Dr. Wilson said, "but as presently constituted, we see it [as] basically another target for physicians to meet – potential double jeopardy, with an SGR as well as the pronouncements from this body."
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." Dr. McClellan added that physicians can be the best sources for innovative and cost-saving mechanisms.
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 May 5.
"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 of the House Energy and Commerce Committee's Subcommittee on Health. "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.
One Size Won't Fit All. 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.
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.
"Private contracting is a key principle of American freedom and liberty," Dr. Williamson said. "[It] will help the federal government achieve fiscal stability while fulfilling its promise to Medicare beneficiaries."
Harold D. Miller, executive director of the Center for Healthcare Quality and Payment Reform, suggested an episode-of-care payment plan through which hospitals and physicians jointly charge one price for all services included in a hospitalization. The model would also include a warranty stating that any infections or complications would be treated at no additional cost. Also, a physician practice would receive one payment for all patient needs associated with chronic diseases or other conditions.
Rep. Burgess, who is also a doctor, said organizations should focus on ways to address patients with chronic conditions, adding that 80% of Medicare funding is spent by 20% of beneficiaries with chronic illnesses.
Is IPAB the New SGR? Rep. Fred Upton (R-Mich.) raised concerns about the Independent Payment Advisory Board (IPAB), created by the Affordable Care Act. The board sets expenditure targets, on which it bases spending cuts. In 2018, targets will be based on the gross domestic product. "Sounds a lot like SGR, which we're trying to get rid of," Mr. Upton said. "Since hospitals are exempt from IPAB cuts through the rest of the decade, it seems that the IPAB has the potential to undermine any serious efforts at physician payment reform."
Some panelists agreed.
"It's not impossible that [the IPAB] could serve a function," Dr. Wilson said, "but as presently constituted, we see it [as] basically another target for physicians to meet – potential double jeopardy, with an SGR as well as the pronouncements from this body."
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." Dr. McClellan added that physicians can be the best sources for innovative and cost-saving mechanisms.
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 May 5.
"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 of the House Energy and Commerce Committee's Subcommittee on Health. "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.
One Size Won't Fit All. 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.
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.
"Private contracting is a key principle of American freedom and liberty," Dr. Williamson said. "[It] will help the federal government achieve fiscal stability while fulfilling its promise to Medicare beneficiaries."
Harold D. Miller, executive director of the Center for Healthcare Quality and Payment Reform, suggested an episode-of-care payment plan through which hospitals and physicians jointly charge one price for all services included in a hospitalization. The model would also include a warranty stating that any infections or complications would be treated at no additional cost. Also, a physician practice would receive one payment for all patient needs associated with chronic diseases or other conditions.
Rep. Burgess, who is also a doctor, said organizations should focus on ways to address patients with chronic conditions, adding that 80% of Medicare funding is spent by 20% of beneficiaries with chronic illnesses.
Is IPAB the New SGR? Rep. Fred Upton (R-Mich.) raised concerns about the Independent Payment Advisory Board (IPAB), created by the Affordable Care Act. The board sets expenditure targets, on which it bases spending cuts. In 2018, targets will be based on the gross domestic product. "Sounds a lot like SGR, which we're trying to get rid of," Mr. Upton said. "Since hospitals are exempt from IPAB cuts through the rest of the decade, it seems that the IPAB has the potential to undermine any serious efforts at physician payment reform."
Some panelists agreed.
"It's not impossible that [the IPAB] could serve a function," Dr. Wilson said, "but as presently constituted, we see it [as] basically another target for physicians to meet – potential double jeopardy, with an SGR as well as the pronouncements from this body."
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." Dr. McClellan added that physicians can be the best sources for innovative and cost-saving mechanisms.
FROM A HEARING OF THE HOUSE ENERGY AND COMMERCE COMMITTEE'S SUBCOMMITTEE ON HEALTH
Survey Links Bullying to Family Violence
Bullying may be connected to factors including family violence, alcohol and drug use, and increased suicidal tendencies, according to results from the 2009 Massachusetts Youth Health Survey released April 22.
The randomized population-based survey was administered during one class period to 138 middle schools and high schools (2,859 middle school students and 2,948 high school students). Through the paper-and-pencil survey, students were asked about their experience being bullied or bullying their peers (MMWR 2011;60:465-71).
Those who responded that they had been bullied before during the last 12 months were categorized as victims; those who responded that they had bullied or pushed someone around in the last 12 months were categorized as bullies. Students who responded that they had experienced both were categorized as bully-victims.
The most striking finding was the frequency by which bullies and bully-victims had been exposed to domestic violence, said Dr. Robert Sege, chief of ambulatory pediatrics at Boston Medical Center.
In the survey, 23% of bully-victims in middle school and 20% of high school bully-victims reported they’d been physically hurt by a family member in the last 12 months. This compared with 19% for bullies and 14% for victims in middle school; the figures for high school were 14% and 13%, respectively.
"Previous studies have shown the bullies themselves are likely to have poorer long-term outcomes and this sort of provides some nuance into that phenomenon," Dr. Sege said in an interview. Additional findings showed bullies-victims were more likely to be dealing with feelings of sadness or hopelessness.
A total of 25% of middle school bully-victims reported they had seriously considered suicide in the past 12 months, compared with 16% bullies and 12% victims. For high school students, the results were 23%, 13%, and 20% respectively. About 5% of middle school victims, 11% of bullies, and 17% of bully-victims actually did attempt suicide, as did 10% of high school victims, 6% of bullies, and 11% of high school bully-victims. Additionally, 41% of bully-victims in middle school and 29% of high school bully-victims reported intentionally hurting themselves (but not attempting suicide).
While parents and teachers are often on the forefront of discovering issues of bullying among youth, Dr. Sege said pediatricians can also play a part. Victims of bullying may exhibit frequent injuries. In addition, children showing sudden symptoms of ADHD, with no previous issues with attention, could be a victim of bullying.
Many pediatricians feel unprepared to screen for or manage forms of violence other than child maltreatment, according to the American Academy of Pediatrics. Parenting styles that offer emotional support and cognitive stimulation can help prevent future bullying behavior, according to a 2009 AAP policy statement.
"Promotion and reinforcement of such parenting skills plus recognition, screening, and appropriate referral as secondary prevention strategies are essential ways that pediatricians can collectively contribute to this aspect of youth violence prevention," according to the statement.
Dr. Sege said he had no relevant financial disclosures.
While he admits that bullying continues to be a concern for adolescents, Dr. Carl Bell said there are internal and external factors that can help.
|
"Kids are getting bullied, no question about it. But there also are these protective factors of being monitored and having peer support, innate intelligence, adaptability, friendliness, good relationships with people, and social support, as well as being able to figure out how to master this mess," he said. "There are other things in life that keep people from succumbing to this negative mess that they’re around. And I think that’s what’s missing in the conversations around bullying."
As children and adolescents lack a fully developed rational mind, Dr. Bell said any successful program to control bullying must include actively involved adults.
"Children [and] teenagers are all gasoline, no brakes, and no steering wheel," he said. "They need adults around to be the brakes and the steering wheel."
Dr. Bell is president and CEO of the Community Mental Health Council and Foundation of Chicago. He is also a clinical professor of psychiatry and public health at the University of Illinois College of Medicine at Chicago. Dr. Bell said that he had no relevant financial disclosures.
While he admits that bullying continues to be a concern for adolescents, Dr. Carl Bell said there are internal and external factors that can help.
|
"Kids are getting bullied, no question about it. But there also are these protective factors of being monitored and having peer support, innate intelligence, adaptability, friendliness, good relationships with people, and social support, as well as being able to figure out how to master this mess," he said. "There are other things in life that keep people from succumbing to this negative mess that they’re around. And I think that’s what’s missing in the conversations around bullying."
As children and adolescents lack a fully developed rational mind, Dr. Bell said any successful program to control bullying must include actively involved adults.
"Children [and] teenagers are all gasoline, no brakes, and no steering wheel," he said. "They need adults around to be the brakes and the steering wheel."
Dr. Bell is president and CEO of the Community Mental Health Council and Foundation of Chicago. He is also a clinical professor of psychiatry and public health at the University of Illinois College of Medicine at Chicago. Dr. Bell said that he had no relevant financial disclosures.
While he admits that bullying continues to be a concern for adolescents, Dr. Carl Bell said there are internal and external factors that can help.
|
"Kids are getting bullied, no question about it. But there also are these protective factors of being monitored and having peer support, innate intelligence, adaptability, friendliness, good relationships with people, and social support, as well as being able to figure out how to master this mess," he said. "There are other things in life that keep people from succumbing to this negative mess that they’re around. And I think that’s what’s missing in the conversations around bullying."
As children and adolescents lack a fully developed rational mind, Dr. Bell said any successful program to control bullying must include actively involved adults.
"Children [and] teenagers are all gasoline, no brakes, and no steering wheel," he said. "They need adults around to be the brakes and the steering wheel."
Dr. Bell is president and CEO of the Community Mental Health Council and Foundation of Chicago. He is also a clinical professor of psychiatry and public health at the University of Illinois College of Medicine at Chicago. Dr. Bell said that he had no relevant financial disclosures.
Bullying may be connected to factors including family violence, alcohol and drug use, and increased suicidal tendencies, according to results from the 2009 Massachusetts Youth Health Survey released April 22.
The randomized population-based survey was administered during one class period to 138 middle schools and high schools (2,859 middle school students and 2,948 high school students). Through the paper-and-pencil survey, students were asked about their experience being bullied or bullying their peers (MMWR 2011;60:465-71).
Those who responded that they had been bullied before during the last 12 months were categorized as victims; those who responded that they had bullied or pushed someone around in the last 12 months were categorized as bullies. Students who responded that they had experienced both were categorized as bully-victims.
The most striking finding was the frequency by which bullies and bully-victims had been exposed to domestic violence, said Dr. Robert Sege, chief of ambulatory pediatrics at Boston Medical Center.
In the survey, 23% of bully-victims in middle school and 20% of high school bully-victims reported they’d been physically hurt by a family member in the last 12 months. This compared with 19% for bullies and 14% for victims in middle school; the figures for high school were 14% and 13%, respectively.
"Previous studies have shown the bullies themselves are likely to have poorer long-term outcomes and this sort of provides some nuance into that phenomenon," Dr. Sege said in an interview. Additional findings showed bullies-victims were more likely to be dealing with feelings of sadness or hopelessness.
A total of 25% of middle school bully-victims reported they had seriously considered suicide in the past 12 months, compared with 16% bullies and 12% victims. For high school students, the results were 23%, 13%, and 20% respectively. About 5% of middle school victims, 11% of bullies, and 17% of bully-victims actually did attempt suicide, as did 10% of high school victims, 6% of bullies, and 11% of high school bully-victims. Additionally, 41% of bully-victims in middle school and 29% of high school bully-victims reported intentionally hurting themselves (but not attempting suicide).
While parents and teachers are often on the forefront of discovering issues of bullying among youth, Dr. Sege said pediatricians can also play a part. Victims of bullying may exhibit frequent injuries. In addition, children showing sudden symptoms of ADHD, with no previous issues with attention, could be a victim of bullying.
Many pediatricians feel unprepared to screen for or manage forms of violence other than child maltreatment, according to the American Academy of Pediatrics. Parenting styles that offer emotional support and cognitive stimulation can help prevent future bullying behavior, according to a 2009 AAP policy statement.
"Promotion and reinforcement of such parenting skills plus recognition, screening, and appropriate referral as secondary prevention strategies are essential ways that pediatricians can collectively contribute to this aspect of youth violence prevention," according to the statement.
Dr. Sege said he had no relevant financial disclosures.
Bullying may be connected to factors including family violence, alcohol and drug use, and increased suicidal tendencies, according to results from the 2009 Massachusetts Youth Health Survey released April 22.
The randomized population-based survey was administered during one class period to 138 middle schools and high schools (2,859 middle school students and 2,948 high school students). Through the paper-and-pencil survey, students were asked about their experience being bullied or bullying their peers (MMWR 2011;60:465-71).
Those who responded that they had been bullied before during the last 12 months were categorized as victims; those who responded that they had bullied or pushed someone around in the last 12 months were categorized as bullies. Students who responded that they had experienced both were categorized as bully-victims.
The most striking finding was the frequency by which bullies and bully-victims had been exposed to domestic violence, said Dr. Robert Sege, chief of ambulatory pediatrics at Boston Medical Center.
In the survey, 23% of bully-victims in middle school and 20% of high school bully-victims reported they’d been physically hurt by a family member in the last 12 months. This compared with 19% for bullies and 14% for victims in middle school; the figures for high school were 14% and 13%, respectively.
"Previous studies have shown the bullies themselves are likely to have poorer long-term outcomes and this sort of provides some nuance into that phenomenon," Dr. Sege said in an interview. Additional findings showed bullies-victims were more likely to be dealing with feelings of sadness or hopelessness.
A total of 25% of middle school bully-victims reported they had seriously considered suicide in the past 12 months, compared with 16% bullies and 12% victims. For high school students, the results were 23%, 13%, and 20% respectively. About 5% of middle school victims, 11% of bullies, and 17% of bully-victims actually did attempt suicide, as did 10% of high school victims, 6% of bullies, and 11% of high school bully-victims. Additionally, 41% of bully-victims in middle school and 29% of high school bully-victims reported intentionally hurting themselves (but not attempting suicide).
While parents and teachers are often on the forefront of discovering issues of bullying among youth, Dr. Sege said pediatricians can also play a part. Victims of bullying may exhibit frequent injuries. In addition, children showing sudden symptoms of ADHD, with no previous issues with attention, could be a victim of bullying.
Many pediatricians feel unprepared to screen for or manage forms of violence other than child maltreatment, according to the American Academy of Pediatrics. Parenting styles that offer emotional support and cognitive stimulation can help prevent future bullying behavior, according to a 2009 AAP policy statement.
"Promotion and reinforcement of such parenting skills plus recognition, screening, and appropriate referral as secondary prevention strategies are essential ways that pediatricians can collectively contribute to this aspect of youth violence prevention," according to the statement.
Dr. Sege said he had no relevant financial disclosures.
FROM MORBIDITY AND MORTALITY WEEKLY REPORT
Major Finding: Twenty-three percent of bully-victims in middle school and 20% of high school bully-victims reported they’d been physically hurt by a family member in the last 12 months. This compared with 19% for bullies and 14% for victims in middle school; the figures for high school were 14% and 13%, respectively.
Data Source: The randomized population-based survey was administered during one class period to 138 middle schools and high schools (2,859 middle school students and 2,948 high school students).
Disclosures: Dr. Sege said he had no relevant financial disclosures.
Survey Links Bullying to Family Violence
Bullying may be connected to factors including family violence, alcohol and drug use, and increased suicidal tendencies, according to results from the 2009 Massachusetts Youth Health Survey released April 22.
The randomized population-based survey was administered during one class period to 138 middle schools and high schools (2,859 middle school students and 2,948 high school students). Through the paper-and-pencil survey, students were asked about their experience being bullied or bullying their peers (MMWR 2011;60:465-71).
Those who responded that they had been bullied before during the last 12 months were categorized as victims; those who responded that they had bullied or pushed someone around in the last 12 months were categorized as bullies. Students who responded that they had experienced both were categorized as bully-victims.
The most striking finding was the frequency by which bullies and bully-victims had been exposed to domestic violence, said Dr. Robert Sege, chief of ambulatory pediatrics at Boston Medical Center.
In the survey, 23% of bully-victims in middle school and 20% of high school bully-victims reported they’d been physically hurt by a family member in the last 12 months. This compared with 19% for bullies and 14% for victims in middle school; the figures for high school were 14% and 13%, respectively.
"Previous studies have shown the bullies themselves are likely to have poorer long-term outcomes and this sort of provides some nuance into that phenomenon," Dr. Sege said in an interview. Additional findings showed bullies-victims were more likely to be dealing with feelings of sadness or hopelessness.
A total of 25% of middle school bully-victims reported they had seriously considered suicide in the past 12 months, compared with 16% bullies and 12% victims. For high school students, the results were 23%, 13%, and 20% respectively. About 5% of middle school victims, 11% of bullies, and 17% of bully-victims actually did attempt suicide, as did 10% of high school victims, 6% of bullies, and 11% of high school bully-victims. Additionally, 41% of bully-victims in middle school and 29% of high school bully-victims reported intentionally hurting themselves (but not attempting suicide).
While parents and teachers are often on the forefront of discovering issues of bullying among youth, Dr. Sege said pediatricians can also play a part. Victims of bullying may exhibit frequent injuries. In addition, children showing sudden symptoms of ADHD, with no previous issues with attention, could be a victim of bullying.
Many pediatricians feel unprepared to screen for or manage forms of violence other than child maltreatment, according to the American Academy of Pediatrics. Parenting styles that offer emotional support and cognitive stimulation can help prevent future bullying behavior, according to a 2009 AAP policy statement.
"Promotion and reinforcement of such parenting skills plus recognition, screening, and appropriate referral as secondary prevention strategies are essential ways that pediatricians can collectively contribute to this aspect of youth violence prevention," according to the statement.
Dr. Sege said he had no relevant financial disclosures.
While he admits that bullying continues to be a concern for adolescents, Dr. Carl Bell said there are internal and external factors that can help.
|
"Kids are getting bullied, no question about it. But there also are these protective factors of being monitored and having peer support, innate intelligence, adaptability, friendliness, good relationships with people, and social support, as well as being able to figure out how to master this mess," he said. "There are other things in life that keep people from succumbing to this negative mess that they’re around. And I think that’s what’s missing in the conversations around bullying."
As children and adolescents lack a fully developed rational mind, Dr. Bell said any successful program to control bullying must include actively involved adults.
"Children [and] teenagers are all gasoline, no brakes, and no steering wheel," he said. "They need adults around to be the brakes and the steering wheel."
Dr. Bell is president and CEO of the Community Mental Health Council and Foundation of Chicago. He is also a clinical professor of psychiatry and public health at the University of Illinois College of Medicine at Chicago. Dr. Bell said that he had no relevant financial disclosures.
While he admits that bullying continues to be a concern for adolescents, Dr. Carl Bell said there are internal and external factors that can help.
|
"Kids are getting bullied, no question about it. But there also are these protective factors of being monitored and having peer support, innate intelligence, adaptability, friendliness, good relationships with people, and social support, as well as being able to figure out how to master this mess," he said. "There are other things in life that keep people from succumbing to this negative mess that they’re around. And I think that’s what’s missing in the conversations around bullying."
As children and adolescents lack a fully developed rational mind, Dr. Bell said any successful program to control bullying must include actively involved adults.
"Children [and] teenagers are all gasoline, no brakes, and no steering wheel," he said. "They need adults around to be the brakes and the steering wheel."
Dr. Bell is president and CEO of the Community Mental Health Council and Foundation of Chicago. He is also a clinical professor of psychiatry and public health at the University of Illinois College of Medicine at Chicago. Dr. Bell said that he had no relevant financial disclosures.
While he admits that bullying continues to be a concern for adolescents, Dr. Carl Bell said there are internal and external factors that can help.
|
"Kids are getting bullied, no question about it. But there also are these protective factors of being monitored and having peer support, innate intelligence, adaptability, friendliness, good relationships with people, and social support, as well as being able to figure out how to master this mess," he said. "There are other things in life that keep people from succumbing to this negative mess that they’re around. And I think that’s what’s missing in the conversations around bullying."
As children and adolescents lack a fully developed rational mind, Dr. Bell said any successful program to control bullying must include actively involved adults.
"Children [and] teenagers are all gasoline, no brakes, and no steering wheel," he said. "They need adults around to be the brakes and the steering wheel."
Dr. Bell is president and CEO of the Community Mental Health Council and Foundation of Chicago. He is also a clinical professor of psychiatry and public health at the University of Illinois College of Medicine at Chicago. Dr. Bell said that he had no relevant financial disclosures.
Bullying may be connected to factors including family violence, alcohol and drug use, and increased suicidal tendencies, according to results from the 2009 Massachusetts Youth Health Survey released April 22.
The randomized population-based survey was administered during one class period to 138 middle schools and high schools (2,859 middle school students and 2,948 high school students). Through the paper-and-pencil survey, students were asked about their experience being bullied or bullying their peers (MMWR 2011;60:465-71).
Those who responded that they had been bullied before during the last 12 months were categorized as victims; those who responded that they had bullied or pushed someone around in the last 12 months were categorized as bullies. Students who responded that they had experienced both were categorized as bully-victims.
The most striking finding was the frequency by which bullies and bully-victims had been exposed to domestic violence, said Dr. Robert Sege, chief of ambulatory pediatrics at Boston Medical Center.
In the survey, 23% of bully-victims in middle school and 20% of high school bully-victims reported they’d been physically hurt by a family member in the last 12 months. This compared with 19% for bullies and 14% for victims in middle school; the figures for high school were 14% and 13%, respectively.
"Previous studies have shown the bullies themselves are likely to have poorer long-term outcomes and this sort of provides some nuance into that phenomenon," Dr. Sege said in an interview. Additional findings showed bullies-victims were more likely to be dealing with feelings of sadness or hopelessness.
A total of 25% of middle school bully-victims reported they had seriously considered suicide in the past 12 months, compared with 16% bullies and 12% victims. For high school students, the results were 23%, 13%, and 20% respectively. About 5% of middle school victims, 11% of bullies, and 17% of bully-victims actually did attempt suicide, as did 10% of high school victims, 6% of bullies, and 11% of high school bully-victims. Additionally, 41% of bully-victims in middle school and 29% of high school bully-victims reported intentionally hurting themselves (but not attempting suicide).
While parents and teachers are often on the forefront of discovering issues of bullying among youth, Dr. Sege said pediatricians can also play a part. Victims of bullying may exhibit frequent injuries. In addition, children showing sudden symptoms of ADHD, with no previous issues with attention, could be a victim of bullying.
Many pediatricians feel unprepared to screen for or manage forms of violence other than child maltreatment, according to the American Academy of Pediatrics. Parenting styles that offer emotional support and cognitive stimulation can help prevent future bullying behavior, according to a 2009 AAP policy statement.
"Promotion and reinforcement of such parenting skills plus recognition, screening, and appropriate referral as secondary prevention strategies are essential ways that pediatricians can collectively contribute to this aspect of youth violence prevention," according to the statement.
Dr. Sege said he had no relevant financial disclosures.
Bullying may be connected to factors including family violence, alcohol and drug use, and increased suicidal tendencies, according to results from the 2009 Massachusetts Youth Health Survey released April 22.
The randomized population-based survey was administered during one class period to 138 middle schools and high schools (2,859 middle school students and 2,948 high school students). Through the paper-and-pencil survey, students were asked about their experience being bullied or bullying their peers (MMWR 2011;60:465-71).
Those who responded that they had been bullied before during the last 12 months were categorized as victims; those who responded that they had bullied or pushed someone around in the last 12 months were categorized as bullies. Students who responded that they had experienced both were categorized as bully-victims.
The most striking finding was the frequency by which bullies and bully-victims had been exposed to domestic violence, said Dr. Robert Sege, chief of ambulatory pediatrics at Boston Medical Center.
In the survey, 23% of bully-victims in middle school and 20% of high school bully-victims reported they’d been physically hurt by a family member in the last 12 months. This compared with 19% for bullies and 14% for victims in middle school; the figures for high school were 14% and 13%, respectively.
"Previous studies have shown the bullies themselves are likely to have poorer long-term outcomes and this sort of provides some nuance into that phenomenon," Dr. Sege said in an interview. Additional findings showed bullies-victims were more likely to be dealing with feelings of sadness or hopelessness.
A total of 25% of middle school bully-victims reported they had seriously considered suicide in the past 12 months, compared with 16% bullies and 12% victims. For high school students, the results were 23%, 13%, and 20% respectively. About 5% of middle school victims, 11% of bullies, and 17% of bully-victims actually did attempt suicide, as did 10% of high school victims, 6% of bullies, and 11% of high school bully-victims. Additionally, 41% of bully-victims in middle school and 29% of high school bully-victims reported intentionally hurting themselves (but not attempting suicide).
While parents and teachers are often on the forefront of discovering issues of bullying among youth, Dr. Sege said pediatricians can also play a part. Victims of bullying may exhibit frequent injuries. In addition, children showing sudden symptoms of ADHD, with no previous issues with attention, could be a victim of bullying.
Many pediatricians feel unprepared to screen for or manage forms of violence other than child maltreatment, according to the American Academy of Pediatrics. Parenting styles that offer emotional support and cognitive stimulation can help prevent future bullying behavior, according to a 2009 AAP policy statement.
"Promotion and reinforcement of such parenting skills plus recognition, screening, and appropriate referral as secondary prevention strategies are essential ways that pediatricians can collectively contribute to this aspect of youth violence prevention," according to the statement.
Dr. Sege said he had no relevant financial disclosures.
FROM MORBIDITY AND MORTALITY WEEKLY REPORT
Major Finding: Twenty-three percent of bully-victims in middle school and 20% of high school bully-victims reported they’d been physically hurt by a family member in the last 12 months. This compared with 19% for bullies and 14% for victims in middle school; the figures for high school were 14% and 13%, respectively.
Data Source: The randomized population-based survey was administered during one class period to 138 middle schools and high schools (2,859 middle school students and 2,948 high school students).
Disclosures: Dr. Sege said he had no relevant financial disclosures.
Cost of Environmental Diseases Estimated at $76.6 Billion in 2008
Health care costs for environment-related diseases were estimated at $76.6 billion in 2008, according to a study published in the May edition of Health Affairs.
This represents 3.5% of U.S. health care costs. The researchers analyzed prevalence of the disease, the degree of environmental influence, the population at risk, and costs per case. Indirect costs, such as loss of productivity because of parents caring for sick children, also were included.
The study focused on diseases linked to environmental causes: lead poisoning ($50.9 billion), exposure to methyl mercury ($5.1 billion), childhood cancer (costing $95 million), and chronic conditions like asthma ($2.2 billion), attention-deficit/hyperactivity disorder ($5 billion), autism ($7.9 billion), and intellectual disability ($5.4 billion).
After comparing the findings with a similar study from 2002, costs had increased $2.9 billion since 1997. The 2002 study found that costs for environment-related diseases totaled $54.9 billion in 1997 ($73.7 billion in 2008 dollars), or 2.8% of health care costs, reported Dr. Leonardo Trasande of Mount Sinai School of Medicine, New York, and Dr. Yinghua Liu of National Children’s Study New York–Northern New Jersey Center (Health Affairs 2011 [doi:10.1377/hlthaff.2010.1239]).
Although data showed an improvement in asthma costs and reduced lead exposure, those gains are hampered by increased mercury exposure and diseases that have been more recently attributed to the environment, like attention-deficit/hyperactivity disorder. To reduce costs, Dr. Trasande and Dr. Liu recommended premarket testing of new chemicals, toxicity testing of chemicals already in use, reduction of mercury emissions from coal-fired power plants, and reduction of hazards related to lead-based paint.
"Left unchecked, these preventable environmental factors will continue to harm the health of our children and push up health care costs," Dr. Trasande said in a statement. The study was conducted to underline the need for policy change, according to the researchers. Since the 2002 study, the government has failed to update the 1973 Toxic Substances Control Act to require that chemicals be tested for their toxicity before attaining approval by the Environmental Protection Agency, the researchers said.
"By updating environmental regulations and laws aimed at protecting the public’s health, we can reduce the toll taken by such factors on children’s health and the economy," Dr. Trasande noted in his statement.
Dr. Trasande and Dr. Liu said they had no relevant financial disclosures.
Health care costs for environment-related diseases were estimated at $76.6 billion in 2008, according to a study published in the May edition of Health Affairs.
This represents 3.5% of U.S. health care costs. The researchers analyzed prevalence of the disease, the degree of environmental influence, the population at risk, and costs per case. Indirect costs, such as loss of productivity because of parents caring for sick children, also were included.
The study focused on diseases linked to environmental causes: lead poisoning ($50.9 billion), exposure to methyl mercury ($5.1 billion), childhood cancer (costing $95 million), and chronic conditions like asthma ($2.2 billion), attention-deficit/hyperactivity disorder ($5 billion), autism ($7.9 billion), and intellectual disability ($5.4 billion).
After comparing the findings with a similar study from 2002, costs had increased $2.9 billion since 1997. The 2002 study found that costs for environment-related diseases totaled $54.9 billion in 1997 ($73.7 billion in 2008 dollars), or 2.8% of health care costs, reported Dr. Leonardo Trasande of Mount Sinai School of Medicine, New York, and Dr. Yinghua Liu of National Children’s Study New York–Northern New Jersey Center (Health Affairs 2011 [doi:10.1377/hlthaff.2010.1239]).
Although data showed an improvement in asthma costs and reduced lead exposure, those gains are hampered by increased mercury exposure and diseases that have been more recently attributed to the environment, like attention-deficit/hyperactivity disorder. To reduce costs, Dr. Trasande and Dr. Liu recommended premarket testing of new chemicals, toxicity testing of chemicals already in use, reduction of mercury emissions from coal-fired power plants, and reduction of hazards related to lead-based paint.
"Left unchecked, these preventable environmental factors will continue to harm the health of our children and push up health care costs," Dr. Trasande said in a statement. The study was conducted to underline the need for policy change, according to the researchers. Since the 2002 study, the government has failed to update the 1973 Toxic Substances Control Act to require that chemicals be tested for their toxicity before attaining approval by the Environmental Protection Agency, the researchers said.
"By updating environmental regulations and laws aimed at protecting the public’s health, we can reduce the toll taken by such factors on children’s health and the economy," Dr. Trasande noted in his statement.
Dr. Trasande and Dr. Liu said they had no relevant financial disclosures.
Health care costs for environment-related diseases were estimated at $76.6 billion in 2008, according to a study published in the May edition of Health Affairs.
This represents 3.5% of U.S. health care costs. The researchers analyzed prevalence of the disease, the degree of environmental influence, the population at risk, and costs per case. Indirect costs, such as loss of productivity because of parents caring for sick children, also were included.
The study focused on diseases linked to environmental causes: lead poisoning ($50.9 billion), exposure to methyl mercury ($5.1 billion), childhood cancer (costing $95 million), and chronic conditions like asthma ($2.2 billion), attention-deficit/hyperactivity disorder ($5 billion), autism ($7.9 billion), and intellectual disability ($5.4 billion).
After comparing the findings with a similar study from 2002, costs had increased $2.9 billion since 1997. The 2002 study found that costs for environment-related diseases totaled $54.9 billion in 1997 ($73.7 billion in 2008 dollars), or 2.8% of health care costs, reported Dr. Leonardo Trasande of Mount Sinai School of Medicine, New York, and Dr. Yinghua Liu of National Children’s Study New York–Northern New Jersey Center (Health Affairs 2011 [doi:10.1377/hlthaff.2010.1239]).
Although data showed an improvement in asthma costs and reduced lead exposure, those gains are hampered by increased mercury exposure and diseases that have been more recently attributed to the environment, like attention-deficit/hyperactivity disorder. To reduce costs, Dr. Trasande and Dr. Liu recommended premarket testing of new chemicals, toxicity testing of chemicals already in use, reduction of mercury emissions from coal-fired power plants, and reduction of hazards related to lead-based paint.
"Left unchecked, these preventable environmental factors will continue to harm the health of our children and push up health care costs," Dr. Trasande said in a statement. The study was conducted to underline the need for policy change, according to the researchers. Since the 2002 study, the government has failed to update the 1973 Toxic Substances Control Act to require that chemicals be tested for their toxicity before attaining approval by the Environmental Protection Agency, the researchers said.
"By updating environmental regulations and laws aimed at protecting the public’s health, we can reduce the toll taken by such factors on children’s health and the economy," Dr. Trasande noted in his statement.
Dr. Trasande and Dr. Liu said they had no relevant financial disclosures.
FROM HEALTH AFFAIRS
Major Finding: After comparing the findings with a similar study from 2002, costs had increased $2.9 billion since 1997, to a total of $76.6 billion.
Data Source: Multiple sources, including the 2007-2008 National Health and Nutrition Examination Survey, the 2008 National Health Interview Survey, and the 2007 National Survey of Children’s Health.
Disclosures: Dr. Trasande and Dr. Liu said they had no relevant financial disclosures.
Cost of Environmental Diseases Estimated at $76.6 Billion in 2008
Health care costs for environment-related diseases were estimated at $76.6 billion in 2008, according to a study published in the May edition of Health Affairs.
This represents 3.5% of U.S. health care costs. The researchers analyzed prevalence of the disease, the degree of environmental influence, the population at risk, and costs per case. Indirect costs, such as loss of productivity because of parents caring for sick children, also were included.
The study focused on diseases linked to environmental causes: lead poisoning ($50.9 billion), exposure to methyl mercury ($5.1 billion), childhood cancer (costing $95 million), and chronic conditions like asthma ($2.2 billion), attention-deficit/hyperactivity disorder ($5 billion), autism ($7.9 billion), and intellectual disability ($5.4 billion).
After comparing the findings with a similar study from 2002, costs had increased $2.9 billion since 1997. The 2002 study found that costs for environment-related diseases totaled $54.9 billion in 1997 ($73.7 billion in 2008 dollars), or 2.8% of health care costs, reported Dr. Leonardo Trasande of Mount Sinai School of Medicine, New York, and Dr. Yinghua Liu of National Children’s Study New York–Northern New Jersey Center (Health Affairs 2011 [doi:10.1377/hlthaff.2010.1239]).
Although data showed an improvement in asthma costs and reduced lead exposure, those gains are hampered by increased mercury exposure and diseases that have been more recently attributed to the environment, like attention-deficit/hyperactivity disorder. To reduce costs, Dr. Trasande and Dr. Liu recommended premarket testing of new chemicals, toxicity testing of chemicals already in use, reduction of mercury emissions from coal-fired power plants, and reduction of hazards related to lead-based paint.
"Left unchecked, these preventable environmental factors will continue to harm the health of our children and push up health care costs," Dr. Trasande said in a statement. The study was conducted to underline the need for policy change, according to the researchers. Since the 2002 study, the government has failed to update the 1973 Toxic Substances Control Act to require that chemicals be tested for their toxicity before attaining approval by the Environmental Protection Agency, the researchers said.
"By updating environmental regulations and laws aimed at protecting the public’s health, we can reduce the toll taken by such factors on children’s health and the economy," Dr. Trasande noted in his statement.
Dr. Trasande and Dr. Liu said they had no relevant financial disclosures.
Health care costs for environment-related diseases were estimated at $76.6 billion in 2008, according to a study published in the May edition of Health Affairs.
This represents 3.5% of U.S. health care costs. The researchers analyzed prevalence of the disease, the degree of environmental influence, the population at risk, and costs per case. Indirect costs, such as loss of productivity because of parents caring for sick children, also were included.
The study focused on diseases linked to environmental causes: lead poisoning ($50.9 billion), exposure to methyl mercury ($5.1 billion), childhood cancer (costing $95 million), and chronic conditions like asthma ($2.2 billion), attention-deficit/hyperactivity disorder ($5 billion), autism ($7.9 billion), and intellectual disability ($5.4 billion).
After comparing the findings with a similar study from 2002, costs had increased $2.9 billion since 1997. The 2002 study found that costs for environment-related diseases totaled $54.9 billion in 1997 ($73.7 billion in 2008 dollars), or 2.8% of health care costs, reported Dr. Leonardo Trasande of Mount Sinai School of Medicine, New York, and Dr. Yinghua Liu of National Children’s Study New York–Northern New Jersey Center (Health Affairs 2011 [doi:10.1377/hlthaff.2010.1239]).
Although data showed an improvement in asthma costs and reduced lead exposure, those gains are hampered by increased mercury exposure and diseases that have been more recently attributed to the environment, like attention-deficit/hyperactivity disorder. To reduce costs, Dr. Trasande and Dr. Liu recommended premarket testing of new chemicals, toxicity testing of chemicals already in use, reduction of mercury emissions from coal-fired power plants, and reduction of hazards related to lead-based paint.
"Left unchecked, these preventable environmental factors will continue to harm the health of our children and push up health care costs," Dr. Trasande said in a statement. The study was conducted to underline the need for policy change, according to the researchers. Since the 2002 study, the government has failed to update the 1973 Toxic Substances Control Act to require that chemicals be tested for their toxicity before attaining approval by the Environmental Protection Agency, the researchers said.
"By updating environmental regulations and laws aimed at protecting the public’s health, we can reduce the toll taken by such factors on children’s health and the economy," Dr. Trasande noted in his statement.
Dr. Trasande and Dr. Liu said they had no relevant financial disclosures.
Health care costs for environment-related diseases were estimated at $76.6 billion in 2008, according to a study published in the May edition of Health Affairs.
This represents 3.5% of U.S. health care costs. The researchers analyzed prevalence of the disease, the degree of environmental influence, the population at risk, and costs per case. Indirect costs, such as loss of productivity because of parents caring for sick children, also were included.
The study focused on diseases linked to environmental causes: lead poisoning ($50.9 billion), exposure to methyl mercury ($5.1 billion), childhood cancer (costing $95 million), and chronic conditions like asthma ($2.2 billion), attention-deficit/hyperactivity disorder ($5 billion), autism ($7.9 billion), and intellectual disability ($5.4 billion).
After comparing the findings with a similar study from 2002, costs had increased $2.9 billion since 1997. The 2002 study found that costs for environment-related diseases totaled $54.9 billion in 1997 ($73.7 billion in 2008 dollars), or 2.8% of health care costs, reported Dr. Leonardo Trasande of Mount Sinai School of Medicine, New York, and Dr. Yinghua Liu of National Children’s Study New York–Northern New Jersey Center (Health Affairs 2011 [doi:10.1377/hlthaff.2010.1239]).
Although data showed an improvement in asthma costs and reduced lead exposure, those gains are hampered by increased mercury exposure and diseases that have been more recently attributed to the environment, like attention-deficit/hyperactivity disorder. To reduce costs, Dr. Trasande and Dr. Liu recommended premarket testing of new chemicals, toxicity testing of chemicals already in use, reduction of mercury emissions from coal-fired power plants, and reduction of hazards related to lead-based paint.
"Left unchecked, these preventable environmental factors will continue to harm the health of our children and push up health care costs," Dr. Trasande said in a statement. The study was conducted to underline the need for policy change, according to the researchers. Since the 2002 study, the government has failed to update the 1973 Toxic Substances Control Act to require that chemicals be tested for their toxicity before attaining approval by the Environmental Protection Agency, the researchers said.
"By updating environmental regulations and laws aimed at protecting the public’s health, we can reduce the toll taken by such factors on children’s health and the economy," Dr. Trasande noted in his statement.
Dr. Trasande and Dr. Liu said they had no relevant financial disclosures.
FROM HEALTH AFFAIRS
Major Finding: After comparing the findings with a similar study from 2002, costs had increased $2.9 billion since 1997, to a total of $76.6 billion.
Data Source: Multiple sources, including the 2007-2008 National Health and Nutrition Examination Survey, the 2008 National Health Interview Survey, and the 2007 National Survey of Children’s Health.
Disclosures: Dr. Trasande and Dr. Liu said they had no relevant financial disclosures.
Hospital Association Questions Data Behind Public Performance Reports
WASHINGTON – At an April 27 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?"
It was sponsored by the Alliance for Health Reform and The Commonwealth Fund.
On March 31, 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 presents each condition per 1,000 discharges and includes 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.’ "
While he admitted that there may be flaws in the current data from public reporting, 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. Dr. Audet said 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 an April 27 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?"
It was sponsored by the Alliance for Health Reform and The Commonwealth Fund.
On March 31, 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 presents each condition per 1,000 discharges and includes 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.’ "
While he admitted that there may be flaws in the current data from public reporting, 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. Dr. Audet said 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 an April 27 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?"
It was sponsored by the Alliance for Health Reform and The Commonwealth Fund.
On March 31, 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 presents each condition per 1,000 discharges and includes 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.’ "
While he admitted that there may be flaws in the current data from public reporting, 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. Dr. Audet said 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 FORUM SPONSORED BY THE ALLIANCE FOR HEALTH REFORM AND THE COMMONWEALTH FUND
Hospital Association Questions Data Behind Public Performance Reports
WASHINGTON – At an April 27 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?"
It was sponsored by the Alliance for Health Reform and The Commonwealth Fund.
On March 31, 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 presents each condition per 1,000 discharges and includes 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.’ "
While he admitted that there may be flaws in the current data from public reporting, 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. Dr. Audet said 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 an April 27 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?"
It was sponsored by the Alliance for Health Reform and The Commonwealth Fund.
On March 31, 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 presents each condition per 1,000 discharges and includes 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.’ "
While he admitted that there may be flaws in the current data from public reporting, 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. Dr. Audet said 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 an April 27 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?"
It was sponsored by the Alliance for Health Reform and The Commonwealth Fund.
On March 31, 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 presents each condition per 1,000 discharges and includes 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.’ "
While he admitted that there may be flaws in the current data from public reporting, 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. Dr. Audet said 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 FORUM SPONSORED BY THE ALLIANCE FOR HEALTH REFORM AND THE COMMONWEALTH FUND
House Hears SGR Alternatives, Vows Action
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.
One Size Won't Fit All
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.
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.” Dr. McClellan added that physicians can be the best sources for innovative and cost-saving mechanisms.
Dr. Mark B. McClellan (left) and Dr. Cecil B. Wilson (center) take their ideas about SGR to the House.
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.
One Size Won't Fit All
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.
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.” Dr. McClellan added that physicians can be the best sources for innovative and cost-saving mechanisms.
Dr. Mark B. McClellan (left) and Dr. Cecil B. Wilson (center) take their ideas about SGR to the House.
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.
One Size Won't Fit All
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.
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.” Dr. McClellan added that physicians can be the best sources for innovative and cost-saving mechanisms.
Dr. Mark B. McClellan (left) and Dr. Cecil B. Wilson (center) take their ideas about SGR to the House.
Source Courtesy American Medical Association