Frances Correa

To accomplish the goals of the health reform act, accountable care organizations will have to engage and inform their patients, have a strong foundation of primary care, and commit to serve their communities – besides their underlying mission to take financial responsibility for the quality of care for Medicare patients, according to a paper released April 14 by the Commonwealth Fund.

In response to the recently released, proposed regulations for accountable care organizations (ACOs) from the Centers for Medicare and Medicaid Services, Mark Zezza, Ph.D., and Stuart Guterman of the Commonwealth Fund outlined 10 recommendations for Medicare officials to consider as they finalize the regulations before the end of this year.

ACOs should be part of a shared savings system that incorporates "creativity and flexibility" in rewarding participating organizations for improving care, the authors stressed. They also recommended that Medicare’s payment models for ACOs should accommodate a variety of organizational structures.

"The notion that there would be one kind of [ACO] model, or even a few kinds of models" doesn’t hold for existing integrated health systems that are likely to transition easily into ACOs, Mr. Guterman said in a press conference.

The CMS has estimated that 75-150 organizations will form ACOs and that each will face first-year costs of approximately $1.7 million to do so. Despite the potential of rewards from Medicare for patient-care savings while improving quality, some physician organizations have expressed reservations about ACOs.

The answer to that concern is teamwork. "The more payers that are involved, the more patients, the more the costs get spread" in an ACO and the "less onerous" the process becomes, Mr. Guterman said. He and Dr. Zezza also recommended that the CMS cover some start-up fees for ACOs, which Mr. Guterman said should apply especially to providers who offer care to low-income citizens.

When asked whether enough physician groups will buy into the ACO model, Karen Davis, Ph.D., president of the Commonwealth Fund, said she is not concerned. According to Dr. Davis, the 36,000 medical practices that have met the meaningful-use standards for electronic medical records suggest the number of physicians who are interested in ACOs.

If similar numbers of physicians sign up, ACOs "will be regarded as a success," Dr. Davis said. However, she added that meeting ACO standards will take time for some medical practices.

"Those that are not there today should start working towards it today," Dr. Davis said.

To accomplish the goals of the health reform act, accountable care organizations will have to engage and inform their patients, have a strong foundation of primary care, and commit to serve their communities – besides their underlying mission to take financial responsibility for the quality of care for Medicare patients, according to a paper released April 14 by the Commonwealth Fund.

In response to the recently released, proposed regulations for accountable care organizations (ACOs) from the Centers for Medicare and Medicaid Services, Mark Zezza, Ph.D., and Stuart Guterman of the Commonwealth Fund outlined 10 recommendations for Medicare officials to consider as they finalize the regulations before the end of this year.

ACOs should be part of a shared savings system that incorporates "creativity and flexibility" in rewarding participating organizations for improving care, the authors stressed. They also recommended that Medicare’s payment models for ACOs should accommodate a variety of organizational structures.

"The notion that there would be one kind of [ACO] model, or even a few kinds of models" doesn’t hold for existing integrated health systems that are likely to transition easily into ACOs, Mr. Guterman said in a press conference.

The CMS has estimated that 75-150 organizations will form ACOs and that each will face first-year costs of approximately $1.7 million to do so. Despite the potential of rewards from Medicare for patient-care savings while improving quality, some physician organizations have expressed reservations about ACOs.

The answer to that concern is teamwork. "The more payers that are involved, the more patients, the more the costs get spread" in an ACO and the "less onerous" the process becomes, Mr. Guterman said. He and Dr. Zezza also recommended that the CMS cover some start-up fees for ACOs, which Mr. Guterman said should apply especially to providers who offer care to low-income citizens.

When asked whether enough physician groups will buy into the ACO model, Karen Davis, Ph.D., president of the Commonwealth Fund, said she is not concerned. According to Dr. Davis, the 36,000 medical practices that have met the meaningful-use standards for electronic medical records suggest the number of physicians who are interested in ACOs.

If similar numbers of physicians sign up, ACOs "will be regarded as a success," Dr. Davis said. However, she added that meeting ACO standards will take time for some medical practices.

"Those that are not there today should start working towards it today," Dr. Davis said.

To accomplish the goals of the health reform act, accountable care organizations will have to engage and inform their patients, have a strong foundation of primary care, and commit to serve their communities – besides their underlying mission to take financial responsibility for the quality of care for Medicare patients, according to a paper released April 14 by the Commonwealth Fund.

In response to the recently released, proposed regulations for accountable care organizations (ACOs) from the Centers for Medicare and Medicaid Services, Mark Zezza, Ph.D., and Stuart Guterman of the Commonwealth Fund outlined 10 recommendations for Medicare officials to consider as they finalize the regulations before the end of this year.

ACOs should be part of a shared savings system that incorporates "creativity and flexibility" in rewarding participating organizations for improving care, the authors stressed. They also recommended that Medicare’s payment models for ACOs should accommodate a variety of organizational structures.

"The notion that there would be one kind of [ACO] model, or even a few kinds of models" doesn’t hold for existing integrated health systems that are likely to transition easily into ACOs, Mr. Guterman said in a press conference.

The CMS has estimated that 75-150 organizations will form ACOs and that each will face first-year costs of approximately $1.7 million to do so. Despite the potential of rewards from Medicare for patient-care savings while improving quality, some physician organizations have expressed reservations about ACOs.

The answer to that concern is teamwork. "The more payers that are involved, the more patients, the more the costs get spread" in an ACO and the "less onerous" the process becomes, Mr. Guterman said. He and Dr. Zezza also recommended that the CMS cover some start-up fees for ACOs, which Mr. Guterman said should apply especially to providers who offer care to low-income citizens.

When asked whether enough physician groups will buy into the ACO model, Karen Davis, Ph.D., president of the Commonwealth Fund, said she is not concerned. According to Dr. Davis, the 36,000 medical practices that have met the meaningful-use standards for electronic medical records suggest the number of physicians who are interested in ACOs.

If similar numbers of physicians sign up, ACOs "will be regarded as a success," Dr. Davis said. However, she added that meeting ACO standards will take time for some medical practices.

"Those that are not there today should start working towards it today," Dr. Davis said.

To accomplish the goals of the health reform act, accountable care organizations will have to engage and inform their patients, have a strong foundation of primary care, and commit to serve their communities – besides their underlying mission to take financial responsibility for the quality of care for Medicare patients, according to a paper released April 14 by the Commonwealth Fund.

In response to the recently released, proposed regulations for accountable care organizations (ACOs) from the Centers for Medicare and Medicaid Services, Mark Zezza, Ph.D., and Stuart Guterman of the Commonwealth Fund outlined 10 recommendations for Medicare officials to consider as they finalize the regulations before the end of this year.

ACOs should be part of a shared savings system that incorporates "creativity and flexibility" in rewarding participating organizations for improving care, the authors stressed. They also recommended that Medicare’s payment models for ACOs should accommodate a variety of organizational structures.

"The notion that there would be one kind of [ACO] model, or even a few kinds of models" doesn’t hold for existing integrated health systems that are likely to transition easily into ACOs, Mr. Guterman said in a press conference.

The CMS has estimated that 75-150 organizations will form ACOs and that each will face first-year costs of approximately $1.7 million to do so. Despite the potential of rewards from Medicare for patient-care savings while improving quality, some physician organizations have expressed reservations about ACOs.

The answer to that concern is teamwork. "The more payers that are involved, the more patients, the more the costs get spread" in an ACO and the "less onerous" the process becomes, Mr. Guterman said. He and Dr. Zezza also recommended that the CMS cover some start-up fees for ACOs, which Mr. Guterman said should apply especially to providers who offer care to low-income citizens.

When asked whether enough physician groups will buy into the ACO model, Karen Davis, Ph.D., president of the Commonwealth Fund, said she is not concerned. According to Dr. Davis, the 36,000 medical practices that have met the meaningful-use standards for electronic medical records suggest the number of physicians who are interested in ACOs.

If similar numbers of physicians sign up, ACOs "will be regarded as a success," Dr. Davis said. However, she added that meeting ACO standards will take time for some medical practices.

"Those that are not there today should start working towards it today," Dr. Davis said.

To accomplish the goals of the health reform act, accountable care organizations will have to engage and inform their patients, have a strong foundation of primary care, and commit to serve their communities – besides their underlying mission to take financial responsibility for the quality of care for Medicare patients, according to a paper released April 14 by the Commonwealth Fund.

In response to the recently released, proposed regulations for accountable care organizations (ACOs) from the Centers for Medicare and Medicaid Services, Mark Zezza, Ph.D., and Stuart Guterman of the Commonwealth Fund outlined 10 recommendations for Medicare officials to consider as they finalize the regulations before the end of this year.

ACOs should be part of a shared savings system that incorporates "creativity and flexibility" in rewarding participating organizations for improving care, the authors stressed. They also recommended that Medicare’s payment models for ACOs should accommodate a variety of organizational structures.

"The notion that there would be one kind of [ACO] model, or even a few kinds of models" doesn’t hold for existing integrated health systems that are likely to transition easily into ACOs, Mr. Guterman said in a press conference.

The CMS has estimated that 75-150 organizations will form ACOs and that each will face first-year costs of approximately $1.7 million to do so. Despite the potential of rewards from Medicare for patient-care savings while improving quality, some physician organizations have expressed reservations about ACOs.

The answer to that concern is teamwork. "The more payers that are involved, the more patients, the more the costs get spread" in an ACO and the "less onerous" the process becomes, Mr. Guterman said. He and Dr. Zezza also recommended that the CMS cover some start-up fees for ACOs, which Mr. Guterman said should apply especially to providers who offer care to low-income citizens.

When asked whether enough physician groups will buy into the ACO model, Karen Davis, Ph.D., president of the Commonwealth Fund, said she is not concerned. According to Dr. Davis, the 36,000 medical practices that have met the meaningful-use standards for electronic medical records suggest the number of physicians who are interested in ACOs.

If similar numbers of physicians sign up, ACOs "will be regarded as a success," Dr. Davis said. However, she added that meeting ACO standards will take time for some medical practices.

"Those that are not there today should start working towards it today," Dr. Davis said.

To accomplish the goals of the health reform act, accountable care organizations will have to engage and inform their patients, have a strong foundation of primary care, and commit to serve their communities – besides their underlying mission to take financial responsibility for the quality of care for Medicare patients, according to a paper released April 14 by the Commonwealth Fund.

In response to the recently released, proposed regulations for accountable care organizations (ACOs) from the Centers for Medicare and Medicaid Services, Mark Zezza, Ph.D., and Stuart Guterman of the Commonwealth Fund outlined 10 recommendations for Medicare officials to consider as they finalize the regulations before the end of this year.

ACOs should be part of a shared savings system that incorporates "creativity and flexibility" in rewarding participating organizations for improving care, the authors stressed. They also recommended that Medicare’s payment models for ACOs should accommodate a variety of organizational structures.

"The notion that there would be one kind of [ACO] model, or even a few kinds of models" doesn’t hold for existing integrated health systems that are likely to transition easily into ACOs, Mr. Guterman said in a press conference.

The CMS has estimated that 75-150 organizations will form ACOs and that each will face first-year costs of approximately $1.7 million to do so. Despite the potential of rewards from Medicare for patient-care savings while improving quality, some physician organizations have expressed reservations about ACOs.

The answer to that concern is teamwork. "The more payers that are involved, the more patients, the more the costs get spread" in an ACO and the "less onerous" the process becomes, Mr. Guterman said. He and Dr. Zezza also recommended that the CMS cover some start-up fees for ACOs, which Mr. Guterman said should apply especially to providers who offer care to low-income citizens.

When asked whether enough physician groups will buy into the ACO model, Karen Davis, Ph.D., president of the Commonwealth Fund, said she is not concerned. According to Dr. Davis, the 36,000 medical practices that have met the meaningful-use standards for electronic medical records suggest the number of physicians who are interested in ACOs.

If similar numbers of physicians sign up, ACOs "will be regarded as a success," Dr. Davis said. However, she added that meeting ACO standards will take time for some medical practices.

"Those that are not there today should start working towards it today," Dr. Davis said.

To accomplish the goals of the health reform act, accountable care organizations will have to engage and inform their patients, have a strong foundation of primary care, and commit to serve their communities – besides their underlying mission to take financial responsibility for the quality of care for Medicare patients, according to a paper released April 14 by the Commonwealth Fund.

In response to the recently released, proposed regulations for accountable care organizations (ACOs) from the Centers for Medicare and Medicaid Services, Mark Zezza, Ph.D., and Stuart Guterman of the Commonwealth Fund outlined 10 recommendations for Medicare officials to consider as they finalize the regulations before the end of this year.

ACOs should be part of a shared savings system that incorporates "creativity and flexibility" in rewarding participating organizations for improving care, the authors stressed. They also recommended that Medicare’s payment models for ACOs should accommodate a variety of organizational structures.

"The notion that there would be one kind of [ACO] model, or even a few kinds of models" doesn’t hold for existing integrated health systems that are likely to transition easily into ACOs, Mr. Guterman said in a press conference.

The CMS has estimated that 75-150 organizations will form ACOs and that each will face first-year costs of approximately $1.7 million to do so. Despite the potential of rewards from Medicare for patient-care savings while improving quality, some physician organizations have expressed reservations about ACOs.

The answer to that concern is teamwork. "The more payers that are involved, the more patients, the more the costs get spread" in an ACO and the "less onerous" the process becomes, Mr. Guterman said. He and Dr. Zezza also recommended that the CMS cover some start-up fees for ACOs, which Mr. Guterman said should apply especially to providers who offer care to low-income citizens.

When asked whether enough physician groups will buy into the ACO model, Karen Davis, Ph.D., president of the Commonwealth Fund, said she is not concerned. According to Dr. Davis, the 36,000 medical practices that have met the meaningful-use standards for electronic medical records suggest the number of physicians who are interested in ACOs.

If similar numbers of physicians sign up, ACOs "will be regarded as a success," Dr. Davis said. However, she added that meeting ACO standards will take time for some medical practices.

"Those that are not there today should start working towards it today," Dr. Davis said.

To accomplish the goals of the health reform act, accountable care organizations will have to engage and inform their patients, have a strong foundation of primary care, and commit to serve their communities – besides their underlying mission to take financial responsibility for the quality of care for Medicare patients, according to a paper released April 14 by the Commonwealth Fund.

In response to the recently released, proposed regulations for accountable care organizations (ACOs) from the Centers for Medicare and Medicaid Services, Mark Zezza, Ph.D., and Stuart Guterman of the Commonwealth Fund outlined 10 recommendations for Medicare officials to consider as they finalize the regulations before the end of this year.

ACOs should be part of a shared savings system that incorporates "creativity and flexibility" in rewarding participating organizations for improving care, the authors stressed. They also recommended that Medicare’s payment models for ACOs should accommodate a variety of organizational structures.

"The notion that there would be one kind of [ACO] model, or even a few kinds of models" doesn’t hold for existing integrated health systems that are likely to transition easily into ACOs, Mr. Guterman said in a press conference.

The CMS has estimated that 75-150 organizations will form ACOs and that each will face first-year costs of approximately $1.7 million to do so. Despite the potential of rewards from Medicare for patient-care savings while improving quality, some physician organizations have expressed reservations about ACOs.

The answer to that concern is teamwork. "The more payers that are involved, the more patients, the more the costs get spread" in an ACO and the "less onerous" the process becomes, Mr. Guterman said. He and Dr. Zezza also recommended that the CMS cover some start-up fees for ACOs, which Mr. Guterman said should apply especially to providers who offer care to low-income citizens.

When asked whether enough physician groups will buy into the ACO model, Karen Davis, Ph.D., president of the Commonwealth Fund, said she is not concerned. According to Dr. Davis, the 36,000 medical practices that have met the meaningful-use standards for electronic medical records suggest the number of physicians who are interested in ACOs.

If similar numbers of physicians sign up, ACOs "will be regarded as a success," Dr. Davis said. However, she added that meeting ACO standards will take time for some medical practices.

"Those that are not there today should start working towards it today," Dr. Davis said.

To accomplish the goals of the health reform act, accountable care organizations will have to engage and inform their patients, have a strong foundation of primary care, and commit to serve their communities – besides their underlying mission to take financial responsibility for the quality of care for Medicare patients, according to a paper released April 14 by the Commonwealth Fund.

In response to the recently released, proposed regulations for accountable care organizations (ACOs) from the Centers for Medicare and Medicaid Services, Mark Zezza, Ph.D., and Stuart Guterman of the Commonwealth Fund outlined 10 recommendations for Medicare officials to consider as they finalize the regulations before the end of this year.

ACOs should be part of a shared savings system that incorporates "creativity and flexibility" in rewarding participating organizations for improving care, the authors stressed. They also recommended that Medicare’s payment models for ACOs should accommodate a variety of organizational structures.

"The notion that there would be one kind of [ACO] model, or even a few kinds of models" doesn’t hold for existing integrated health systems that are likely to transition easily into ACOs, Mr. Guterman said in a press conference.

The CMS has estimated that 75-150 organizations will form ACOs and that each will face first-year costs of approximately $1.7 million to do so. Despite the potential of rewards from Medicare for patient-care savings while improving quality, some physician organizations have expressed reservations about ACOs.

The answer to that concern is teamwork. "The more payers that are involved, the more patients, the more the costs get spread" in an ACO and the "less onerous" the process becomes, Mr. Guterman said. He and Dr. Zezza also recommended that the CMS cover some start-up fees for ACOs, which Mr. Guterman said should apply especially to providers who offer care to low-income citizens.

When asked whether enough physician groups will buy into the ACO model, Karen Davis, Ph.D., president of the Commonwealth Fund, said she is not concerned. According to Dr. Davis, the 36,000 medical practices that have met the meaningful-use standards for electronic medical records suggest the number of physicians who are interested in ACOs.

If similar numbers of physicians sign up, ACOs "will be regarded as a success," Dr. Davis said. However, she added that meeting ACO standards will take time for some medical practices.

"Those that are not there today should start working towards it today," Dr. Davis said.

WASHINGTON – Health experts and policy makers weighed in on the Affordable Care Act’s end-of-life provision at a National Journal Policy Summit in March.

The provision would reimburse doctors for consulting with elderly patients about end-of-life issues and palliative care. Medicare would provide coverage for this consultation once every 5 years per patient, and more frequently if the patient faces a life-threatening condition. However, consultations would not be a requirement.

Opponents say the provision means less care for the elderly, likening it to euthanasia, but some panelists said the benefits outweigh concerns.

"The quality of a patient’s life goes up. The quality of the family’s life goes up. More patients die at home, which is where 80% of Americans say they’d like to die," said panelist Dr. Allen S. Lichter. "Now, when you do the cost analysis, it happens to save money. That’s the sprinkles on the icing on the top of the cake – that’s not the cake."

Dr. Lichter, a professor of radiation oncology at the University of Michigan, Ann Arbor, added that physicians should focus on making patients comfortable in their last days, instead of offering "false hope" for a cure.

Panelist Michael F. Cannon, director of health policy studies at the Cato Institute, argued that as doctors pursue every possible option for care of patients at the end of life, costs mount with little benefit to the patient. Mr. Cannon cited findings of a study done by a Dartmouth Atlas working group that analyzed patient care in the final 6 months of life. The study included a 20% sample of Medicare beneficiaries, aged 66-99 years, who died between 2003 and 2007. One of the study’s conclusions was that the differences in the cost of patient care at different hospitals could not be explained by quality of care or patient preferences.

Barbara Coombs Lee, president of nonprofit advocacy group Compassion and Choices, said the lack of communication between health care providers and patients is a more crucial issue than cost. "If there’s a dichotomy, it’s about dialogue and suffering. As dialogue goes down, suffering goes up; as dialogue goes up, suffering goes down," Ms. Lee said.

Rep. Earl Blumenauer (D-Ore.) said all treatment choices need to be examined.

"This is a sort of effort to help us understand the complexities of modern medicine and for us to be able to help guide our own preferences for our treatment – whether it’s end of life, whether our leg’s going to be amputated, or what happens if we’re suddenly unconscious," Rep. Blumenauer said. "It seems to me that this is a more fundamental conversation that we have failed to appropriately spotlight."

Patients would likely agree. In a February telephone survey of 1,000 adults aged 18 and older by the Regence Foundation and the National Journal, 78% of Americans said they think there should be more open debate about end of life and palliative care, and 97% said patients should be educated about palliative and end-of-life care as well as curative treatment.

WASHINGTON – Health experts and policy makers weighed in on the Affordable Care Act’s end-of-life provision at a National Journal Policy Summit in March.

The provision would reimburse doctors for consulting with elderly patients about end-of-life issues and palliative care. Medicare would provide coverage for this consultation once every 5 years per patient, and more frequently if the patient faces a life-threatening condition. However, consultations would not be a requirement.

Opponents say the provision means less care for the elderly, likening it to euthanasia, but some panelists said the benefits outweigh concerns.

"The quality of a patient’s life goes up. The quality of the family’s life goes up. More patients die at home, which is where 80% of Americans say they’d like to die," said panelist Dr. Allen S. Lichter. "Now, when you do the cost analysis, it happens to save money. That’s the sprinkles on the icing on the top of the cake – that’s not the cake."

Dr. Lichter, a professor of radiation oncology at the University of Michigan, Ann Arbor, added that physicians should focus on making patients comfortable in their last days, instead of offering "false hope" for a cure.

Panelist Michael F. Cannon, director of health policy studies at the Cato Institute, argued that as doctors pursue every possible option for care of patients at the end of life, costs mount with little benefit to the patient. Mr. Cannon cited findings of a study done by a Dartmouth Atlas working group that analyzed patient care in the final 6 months of life. The study included a 20% sample of Medicare beneficiaries, aged 66-99 years, who died between 2003 and 2007. One of the study’s conclusions was that the differences in the cost of patient care at different hospitals could not be explained by quality of care or patient preferences.

Barbara Coombs Lee, president of nonprofit advocacy group Compassion and Choices, said the lack of communication between health care providers and patients is a more crucial issue than cost. "If there’s a dichotomy, it’s about dialogue and suffering. As dialogue goes down, suffering goes up; as dialogue goes up, suffering goes down," Ms. Lee said.

Rep. Earl Blumenauer (D-Ore.) said all treatment choices need to be examined.

"This is a sort of effort to help us understand the complexities of modern medicine and for us to be able to help guide our own preferences for our treatment – whether it’s end of life, whether our leg’s going to be amputated, or what happens if we’re suddenly unconscious," Rep. Blumenauer said. "It seems to me that this is a more fundamental conversation that we have failed to appropriately spotlight."

Patients would likely agree. In a February telephone survey of 1,000 adults aged 18 and older by the Regence Foundation and the National Journal, 78% of Americans said they think there should be more open debate about end of life and palliative care, and 97% said patients should be educated about palliative and end-of-life care as well as curative treatment.

WASHINGTON – Health experts and policy makers weighed in on the Affordable Care Act’s end-of-life provision at a National Journal Policy Summit in March.

The provision would reimburse doctors for consulting with elderly patients about end-of-life issues and palliative care. Medicare would provide coverage for this consultation once every 5 years per patient, and more frequently if the patient faces a life-threatening condition. However, consultations would not be a requirement.

Opponents say the provision means less care for the elderly, likening it to euthanasia, but some panelists said the benefits outweigh concerns.

"The quality of a patient’s life goes up. The quality of the family’s life goes up. More patients die at home, which is where 80% of Americans say they’d like to die," said panelist Dr. Allen S. Lichter. "Now, when you do the cost analysis, it happens to save money. That’s the sprinkles on the icing on the top of the cake – that’s not the cake."

Dr. Lichter, a professor of radiation oncology at the University of Michigan, Ann Arbor, added that physicians should focus on making patients comfortable in their last days, instead of offering "false hope" for a cure.

Panelist Michael F. Cannon, director of health policy studies at the Cato Institute, argued that as doctors pursue every possible option for care of patients at the end of life, costs mount with little benefit to the patient. Mr. Cannon cited findings of a study done by a Dartmouth Atlas working group that analyzed patient care in the final 6 months of life. The study included a 20% sample of Medicare beneficiaries, aged 66-99 years, who died between 2003 and 2007. One of the study’s conclusions was that the differences in the cost of patient care at different hospitals could not be explained by quality of care or patient preferences.

Barbara Coombs Lee, president of nonprofit advocacy group Compassion and Choices, said the lack of communication between health care providers and patients is a more crucial issue than cost. "If there’s a dichotomy, it’s about dialogue and suffering. As dialogue goes down, suffering goes up; as dialogue goes up, suffering goes down," Ms. Lee said.

Rep. Earl Blumenauer (D-Ore.) said all treatment choices need to be examined.

"This is a sort of effort to help us understand the complexities of modern medicine and for us to be able to help guide our own preferences for our treatment – whether it’s end of life, whether our leg’s going to be amputated, or what happens if we’re suddenly unconscious," Rep. Blumenauer said. "It seems to me that this is a more fundamental conversation that we have failed to appropriately spotlight."

Patients would likely agree. In a February telephone survey of 1,000 adults aged 18 and older by the Regence Foundation and the National Journal, 78% of Americans said they think there should be more open debate about end of life and palliative care, and 97% said patients should be educated about palliative and end-of-life care as well as curative treatment.

WASHINGTON – Health experts and policy makers weighed in on the Affordable Care Act’s end-of-life provision at a National Journal Policy Summit in March.

The provision would reimburse doctors for consulting with elderly patients about end-of-life issues and palliative care. Medicare would provide coverage for this consultation once every 5 years per patient, and more frequently if the patient faces a life-threatening condition. However, consultations would not be a requirement.

Opponents say the provision means less care for the elderly, likening it to euthanasia, but some panelists said the benefits outweigh concerns.

"The quality of a patient’s life goes up. The quality of the family’s life goes up. More patients die at home, which is where 80% of Americans say they’d like to die," said panelist Dr. Allen S. Lichter. "Now, when you do the cost analysis, it happens to save money. That’s the sprinkles on the icing on the top of the cake – that’s not the cake."

Dr. Lichter, a professor of radiation oncology at the University of Michigan, Ann Arbor, added that physicians should focus on making patients comfortable in their last days, instead of offering "false hope" for a cure.

Panelist Michael F. Cannon, director of health policy studies at the Cato Institute, argued that as doctors pursue every possible option for care of patients at the end of life, costs mount with little benefit to the patient. Mr. Cannon cited findings of a study done by a Dartmouth Atlas working group that analyzed patient care in the final 6 months of life. The study included a 20% sample of Medicare beneficiaries, aged 66-99 years, who died between 2003 and 2007. One of the study’s conclusions was that the differences in the cost of patient care at different hospitals could not be explained by quality of care or patient preferences.

Barbara Coombs Lee, president of nonprofit advocacy group Compassion and Choices, said the lack of communication between health care providers and patients is a more crucial issue than cost. "If there’s a dichotomy, it’s about dialogue and suffering. As dialogue goes down, suffering goes up; as dialogue goes up, suffering goes down," Ms. Lee said.

Rep. Earl Blumenauer (D-Ore.) said all treatment choices need to be examined.

"This is a sort of effort to help us understand the complexities of modern medicine and for us to be able to help guide our own preferences for our treatment – whether it’s end of life, whether our leg’s going to be amputated, or what happens if we’re suddenly unconscious," Rep. Blumenauer said. "It seems to me that this is a more fundamental conversation that we have failed to appropriately spotlight."

Patients would likely agree. In a February telephone survey of 1,000 adults aged 18 and older by the Regence Foundation and the National Journal, 78% of Americans said they think there should be more open debate about end of life and palliative care, and 97% said patients should be educated about palliative and end-of-life care as well as curative treatment.

WASHINGTON – Health experts and policy makers weighed in on the Affordable Care Act’s end-of-life provision at a National Journal Policy Summit in March.

The provision would reimburse doctors for consulting with elderly patients about end-of-life issues and palliative care. Medicare would provide coverage for this consultation once every 5 years per patient, and more frequently if the patient faces a life-threatening condition. However, consultations would not be a requirement.

Opponents say the provision means less care for the elderly, likening it to euthanasia, but some panelists said the benefits outweigh concerns.

"The quality of a patient’s life goes up. The quality of the family’s life goes up. More patients die at home, which is where 80% of Americans say they’d like to die," said panelist Dr. Allen S. Lichter. "Now, when you do the cost analysis, it happens to save money. That’s the sprinkles on the icing on the top of the cake – that’s not the cake."

Dr. Lichter, a professor of radiation oncology at the University of Michigan, Ann Arbor, added that physicians should focus on making patients comfortable in their last days, instead of offering "false hope" for a cure.

Panelist Michael F. Cannon, director of health policy studies at the Cato Institute, argued that as doctors pursue every possible option for care of patients at the end of life, costs mount with little benefit to the patient. Mr. Cannon cited findings of a study done by a Dartmouth Atlas working group that analyzed patient care in the final 6 months of life. The study included a 20% sample of Medicare beneficiaries, aged 66-99 years, who died between 2003 and 2007. One of the study’s conclusions was that the differences in the cost of patient care at different hospitals could not be explained by quality of care or patient preferences.

Barbara Coombs Lee, president of nonprofit advocacy group Compassion and Choices, said the lack of communication between health care providers and patients is a more crucial issue than cost. "If there’s a dichotomy, it’s about dialogue and suffering. As dialogue goes down, suffering goes up; as dialogue goes up, suffering goes down," Ms. Lee said.

Rep. Earl Blumenauer (D-Ore.) said all treatment choices need to be examined.

"This is a sort of effort to help us understand the complexities of modern medicine and for us to be able to help guide our own preferences for our treatment – whether it’s end of life, whether our leg’s going to be amputated, or what happens if we’re suddenly unconscious," Rep. Blumenauer said. "It seems to me that this is a more fundamental conversation that we have failed to appropriately spotlight."

Patients would likely agree. In a February telephone survey of 1,000 adults aged 18 and older by the Regence Foundation and the National Journal, 78% of Americans said they think there should be more open debate about end of life and palliative care, and 97% said patients should be educated about palliative and end-of-life care as well as curative treatment.

WASHINGTON – Health experts and policy makers weighed in on the Affordable Care Act’s end-of-life provision at a National Journal Policy Summit in March.

The provision would reimburse doctors for consulting with elderly patients about end-of-life issues and palliative care. Medicare would provide coverage for this consultation once every 5 years per patient, and more frequently if the patient faces a life-threatening condition. However, consultations would not be a requirement.

Opponents say the provision means less care for the elderly, likening it to euthanasia, but some panelists said the benefits outweigh concerns.

"The quality of a patient’s life goes up. The quality of the family’s life goes up. More patients die at home, which is where 80% of Americans say they’d like to die," said panelist Dr. Allen S. Lichter. "Now, when you do the cost analysis, it happens to save money. That’s the sprinkles on the icing on the top of the cake – that’s not the cake."

Dr. Lichter, a professor of radiation oncology at the University of Michigan, Ann Arbor, added that physicians should focus on making patients comfortable in their last days, instead of offering "false hope" for a cure.

Panelist Michael F. Cannon, director of health policy studies at the Cato Institute, argued that as doctors pursue every possible option for care of patients at the end of life, costs mount with little benefit to the patient. Mr. Cannon cited findings of a study done by a Dartmouth Atlas working group that analyzed patient care in the final 6 months of life. The study included a 20% sample of Medicare beneficiaries, aged 66-99 years, who died between 2003 and 2007. One of the study’s conclusions was that the differences in the cost of patient care at different hospitals could not be explained by quality of care or patient preferences.

Barbara Coombs Lee, president of nonprofit advocacy group Compassion and Choices, said the lack of communication between health care providers and patients is a more crucial issue than cost. "If there’s a dichotomy, it’s about dialogue and suffering. As dialogue goes down, suffering goes up; as dialogue goes up, suffering goes down," Ms. Lee said.

Rep. Earl Blumenauer (D-Ore.) said all treatment choices need to be examined.

"This is a sort of effort to help us understand the complexities of modern medicine and for us to be able to help guide our own preferences for our treatment – whether it’s end of life, whether our leg’s going to be amputated, or what happens if we’re suddenly unconscious," Rep. Blumenauer said. "It seems to me that this is a more fundamental conversation that we have failed to appropriately spotlight."

Patients would likely agree. In a February telephone survey of 1,000 adults aged 18 and older by the Regence Foundation and the National Journal, 78% of Americans said they think there should be more open debate about end of life and palliative care, and 97% said patients should be educated about palliative and end-of-life care as well as curative treatment.

WASHINGTON – Health experts and policy makers weighed in on the Affordable Care Act’s end-of-life provision at a National Journal Policy Summit in March.

The provision would reimburse doctors for consulting with elderly patients about end-of-life issues and palliative care. Medicare would provide coverage for this consultation once every 5 years per patient, and more frequently if the patient faces a life-threatening condition. However, consultations would not be a requirement.

Opponents say the provision means less care for the elderly, likening it to euthanasia, but some panelists said the benefits outweigh concerns.

"The quality of a patient’s life goes up. The quality of the family’s life goes up. More patients die at home, which is where 80% of Americans say they’d like to die," said panelist Dr. Allen S. Lichter. "Now, when you do the cost analysis, it happens to save money. That’s the sprinkles on the icing on the top of the cake – that’s not the cake."

Dr. Lichter, a professor of radiation oncology at the University of Michigan, Ann Arbor, added that physicians should focus on making patients comfortable in their last days, instead of offering "false hope" for a cure.

Panelist Michael F. Cannon, director of health policy studies at the Cato Institute, argued that as doctors pursue every possible option for care of patients at the end of life, costs mount with little benefit to the patient. Mr. Cannon cited findings of a study done by a Dartmouth Atlas working group that analyzed patient care in the final 6 months of life. The study included a 20% sample of Medicare beneficiaries, aged 66-99 years, who died between 2003 and 2007. One of the study’s conclusions was that the differences in the cost of patient care at different hospitals could not be explained by quality of care or patient preferences.

Barbara Coombs Lee, president of nonprofit advocacy group Compassion and Choices, said the lack of communication between health care providers and patients is a more crucial issue than cost. "If there’s a dichotomy, it’s about dialogue and suffering. As dialogue goes down, suffering goes up; as dialogue goes up, suffering goes down," Ms. Lee said.

Rep. Earl Blumenauer (D-Ore.) said all treatment choices need to be examined.

"This is a sort of effort to help us understand the complexities of modern medicine and for us to be able to help guide our own preferences for our treatment – whether it’s end of life, whether our leg’s going to be amputated, or what happens if we’re suddenly unconscious," Rep. Blumenauer said. "It seems to me that this is a more fundamental conversation that we have failed to appropriately spotlight."

Patients would likely agree. In a February telephone survey of 1,000 adults aged 18 and older by the Regence Foundation and the National Journal, 78% of Americans said they think there should be more open debate about end of life and palliative care, and 97% said patients should be educated about palliative and end-of-life care as well as curative treatment.

WASHINGTON – Health experts and policy makers weighed in on the Affordable Care Act’s end-of-life provision at a National Journal Policy Summit in March.

The provision would reimburse doctors for consulting with elderly patients about end-of-life issues and palliative care. Medicare would provide coverage for this consultation once every 5 years per patient, and more frequently if the patient faces a life-threatening condition. However, consultations would not be a requirement.

Opponents say the provision means less care for the elderly, likening it to euthanasia, but some panelists said the benefits outweigh concerns.

"The quality of a patient’s life goes up. The quality of the family’s life goes up. More patients die at home, which is where 80% of Americans say they’d like to die," said panelist Dr. Allen S. Lichter. "Now, when you do the cost analysis, it happens to save money. That’s the sprinkles on the icing on the top of the cake – that’s not the cake."

Dr. Lichter, a professor of radiation oncology at the University of Michigan, Ann Arbor, added that physicians should focus on making patients comfortable in their last days, instead of offering "false hope" for a cure.

Panelist Michael F. Cannon, director of health policy studies at the Cato Institute, argued that as doctors pursue every possible option for care of patients at the end of life, costs mount with little benefit to the patient. Mr. Cannon cited findings of a study done by a Dartmouth Atlas working group that analyzed patient care in the final 6 months of life. The study included a 20% sample of Medicare beneficiaries, aged 66-99 years, who died between 2003 and 2007. One of the study’s conclusions was that the differences in the cost of patient care at different hospitals could not be explained by quality of care or patient preferences.

Barbara Coombs Lee, president of nonprofit advocacy group Compassion and Choices, said the lack of communication between health care providers and patients is a more crucial issue than cost. "If there’s a dichotomy, it’s about dialogue and suffering. As dialogue goes down, suffering goes up; as dialogue goes up, suffering goes down," Ms. Lee said.

Rep. Earl Blumenauer (D-Ore.) said all treatment choices need to be examined.

"This is a sort of effort to help us understand the complexities of modern medicine and for us to be able to help guide our own preferences for our treatment – whether it’s end of life, whether our leg’s going to be amputated, or what happens if we’re suddenly unconscious," Rep. Blumenauer said. "It seems to me that this is a more fundamental conversation that we have failed to appropriately spotlight."

Patients would likely agree. In a February telephone survey of 1,000 adults aged 18 and older by the Regence Foundation and the National Journal, 78% of Americans said they think there should be more open debate about end of life and palliative care, and 97% said patients should be educated about palliative and end-of-life care as well as curative treatment.

WASHINGTON – Health experts and policy makers weighed in on the Affordable Care Act’s end-of-life provision at a National Journal Policy Summit in March.

The provision would reimburse doctors for consulting with elderly patients about end-of-life issues and palliative care. Medicare would provide coverage for this consultation once every 5 years per patient, and more frequently if the patient faces a life-threatening condition. However, consultations would not be a requirement.

Opponents say the provision means less care for the elderly, likening it to euthanasia, but some panelists said the benefits outweigh concerns.

"The quality of a patient’s life goes up. The quality of the family’s life goes up. More patients die at home, which is where 80% of Americans say they’d like to die," said panelist Dr. Allen S. Lichter. "Now, when you do the cost analysis, it happens to save money. That’s the sprinkles on the icing on the top of the cake – that’s not the cake."

Dr. Lichter, a professor of radiation oncology at the University of Michigan, Ann Arbor, added that physicians should focus on making patients comfortable in their last days, instead of offering "false hope" for a cure.

Panelist Michael F. Cannon, director of health policy studies at the Cato Institute, argued that as doctors pursue every possible option for care of patients at the end of life, costs mount with little benefit to the patient. Mr. Cannon cited findings of a study done by a Dartmouth Atlas working group that analyzed patient care in the final 6 months of life. The study included a 20% sample of Medicare beneficiaries, aged 66-99 years, who died between 2003 and 2007. One of the study’s conclusions was that the differences in the cost of patient care at different hospitals could not be explained by quality of care or patient preferences.

Barbara Coombs Lee, president of nonprofit advocacy group Compassion and Choices, said the lack of communication between health care providers and patients is a more crucial issue than cost. "If there’s a dichotomy, it’s about dialogue and suffering. As dialogue goes down, suffering goes up; as dialogue goes up, suffering goes down," Ms. Lee said.

Rep. Earl Blumenauer (D-Ore.) said all treatment choices need to be examined.

"This is a sort of effort to help us understand the complexities of modern medicine and for us to be able to help guide our own preferences for our treatment – whether it’s end of life, whether our leg’s going to be amputated, or what happens if we’re suddenly unconscious," Rep. Blumenauer said. "It seems to me that this is a more fundamental conversation that we have failed to appropriately spotlight."

Patients would likely agree. In a February telephone survey of 1,000 adults aged 18 and older by the Regence Foundation and the National Journal, 78% of Americans said they think there should be more open debate about end of life and palliative care, and 97% said patients should be educated about palliative and end-of-life care as well as curative treatment.

WASHINGTON – Health experts and policy makers weighed in on the Affordable Care Act’s end-of-life provision at a National Journal Policy Summit in March.

The provision would reimburse doctors for consulting with elderly patients about end-of-life issues and palliative care. Medicare would provide coverage for this consultation once every 5 years per patient, and more frequently if the patient faces a life-threatening condition. However, consultations would not be a requirement.

Opponents say the provision means less care for the elderly, likening it to euthanasia, but some panelists said the benefits outweigh concerns.

"The quality of a patient’s life goes up. The quality of the family’s life goes up. More patients die at home, which is where 80% of Americans say they’d like to die," said panelist Dr. Allen S. Lichter. "Now, when you do the cost analysis, it happens to save money. That’s the sprinkles on the icing on the top of the cake – that’s not the cake."

Dr. Lichter, a professor of radiation oncology at the University of Michigan, Ann Arbor, added that physicians should focus on making patients comfortable in their last days, instead of offering "false hope" for a cure.

Panelist Michael F. Cannon, director of health policy studies at the Cato Institute, argued that as doctors pursue every possible option for care of patients at the end of life, costs mount with little benefit to the patient. Mr. Cannon cited findings of a study done by a Dartmouth Atlas working group that analyzed patient care in the final 6 months of life. The study included a 20% sample of Medicare beneficiaries, aged 66-99 years, who died between 2003 and 2007. One of the study’s conclusions was that the differences in the cost of patient care at different hospitals could not be explained by quality of care or patient preferences.

Barbara Coombs Lee, president of nonprofit advocacy group Compassion and Choices, said the lack of communication between health care providers and patients is a more crucial issue than cost. "If there’s a dichotomy, it’s about dialogue and suffering. As dialogue goes down, suffering goes up; as dialogue goes up, suffering goes down," Ms. Lee said.

Rep. Earl Blumenauer (D-Ore.) said all treatment choices need to be examined.

"This is a sort of effort to help us understand the complexities of modern medicine and for us to be able to help guide our own preferences for our treatment – whether it’s end of life, whether our leg’s going to be amputated, or what happens if we’re suddenly unconscious," Rep. Blumenauer said. "It seems to me that this is a more fundamental conversation that we have failed to appropriately spotlight."

Patients would likely agree. In a February telephone survey of 1,000 adults aged 18 and older by the Regence Foundation and the National Journal, 78% of Americans said they think there should be more open debate about end of life and palliative care, and 97% said patients should be educated about palliative and end-of-life care as well as curative treatment.

WASHINGTON – Health experts and policy makers weighed in on the Affordable Care Act’s end-of-life provision at a National Journal Policy Summit in March.

The provision would reimburse doctors for consulting with elderly patients about end-of-life issues and palliative care. Medicare would provide coverage for this consultation once every 5 years per patient, and more frequently if the patient faces a life-threatening condition. However, consultations would not be a requirement.

Opponents say the provision means less care for the elderly, likening it to euthanasia, but some panelists said the benefits outweigh concerns.

"The quality of a patient’s life goes up. The quality of the family’s life goes up. More patients die at home, which is where 80% of Americans say they’d like to die," said panelist Dr. Allen S. Lichter. "Now, when you do the cost analysis, it happens to save money. That’s the sprinkles on the icing on the top of the cake – that’s not the cake."

Dr. Lichter, a professor of radiation oncology at the University of Michigan, Ann Arbor, added that physicians should focus on making patients comfortable in their last days, instead of offering "false hope" for a cure.

Panelist Michael F. Cannon, director of health policy studies at the Cato Institute, argued that as doctors pursue every possible option for care of patients at the end of life, costs mount with little benefit to the patient. Mr. Cannon cited findings of a study done by a Dartmouth Atlas working group that analyzed patient care in the final 6 months of life. The study included a 20% sample of Medicare beneficiaries, aged 66-99 years, who died between 2003 and 2007. One of the study’s conclusions was that the differences in the cost of patient care at different hospitals could not be explained by quality of care or patient preferences.

Barbara Coombs Lee, president of nonprofit advocacy group Compassion and Choices, said the lack of communication between health care providers and patients is a more crucial issue than cost. "If there’s a dichotomy, it’s about dialogue and suffering. As dialogue goes down, suffering goes up; as dialogue goes up, suffering goes down," Ms. Lee said.

Rep. Earl Blumenauer (D-Ore.) said all treatment choices need to be examined.

"This is a sort of effort to help us understand the complexities of modern medicine and for us to be able to help guide our own preferences for our treatment – whether it’s end of life, whether our leg’s going to be amputated, or what happens if we’re suddenly unconscious," Rep. Blumenauer said. "It seems to me that this is a more fundamental conversation that we have failed to appropriately spotlight."

Patients would likely agree. In a February telephone survey of 1,000 adults aged 18 and older by the Regence Foundation and the National Journal, 78% of Americans said they think there should be more open debate about end of life and palliative care, and 97% said patients should be educated about palliative and end-of-life care as well as curative treatment.

WASHINGTON – Health experts and policy makers weighed in on the Affordable Care Act’s end-of-life provision at a National Journal Policy Summit in March.

The provision would reimburse doctors for consulting with elderly patients about end-of-life issues and palliative care. Medicare would provide coverage for this consultation once every 5 years per patient, and more frequently if the patient faces a life-threatening condition. However, consultations would not be a requirement.

Opponents say the provision means less care for the elderly, likening it to euthanasia, but some panelists said the benefits outweigh concerns.

"The quality of a patient’s life goes up. The quality of the family’s life goes up. More patients die at home, which is where 80% of Americans say they’d like to die," said panelist Dr. Allen S. Lichter. "Now, when you do the cost analysis, it happens to save money. That’s the sprinkles on the icing on the top of the cake – that’s not the cake."

Dr. Lichter, a professor of radiation oncology at the University of Michigan, Ann Arbor, added that physicians should focus on making patients comfortable in their last days, instead of offering "false hope" for a cure.

Panelist Michael F. Cannon, director of health policy studies at the Cato Institute, argued that as doctors pursue every possible option for care of patients at the end of life, costs mount with little benefit to the patient. Mr. Cannon cited findings of a study done by a Dartmouth Atlas working group that analyzed patient care in the final 6 months of life. The study included a 20% sample of Medicare beneficiaries, aged 66-99 years, who died between 2003 and 2007. One of the study’s conclusions was that the differences in the cost of patient care at different hospitals could not be explained by quality of care or patient preferences.

Barbara Coombs Lee, president of nonprofit advocacy group Compassion and Choices, said the lack of communication between health care providers and patients is a more crucial issue than cost. "If there’s a dichotomy, it’s about dialogue and suffering. As dialogue goes down, suffering goes up; as dialogue goes up, suffering goes down," Ms. Lee said.

Rep. Earl Blumenauer (D-Ore.) said all treatment choices need to be examined.

"This is a sort of effort to help us understand the complexities of modern medicine and for us to be able to help guide our own preferences for our treatment – whether it’s end of life, whether our leg’s going to be amputated, or what happens if we’re suddenly unconscious," Rep. Blumenauer said. "It seems to me that this is a more fundamental conversation that we have failed to appropriately spotlight."

Patients would likely agree. In a February telephone survey of 1,000 adults aged 18 and older by the Regence Foundation and the National Journal, 78% of Americans said they think there should be more open debate about end of life and palliative care, and 97% said patients should be educated about palliative and end-of-life care as well as curative treatment.

Participation in youth sports leagues may not provide enough exercise for children, according to a study of 200 youth aged 7-14 years published in the April issue of Archives of Pediatric & Adolescent Medicine.

According to the Centers for Disease Control and Prevention, adolescents should participate in 60 minutes of moderate-to-vigorous physical activity (MVPA) daily. However, the cross-sectional study showed that only 24% of participants met the 60-minute physical activity guideline during practice, said Ms. Desiree Leek of the San Diego State University and her associates.

© Jody Dingle/Fotolia.com

Participants from two moderate-income cities in California were recruited from 29 teams and included 103 soccer players and 97 baseball or softball players. They were separated into age groups of 7- to 10-year-olds (125 players) and 11- to 14-year-olds (75 players). Players each received a small prize worth $2 compensation for participating (Arch. Pediatr. Adolesc. Med. 2011;165:294-9).

Participants wore an ActiGraph accelerometer during practices to record their metabolic equivalents. The response rate was 93% for soccer players and was not collected for soccer and baseball players.

Study results showed a difference in MVPA based on sport, age, and sex. According to results, only 2% of softball players met the 60-minute mark, as soccer players averaged 10.6% (13.7 minutes) more time in MVPA. Fewer than 10% of 11- to 14-year olds met the guideline, with 7- to 10-year-olds averaging 5.8% (7 minutes) more time in MVPA. Only 2% of girls met the guidelines, with boys averaging 7.8% (10.7 minutes) more time in MVPA. Overall, girls spent 11 minutes less being active during practices than did boys.

According to Dr. James Sallis, one of the study’s main researchers, these results highlight a national trend and the importance of community action.

"Physicians and parents should not assume that just because a child is enrolled in sports, they are active enough," Dr. Sallis said in an interview. "In the midst of the childhood obesity epidemic, we need sports, dance lessons, PE classes, and after-school programs to do their part to get kids active every day."

Dr. Sallis said physicians should encourage parents to put pedometers on their children to see how much exercise they are getting, recommending 10,000-15,000 steps daily.

Study weaknesses included recruitment from one geographic region, limited responses on the demographic survey, and the nonrandomized, cross-sectional design. In addition, the study assessed only community leagues that required payment.

The study was supported by a National Institutes of Health Summer Research Grant through the University of California, San Diego. Ms. Desiree Leek and her associates reported no relevant financial disclosures.

Participation in youth sports leagues may not provide enough exercise for children, according to a study of 200 youth aged 7-14 years published in the April issue of Archives of Pediatric & Adolescent Medicine.

According to the Centers for Disease Control and Prevention, adolescents should participate in 60 minutes of moderate-to-vigorous physical activity (MVPA) daily. However, the cross-sectional study showed that only 24% of participants met the 60-minute physical activity guideline during practice, said Ms. Desiree Leek of the San Diego State University and her associates.

© Jody Dingle/Fotolia.com

Participants from two moderate-income cities in California were recruited from 29 teams and included 103 soccer players and 97 baseball or softball players. They were separated into age groups of 7- to 10-year-olds (125 players) and 11- to 14-year-olds (75 players). Players each received a small prize worth $2 compensation for participating (Arch. Pediatr. Adolesc. Med. 2011;165:294-9).

Participants wore an ActiGraph accelerometer during practices to record their metabolic equivalents. The response rate was 93% for soccer players and was not collected for soccer and baseball players.

Study results showed a difference in MVPA based on sport, age, and sex. According to results, only 2% of softball players met the 60-minute mark, as soccer players averaged 10.6% (13.7 minutes) more time in MVPA. Fewer than 10% of 11- to 14-year olds met the guideline, with 7- to 10-year-olds averaging 5.8% (7 minutes) more time in MVPA. Only 2% of girls met the guidelines, with boys averaging 7.8% (10.7 minutes) more time in MVPA. Overall, girls spent 11 minutes less being active during practices than did boys.

According to Dr. James Sallis, one of the study’s main researchers, these results highlight a national trend and the importance of community action.

"Physicians and parents should not assume that just because a child is enrolled in sports, they are active enough," Dr. Sallis said in an interview. "In the midst of the childhood obesity epidemic, we need sports, dance lessons, PE classes, and after-school programs to do their part to get kids active every day."

Dr. Sallis said physicians should encourage parents to put pedometers on their children to see how much exercise they are getting, recommending 10,000-15,000 steps daily.

Study weaknesses included recruitment from one geographic region, limited responses on the demographic survey, and the nonrandomized, cross-sectional design. In addition, the study assessed only community leagues that required payment.

The study was supported by a National Institutes of Health Summer Research Grant through the University of California, San Diego. Ms. Desiree Leek and her associates reported no relevant financial disclosures.

Participation in youth sports leagues may not provide enough exercise for children, according to a study of 200 youth aged 7-14 years published in the April issue of Archives of Pediatric & Adolescent Medicine.

According to the Centers for Disease Control and Prevention, adolescents should participate in 60 minutes of moderate-to-vigorous physical activity (MVPA) daily. However, the cross-sectional study showed that only 24% of participants met the 60-minute physical activity guideline during practice, said Ms. Desiree Leek of the San Diego State University and her associates.

© Jody Dingle/Fotolia.com

Participants from two moderate-income cities in California were recruited from 29 teams and included 103 soccer players and 97 baseball or softball players. They were separated into age groups of 7- to 10-year-olds (125 players) and 11- to 14-year-olds (75 players). Players each received a small prize worth $2 compensation for participating (Arch. Pediatr. Adolesc. Med. 2011;165:294-9).

Participants wore an ActiGraph accelerometer during practices to record their metabolic equivalents. The response rate was 93% for soccer players and was not collected for soccer and baseball players.

Study results showed a difference in MVPA based on sport, age, and sex. According to results, only 2% of softball players met the 60-minute mark, as soccer players averaged 10.6% (13.7 minutes) more time in MVPA. Fewer than 10% of 11- to 14-year olds met the guideline, with 7- to 10-year-olds averaging 5.8% (7 minutes) more time in MVPA. Only 2% of girls met the guidelines, with boys averaging 7.8% (10.7 minutes) more time in MVPA. Overall, girls spent 11 minutes less being active during practices than did boys.

According to Dr. James Sallis, one of the study’s main researchers, these results highlight a national trend and the importance of community action.

"Physicians and parents should not assume that just because a child is enrolled in sports, they are active enough," Dr. Sallis said in an interview. "In the midst of the childhood obesity epidemic, we need sports, dance lessons, PE classes, and after-school programs to do their part to get kids active every day."

Dr. Sallis said physicians should encourage parents to put pedometers on their children to see how much exercise they are getting, recommending 10,000-15,000 steps daily.

Study weaknesses included recruitment from one geographic region, limited responses on the demographic survey, and the nonrandomized, cross-sectional design. In addition, the study assessed only community leagues that required payment.

The study was supported by a National Institutes of Health Summer Research Grant through the University of California, San Diego. Ms. Desiree Leek and her associates reported no relevant financial disclosures.

Participation in youth sports leagues may not provide enough exercise for children, according to a study of 200 youth aged 7-14 years published in the April issue of Archives of Pediatric & Adolescent Medicine.

According to the Centers for Disease Control and Prevention, adolescents should participate in 60 minutes of moderate-to-vigorous physical activity (MVPA) daily. However, the cross-sectional study showed that only 24% of participants met the 60-minute physical activity guideline during practice, said Ms. Desiree Leek of the San Diego State University and her associates.

© Jody Dingle/Fotolia.com

Participants from two moderate-income cities in California were recruited from 29 teams and included 103 soccer players and 97 baseball or softball players. They were separated into age groups of 7- to 10-year-olds (125 players) and 11- to 14-year-olds (75 players). Players each received a small prize worth $2 compensation for participating (Arch. Pediatr. Adolesc. Med. 2011;165:294-9).

Participants wore an ActiGraph accelerometer during practices to record their metabolic equivalents. The response rate was 93% for soccer players and was not collected for soccer and baseball players.

Study results showed a difference in MVPA based on sport, age, and sex. According to results, only 2% of softball players met the 60-minute mark, as soccer players averaged 10.6% (13.7 minutes) more time in MVPA. Fewer than 10% of 11- to 14-year olds met the guideline, with 7- to 10-year-olds averaging 5.8% (7 minutes) more time in MVPA. Only 2% of girls met the guidelines, with boys averaging 7.8% (10.7 minutes) more time in MVPA. Overall, girls spent 11 minutes less being active during practices than did boys.

According to Dr. James Sallis, one of the study’s main researchers, these results highlight a national trend and the importance of community action.

"Physicians and parents should not assume that just because a child is enrolled in sports, they are active enough," Dr. Sallis said in an interview. "In the midst of the childhood obesity epidemic, we need sports, dance lessons, PE classes, and after-school programs to do their part to get kids active every day."

Dr. Sallis said physicians should encourage parents to put pedometers on their children to see how much exercise they are getting, recommending 10,000-15,000 steps daily.

Study weaknesses included recruitment from one geographic region, limited responses on the demographic survey, and the nonrandomized, cross-sectional design. In addition, the study assessed only community leagues that required payment.

The study was supported by a National Institutes of Health Summer Research Grant through the University of California, San Diego. Ms. Desiree Leek and her associates reported no relevant financial disclosures.

Participation in youth sports leagues may not provide enough exercise for children, according to a study of 200 youth aged 7-14 years published in the April issue of Archives of Pediatric & Adolescent Medicine.

According to the Centers for Disease Control and Prevention, adolescents should participate in 60 minutes of moderate-to-vigorous physical activity (MVPA) daily. However, the cross-sectional study showed that only 24% of participants met the 60-minute physical activity guideline during practice, said Ms. Desiree Leek of the San Diego State University and her associates.

© Jody Dingle/Fotolia.com

Participants from two moderate-income cities in California were recruited from 29 teams and included 103 soccer players and 97 baseball or softball players. They were separated into age groups of 7- to 10-year-olds (125 players) and 11- to 14-year-olds (75 players). Players each received a small prize worth $2 compensation for participating (Arch. Pediatr. Adolesc. Med. 2011;165:294-9).

Participants wore an ActiGraph accelerometer during practices to record their metabolic equivalents. The response rate was 93% for soccer players and was not collected for soccer and baseball players.

Study results showed a difference in MVPA based on sport, age, and sex. According to results, only 2% of softball players met the 60-minute mark, as soccer players averaged 10.6% (13.7 minutes) more time in MVPA. Fewer than 10% of 11- to 14-year olds met the guideline, with 7- to 10-year-olds averaging 5.8% (7 minutes) more time in MVPA. Only 2% of girls met the guidelines, with boys averaging 7.8% (10.7 minutes) more time in MVPA. Overall, girls spent 11 minutes less being active during practices than did boys.

According to Dr. James Sallis, one of the study’s main researchers, these results highlight a national trend and the importance of community action.

"Physicians and parents should not assume that just because a child is enrolled in sports, they are active enough," Dr. Sallis said in an interview. "In the midst of the childhood obesity epidemic, we need sports, dance lessons, PE classes, and after-school programs to do their part to get kids active every day."

Dr. Sallis said physicians should encourage parents to put pedometers on their children to see how much exercise they are getting, recommending 10,000-15,000 steps daily.

Study weaknesses included recruitment from one geographic region, limited responses on the demographic survey, and the nonrandomized, cross-sectional design. In addition, the study assessed only community leagues that required payment.

The study was supported by a National Institutes of Health Summer Research Grant through the University of California, San Diego. Ms. Desiree Leek and her associates reported no relevant financial disclosures.

Participation in youth sports leagues may not provide enough exercise for children, according to a study of 200 youth aged 7-14 years published in the April issue of Archives of Pediatric & Adolescent Medicine.

According to the Centers for Disease Control and Prevention, adolescents should participate in 60 minutes of moderate-to-vigorous physical activity (MVPA) daily. However, the cross-sectional study showed that only 24% of participants met the 60-minute physical activity guideline during practice, said Ms. Desiree Leek of the San Diego State University and her associates.

© Jody Dingle/Fotolia.com

Participants from two moderate-income cities in California were recruited from 29 teams and included 103 soccer players and 97 baseball or softball players. They were separated into age groups of 7- to 10-year-olds (125 players) and 11- to 14-year-olds (75 players). Players each received a small prize worth $2 compensation for participating (Arch. Pediatr. Adolesc. Med. 2011;165:294-9).

Participants wore an ActiGraph accelerometer during practices to record their metabolic equivalents. The response rate was 93% for soccer players and was not collected for soccer and baseball players.

Study results showed a difference in MVPA based on sport, age, and sex. According to results, only 2% of softball players met the 60-minute mark, as soccer players averaged 10.6% (13.7 minutes) more time in MVPA. Fewer than 10% of 11- to 14-year olds met the guideline, with 7- to 10-year-olds averaging 5.8% (7 minutes) more time in MVPA. Only 2% of girls met the guidelines, with boys averaging 7.8% (10.7 minutes) more time in MVPA. Overall, girls spent 11 minutes less being active during practices than did boys.

According to Dr. James Sallis, one of the study’s main researchers, these results highlight a national trend and the importance of community action.

"Physicians and parents should not assume that just because a child is enrolled in sports, they are active enough," Dr. Sallis said in an interview. "In the midst of the childhood obesity epidemic, we need sports, dance lessons, PE classes, and after-school programs to do their part to get kids active every day."

Dr. Sallis said physicians should encourage parents to put pedometers on their children to see how much exercise they are getting, recommending 10,000-15,000 steps daily.

Study weaknesses included recruitment from one geographic region, limited responses on the demographic survey, and the nonrandomized, cross-sectional design. In addition, the study assessed only community leagues that required payment.

The study was supported by a National Institutes of Health Summer Research Grant through the University of California, San Diego. Ms. Desiree Leek and her associates reported no relevant financial disclosures.

WASHINGTON – The rate of ADHD among Latino youth is relatively low, but that percentage is misleading, according to an expert in cultural diversity and mental health.

Dr. Andres J. Pumariega, who has worked in this clinical area for 30 years, said a 2010 survey from the Centers for Disease Control and Prevention found that the percentage of Latinos who were diagnosed with ADHD is 5.6%, compared with 9.5% of whites and 10.1% of blacks (MMWR 2010;59:1439-43). ADHD is typically diagnosed through parental report. Dr. Pumariega, chairman of the psychiatry department at Cooper University Hospital in Camden, N.J., suspects that cultural misconceptions might prevent parents from recognizing or acknowledging the illness in their children.

Parents "often believe ADHD is misdiagnosed in Latino children, but they often think that it is being overdiagnosed, and our data from more objective studies actually point to it being underdiagnosed. That’s a big gap," said Dr. Pumariega, who presented the findings at the annual conference of the National Hispanic Medical Association.

Other data support Dr. Pumariega’s contention. For example, the 2010 National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey revealed that Latino children were less likely to receive stimulant medication. Results were based on data from 26,000 office- and hospital-based primary care visits. In addition, a longitudinal study of 2,000 caregivers in Puerto Rico showed that only 3.6% of children with ADHD adhered to their medication after a year (J. Am. Acad. Child Adolesc. Psychiatry, 2007;46:5-14).

In a related presentation, Dr. Eugenio M. Rothe cited an article he wrote suggesting that disparities in treatment between Latino youth and their white counterparts might be tied to several factors, including language barriers and a lack of parental understanding (J. Natl. Med. Assoc. 2005;97[suppl. 10]:17S-23).

Dr. Rothe also cited a national survey conducted by Harris Interactive that found that Latinos were less likely to be familiar with ADHD and nearly 10% less likely to know where to get treatment. In addition, Dr. Rothe said, 23% of Latinos vs. 14% of whites thought that ADHD is misdiagnosed in Latino children. The survey was based on online and phone interviews with more than 3,300 parents or caregivers of children aged 6-17 years, said Dr. Rothe, professor of psychiatry and public health at Florida International University, Miami.

Another complicating factor is the acculturation gap between Latino youth and their parents. That gap can generate conflict that can be further aggravated by ADHD, according to Dr. Pumariega. "ADHD can add fuel to the fire in terms of more impulsivity and less adaptive capacity on the part of the youth," he said.

He also suggested that ADHD can contribute to some of the psychosocial problems of Latino youth, including the school dropout rate, the teen pregnancy rate, and substance abuse.

To bridge the gap in diagnosis and treatment of ADHD in Latinos, Dr. Rothe recommended practices aimed at increasing the availability of Spanish-translated ADHD patient education materials, as well as increasing the number of Spanish-speaking physicians, nurses, and health care providers.

The Latino value of strong personal relationships and attachment to family should be factored into care, Dr. Rothe suggested.

"Therefore, clinicians may increase rapport with patients by seeking the opinion of respected family members, decreasing personal space during interactions, using friendly gestures, and displaying a genuine interest in the life of the patient to increase the probability of patient adherence and earn the trust of the patient," Dr. Rothe said.

Dr. Pumariega has chaired the Latino ADHD Advisory Panel for Shire Pharmaceuticals. Dr. Rothe has no relevant disclosures.

WASHINGTON – The rate of ADHD among Latino youth is relatively low, but that percentage is misleading, according to an expert in cultural diversity and mental health.

Dr. Andres J. Pumariega, who has worked in this clinical area for 30 years, said a 2010 survey from the Centers for Disease Control and Prevention found that the percentage of Latinos who were diagnosed with ADHD is 5.6%, compared with 9.5% of whites and 10.1% of blacks (MMWR 2010;59:1439-43). ADHD is typically diagnosed through parental report. Dr. Pumariega, chairman of the psychiatry department at Cooper University Hospital in Camden, N.J., suspects that cultural misconceptions might prevent parents from recognizing or acknowledging the illness in their children.

Parents "often believe ADHD is misdiagnosed in Latino children, but they often think that it is being overdiagnosed, and our data from more objective studies actually point to it being underdiagnosed. That’s a big gap," said Dr. Pumariega, who presented the findings at the annual conference of the National Hispanic Medical Association.

Other data support Dr. Pumariega’s contention. For example, the 2010 National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey revealed that Latino children were less likely to receive stimulant medication. Results were based on data from 26,000 office- and hospital-based primary care visits. In addition, a longitudinal study of 2,000 caregivers in Puerto Rico showed that only 3.6% of children with ADHD adhered to their medication after a year (J. Am. Acad. Child Adolesc. Psychiatry, 2007;46:5-14).

In a related presentation, Dr. Eugenio M. Rothe cited an article he wrote suggesting that disparities in treatment between Latino youth and their white counterparts might be tied to several factors, including language barriers and a lack of parental understanding (J. Natl. Med. Assoc. 2005;97[suppl. 10]:17S-23).

Dr. Rothe also cited a national survey conducted by Harris Interactive that found that Latinos were less likely to be familiar with ADHD and nearly 10% less likely to know where to get treatment. In addition, Dr. Rothe said, 23% of Latinos vs. 14% of whites thought that ADHD is misdiagnosed in Latino children. The survey was based on online and phone interviews with more than 3,300 parents or caregivers of children aged 6-17 years, said Dr. Rothe, professor of psychiatry and public health at Florida International University, Miami.

Another complicating factor is the acculturation gap between Latino youth and their parents. That gap can generate conflict that can be further aggravated by ADHD, according to Dr. Pumariega. "ADHD can add fuel to the fire in terms of more impulsivity and less adaptive capacity on the part of the youth," he said.

He also suggested that ADHD can contribute to some of the psychosocial problems of Latino youth, including the school dropout rate, the teen pregnancy rate, and substance abuse.

To bridge the gap in diagnosis and treatment of ADHD in Latinos, Dr. Rothe recommended practices aimed at increasing the availability of Spanish-translated ADHD patient education materials, as well as increasing the number of Spanish-speaking physicians, nurses, and health care providers.

The Latino value of strong personal relationships and attachment to family should be factored into care, Dr. Rothe suggested.

"Therefore, clinicians may increase rapport with patients by seeking the opinion of respected family members, decreasing personal space during interactions, using friendly gestures, and displaying a genuine interest in the life of the patient to increase the probability of patient adherence and earn the trust of the patient," Dr. Rothe said.

Dr. Pumariega has chaired the Latino ADHD Advisory Panel for Shire Pharmaceuticals. Dr. Rothe has no relevant disclosures.

WASHINGTON – The rate of ADHD among Latino youth is relatively low, but that percentage is misleading, according to an expert in cultural diversity and mental health.

Dr. Andres J. Pumariega, who has worked in this clinical area for 30 years, said a 2010 survey from the Centers for Disease Control and Prevention found that the percentage of Latinos who were diagnosed with ADHD is 5.6%, compared with 9.5% of whites and 10.1% of blacks (MMWR 2010;59:1439-43). ADHD is typically diagnosed through parental report. Dr. Pumariega, chairman of the psychiatry department at Cooper University Hospital in Camden, N.J., suspects that cultural misconceptions might prevent parents from recognizing or acknowledging the illness in their children.

Parents "often believe ADHD is misdiagnosed in Latino children, but they often think that it is being overdiagnosed, and our data from more objective studies actually point to it being underdiagnosed. That’s a big gap," said Dr. Pumariega, who presented the findings at the annual conference of the National Hispanic Medical Association.

Other data support Dr. Pumariega’s contention. For example, the 2010 National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey revealed that Latino children were less likely to receive stimulant medication. Results were based on data from 26,000 office- and hospital-based primary care visits. In addition, a longitudinal study of 2,000 caregivers in Puerto Rico showed that only 3.6% of children with ADHD adhered to their medication after a year (J. Am. Acad. Child Adolesc. Psychiatry, 2007;46:5-14).

In a related presentation, Dr. Eugenio M. Rothe cited an article he wrote suggesting that disparities in treatment between Latino youth and their white counterparts might be tied to several factors, including language barriers and a lack of parental understanding (J. Natl. Med. Assoc. 2005;97[suppl. 10]:17S-23).

Dr. Rothe also cited a national survey conducted by Harris Interactive that found that Latinos were less likely to be familiar with ADHD and nearly 10% less likely to know where to get treatment. In addition, Dr. Rothe said, 23% of Latinos vs. 14% of whites thought that ADHD is misdiagnosed in Latino children. The survey was based on online and phone interviews with more than 3,300 parents or caregivers of children aged 6-17 years, said Dr. Rothe, professor of psychiatry and public health at Florida International University, Miami.

Another complicating factor is the acculturation gap between Latino youth and their parents. That gap can generate conflict that can be further aggravated by ADHD, according to Dr. Pumariega. "ADHD can add fuel to the fire in terms of more impulsivity and less adaptive capacity on the part of the youth," he said.

He also suggested that ADHD can contribute to some of the psychosocial problems of Latino youth, including the school dropout rate, the teen pregnancy rate, and substance abuse.

To bridge the gap in diagnosis and treatment of ADHD in Latinos, Dr. Rothe recommended practices aimed at increasing the availability of Spanish-translated ADHD patient education materials, as well as increasing the number of Spanish-speaking physicians, nurses, and health care providers.

The Latino value of strong personal relationships and attachment to family should be factored into care, Dr. Rothe suggested.

"Therefore, clinicians may increase rapport with patients by seeking the opinion of respected family members, decreasing personal space during interactions, using friendly gestures, and displaying a genuine interest in the life of the patient to increase the probability of patient adherence and earn the trust of the patient," Dr. Rothe said.

Dr. Pumariega has chaired the Latino ADHD Advisory Panel for Shire Pharmaceuticals. Dr. Rothe has no relevant disclosures.