Naseem S. Miller

Children who are underinsured outnumber uninsured children and are almost as likely as uninsured children to have problems with health care access and quality, according to a study published Aug. 25 in the New England Journal of Medicine.

Nearly a quarter of children with continuous health care coverage in 2007 did not have coverage adequate enough to provide access to appropriate services and providers, according to lead author Michael Kogan, Ph.D., of the Health Resources and Services Administration's Maternal and Child Health Bureau, and his colleagues.

Dr. Kogan and his colleagues analyzed data collected from the 2007 National Survey of Children's Health, which was conducted by random-digital-dial interviews with the parents or guardians of 91,642 children (N. Engl. J. Med. 2010;363:841-51).

They found that in 2007, 19% (14.1 million) of all U.S. children were underinsured (continuous but inadequate coverage), while 5% (3.4 million) were uninsured, and 10% (7.6 million) were sometimes insured. In contrast, 66% (48.2 million) were fully insured.

Children with private insurance were twice as likely to be underinsured as those with public insurance, for example coverage under either Medicaid or a State Children's Health Insurance Program (SCHIP), they wrote. Inadequate coverage of charges was the most common source of underinsurance, accounting for 12.1 million children.

Certain groups of insured children were more likely to be underinsured: those older than 6 years, Hispanic and black children, those in the Midwest, and those who had special health care needs.

Underinsured children had no access to a medical home on the same scale as their sometimes insured peers – 55% and 58% respectively. Dr. Kogan and colleagues found a similar situation regarding access to specialty care: 26% of underinsured children had difficulty obtaining specialist care, compared with 29% of sometimes insured children and 25% of uninsured children.

While attention has been focused on the woes of adult underinsurance, less has been paid to childhood underinsurance, according to Dr. Kogan, who added that it is not clear whether the number of uninsured children has been on the rise over the years, because there are no similar studies for comparison.

As implementation of the Affordable Care Act continues, "it may be worthwhile to consider not only the number of uninsured children in the United States but also the adequacy of coverage for those with current insurance," wrote Dr. Kogan and colleagues.

The study is limited in several ways, the authors wrote. Because the study design was cross-sectional, it is difficult to establish the direction of causality. In addition, the data excludes children in institutions. And, because the study is based on data collected in a phone survey, it is subject to biases, "including the exclusion of household without landlines."

"What I would hope from policymakers is that they would be aware that this problem is more prevalent than the number of uninsured kids and to take that into account in the future policy considerations," Dr. Kogan wrote, noting that HRSA plans on repeating the study within the next few years.

In an accompanying editorial, Dr. James Perrin of the MGH Center for Child and Adolescent Health Policy, Boston, noted that the study offers "compelling evidence that underinsured children face major problems in obtaining both the appropriate quality of care and access to that care. Implementation of the Affordable Care Act offers important opportunities to address the problem of underinsurance" (N. Engl. J. Med. 2010;363:9).

He added, however, that "the Affordable Care Act may leave chronically ill children with CHIP coverage and newly insured Medicaid population underinsured." While expansion of benefits is unlikely, "CHIP and the new Medicaid could offer such benefits to persons meeting certain disability criteria [and potentially offer a better federal match to encourage states to include these benefits]."

Disclosures: The study authors and Dr. Perrin disclosed that they have no relevant conflicts of interest.

Children who are underinsured outnumber uninsured children and are almost as likely as uninsured children to have problems with health care access and quality, according to a study published Aug. 25 in the New England Journal of Medicine.

Nearly a quarter of children with continuous health care coverage in 2007 did not have coverage adequate enough to provide access to appropriate services and providers, according to lead author Michael Kogan, Ph.D., of the Health Resources and Services Administration's Maternal and Child Health Bureau, and his colleagues.

Dr. Kogan and his colleagues analyzed data collected from the 2007 National Survey of Children's Health, which was conducted by random-digital-dial interviews with the parents or guardians of 91,642 children (N. Engl. J. Med. 2010;363:841-51).

They found that in 2007, 19% (14.1 million) of all U.S. children were underinsured (continuous but inadequate coverage), while 5% (3.4 million) were uninsured, and 10% (7.6 million) were sometimes insured. In contrast, 66% (48.2 million) were fully insured.

Children with private insurance were twice as likely to be underinsured as those with public insurance, for example coverage under either Medicaid or a State Children's Health Insurance Program (SCHIP), they wrote. Inadequate coverage of charges was the most common source of underinsurance, accounting for 12.1 million children.

Certain groups of insured children were more likely to be underinsured: those older than 6 years, Hispanic and black children, those in the Midwest, and those who had special health care needs.

Underinsured children had no access to a medical home on the same scale as their sometimes insured peers – 55% and 58% respectively. Dr. Kogan and colleagues found a similar situation regarding access to specialty care: 26% of underinsured children had difficulty obtaining specialist care, compared with 29% of sometimes insured children and 25% of uninsured children.

While attention has been focused on the woes of adult underinsurance, less has been paid to childhood underinsurance, according to Dr. Kogan, who added that it is not clear whether the number of uninsured children has been on the rise over the years, because there are no similar studies for comparison.

As implementation of the Affordable Care Act continues, "it may be worthwhile to consider not only the number of uninsured children in the United States but also the adequacy of coverage for those with current insurance," wrote Dr. Kogan and colleagues.

The study is limited in several ways, the authors wrote. Because the study design was cross-sectional, it is difficult to establish the direction of causality. In addition, the data excludes children in institutions. And, because the study is based on data collected in a phone survey, it is subject to biases, "including the exclusion of household without landlines."

"What I would hope from policymakers is that they would be aware that this problem is more prevalent than the number of uninsured kids and to take that into account in the future policy considerations," Dr. Kogan wrote, noting that HRSA plans on repeating the study within the next few years.

In an accompanying editorial, Dr. James Perrin of the MGH Center for Child and Adolescent Health Policy, Boston, noted that the study offers "compelling evidence that underinsured children face major problems in obtaining both the appropriate quality of care and access to that care. Implementation of the Affordable Care Act offers important opportunities to address the problem of underinsurance" (N. Engl. J. Med. 2010;363:9).

He added, however, that "the Affordable Care Act may leave chronically ill children with CHIP coverage and newly insured Medicaid population underinsured." While expansion of benefits is unlikely, "CHIP and the new Medicaid could offer such benefits to persons meeting certain disability criteria [and potentially offer a better federal match to encourage states to include these benefits]."

Disclosures: The study authors and Dr. Perrin disclosed that they have no relevant conflicts of interest.

Children who are underinsured outnumber uninsured children and are almost as likely as uninsured children to have problems with health care access and quality, according to a study published Aug. 25 in the New England Journal of Medicine.

Nearly a quarter of children with continuous health care coverage in 2007 did not have coverage adequate enough to provide access to appropriate services and providers, according to lead author Michael Kogan, Ph.D., of the Health Resources and Services Administration's Maternal and Child Health Bureau, and his colleagues.

Dr. Kogan and his colleagues analyzed data collected from the 2007 National Survey of Children's Health, which was conducted by random-digital-dial interviews with the parents or guardians of 91,642 children (N. Engl. J. Med. 2010;363:841-51).

They found that in 2007, 19% (14.1 million) of all U.S. children were underinsured (continuous but inadequate coverage), while 5% (3.4 million) were uninsured, and 10% (7.6 million) were sometimes insured. In contrast, 66% (48.2 million) were fully insured.

Children with private insurance were twice as likely to be underinsured as those with public insurance, for example coverage under either Medicaid or a State Children's Health Insurance Program (SCHIP), they wrote. Inadequate coverage of charges was the most common source of underinsurance, accounting for 12.1 million children.

Certain groups of insured children were more likely to be underinsured: those older than 6 years, Hispanic and black children, those in the Midwest, and those who had special health care needs.

Underinsured children had no access to a medical home on the same scale as their sometimes insured peers – 55% and 58% respectively. Dr. Kogan and colleagues found a similar situation regarding access to specialty care: 26% of underinsured children had difficulty obtaining specialist care, compared with 29% of sometimes insured children and 25% of uninsured children.

While attention has been focused on the woes of adult underinsurance, less has been paid to childhood underinsurance, according to Dr. Kogan, who added that it is not clear whether the number of uninsured children has been on the rise over the years, because there are no similar studies for comparison.

As implementation of the Affordable Care Act continues, "it may be worthwhile to consider not only the number of uninsured children in the United States but also the adequacy of coverage for those with current insurance," wrote Dr. Kogan and colleagues.

The study is limited in several ways, the authors wrote. Because the study design was cross-sectional, it is difficult to establish the direction of causality. In addition, the data excludes children in institutions. And, because the study is based on data collected in a phone survey, it is subject to biases, "including the exclusion of household without landlines."

"What I would hope from policymakers is that they would be aware that this problem is more prevalent than the number of uninsured kids and to take that into account in the future policy considerations," Dr. Kogan wrote, noting that HRSA plans on repeating the study within the next few years.

In an accompanying editorial, Dr. James Perrin of the MGH Center for Child and Adolescent Health Policy, Boston, noted that the study offers "compelling evidence that underinsured children face major problems in obtaining both the appropriate quality of care and access to that care. Implementation of the Affordable Care Act offers important opportunities to address the problem of underinsurance" (N. Engl. J. Med. 2010;363:9).

He added, however, that "the Affordable Care Act may leave chronically ill children with CHIP coverage and newly insured Medicaid population underinsured." While expansion of benefits is unlikely, "CHIP and the new Medicaid could offer such benefits to persons meeting certain disability criteria [and potentially offer a better federal match to encourage states to include these benefits]."

Disclosures: The study authors and Dr. Perrin disclosed that they have no relevant conflicts of interest.

Children who are underinsured outnumber uninsured children and are almost as likely as uninsured children to have problems with health care access and quality, according to a study published Aug. 25 in the New England Journal of Medicine. 

Nearly a quarter of children with continuous health care coverage in 2007 did not have coverage adequate enough to provide access to appropriate services and providers, according to lead author Michael Kogan, Ph.D., of the Health Resources and Services Administration’s Maternal and Child Health Bureau, and his colleagues.

Dr. Kogan and his colleagues analyzed data collected from the 2007 National Survey of Children’s Health, which was conducted by random-digital-dial interviews with the parents or guardians of 91,642 children.

They found that in 2007, 19% (14.1 million) of all U.S. children were underinsured (continuous but inadequate coverage), while 5% (3.4 million) were uninsured, and 10% (7.6 million) were sometimes insured. In contrast, 66% (48.2 million) were fully insured.

Children with private insurance were twice as likely to be underinsured as those with public insurance, for example coverage under either Medicaid or a State Children’s Health Insurance Program (SCHIP), they wrote. Inadequate coverage of charges was the most common source of underinsurance, accounting for 12.1 million children.

Certain groups of insured children were more likely to be underinsured: those older than 6 years, Hispanic and black children, those in the Midwest, and those who had special health care needs.

Underinsured children had no access to a medical home on the same scale as their sometimes insured peers – 55% and 58% respectively. Dr. Kogan and colleagues found a similar situation regarding access to specialty care: 26% of underinsured children had difficulty obtaining specialist care, compared with 29% of sometimes insured children and 25% of uninsured children.

While attention has been focused on the woes of adult underinsurance, less has been paid to childhood underinsurance, according to Dr. Kogan, who added that it is not clear whether the number of uninsured children has been on the rise over the years, because there are no similar studies for comparison.

As implementation of the Affordable Care Act continues, “it may be worthwhile to consider not only the number of uninsured children in the United States but also the adequacy of coverage for those with current insurance,” wrote Dr. Kogan and colleagues.

The study is limited in several ways, the authors wrote. Because the study design was cross-sectional, it is difficult to establish the direction of causality. In addition, the data excludes children in institutions. And, because the study is based on data collected in a phone survey, it is subject to biases, “including the exclusion of household without landlines.”

“What I would hope from policymakers is that they would be aware that this problem is more prevalent than the number of uninsured kids and to take that into account in the future policy considerations,” Dr. Kogan wrote, noting that HRSA plans on repeating the study within the next few years.

In an accompanying editorial, Dr. James Perrin of the MGH Center for Child and Adolescent Health Policy, Boston, noted that the study offers “compelling evidence that underinsured children face major problems in obtaining both the appropriate quality of care and access to that care. Implementation of the Affordable Care Act offers important opportunities to address the problem of underinsurance.”

He added, however, that “the Affordable Care Act may leave chronically ill children with CHIP coverage and newly insured Medicaid population underinsured.” While expansion of benefits is unlikely, “CHIP and the new Medicaid could offer such benefits to persons meeting certain disability criteria [and potentially offer a better federal match to encourage states to include these benefits].”

The study authors and Dr. Perrin disclosed that they have no relevant conflicts of interest.

Children who are underinsured outnumber uninsured children and are almost as likely as uninsured children to have problems with health care access and quality, according to a study published Aug. 25 in the New England Journal of Medicine. 

Nearly a quarter of children with continuous health care coverage in 2007 did not have coverage adequate enough to provide access to appropriate services and providers, according to lead author Michael Kogan, Ph.D., of the Health Resources and Services Administration’s Maternal and Child Health Bureau, and his colleagues.

Dr. Kogan and his colleagues analyzed data collected from the 2007 National Survey of Children’s Health, which was conducted by random-digital-dial interviews with the parents or guardians of 91,642 children.

They found that in 2007, 19% (14.1 million) of all U.S. children were underinsured (continuous but inadequate coverage), while 5% (3.4 million) were uninsured, and 10% (7.6 million) were sometimes insured. In contrast, 66% (48.2 million) were fully insured.

Children with private insurance were twice as likely to be underinsured as those with public insurance, for example coverage under either Medicaid or a State Children’s Health Insurance Program (SCHIP), they wrote. Inadequate coverage of charges was the most common source of underinsurance, accounting for 12.1 million children.

Certain groups of insured children were more likely to be underinsured: those older than 6 years, Hispanic and black children, those in the Midwest, and those who had special health care needs.

Underinsured children had no access to a medical home on the same scale as their sometimes insured peers – 55% and 58% respectively. Dr. Kogan and colleagues found a similar situation regarding access to specialty care: 26% of underinsured children had difficulty obtaining specialist care, compared with 29% of sometimes insured children and 25% of uninsured children.

While attention has been focused on the woes of adult underinsurance, less has been paid to childhood underinsurance, according to Dr. Kogan, who added that it is not clear whether the number of uninsured children has been on the rise over the years, because there are no similar studies for comparison.

As implementation of the Affordable Care Act continues, “it may be worthwhile to consider not only the number of uninsured children in the United States but also the adequacy of coverage for those with current insurance,” wrote Dr. Kogan and colleagues.

The study is limited in several ways, the authors wrote. Because the study design was cross-sectional, it is difficult to establish the direction of causality. In addition, the data excludes children in institutions. And, because the study is based on data collected in a phone survey, it is subject to biases, “including the exclusion of household without landlines.”

“What I would hope from policymakers is that they would be aware that this problem is more prevalent than the number of uninsured kids and to take that into account in the future policy considerations,” Dr. Kogan wrote, noting that HRSA plans on repeating the study within the next few years.

In an accompanying editorial, Dr. James Perrin of the MGH Center for Child and Adolescent Health Policy, Boston, noted that the study offers “compelling evidence that underinsured children face major problems in obtaining both the appropriate quality of care and access to that care. Implementation of the Affordable Care Act offers important opportunities to address the problem of underinsurance.”

He added, however, that “the Affordable Care Act may leave chronically ill children with CHIP coverage and newly insured Medicaid population underinsured.” While expansion of benefits is unlikely, “CHIP and the new Medicaid could offer such benefits to persons meeting certain disability criteria [and potentially offer a better federal match to encourage states to include these benefits].”

The study authors and Dr. Perrin disclosed that they have no relevant conflicts of interest.

Children who are underinsured outnumber uninsured children and are almost as likely as uninsured children to have problems with health care access and quality, according to a study published Aug. 25 in the New England Journal of Medicine. 

Nearly a quarter of children with continuous health care coverage in 2007 did not have coverage adequate enough to provide access to appropriate services and providers, according to lead author Michael Kogan, Ph.D., of the Health Resources and Services Administration’s Maternal and Child Health Bureau, and his colleagues.

Dr. Kogan and his colleagues analyzed data collected from the 2007 National Survey of Children’s Health, which was conducted by random-digital-dial interviews with the parents or guardians of 91,642 children.

They found that in 2007, 19% (14.1 million) of all U.S. children were underinsured (continuous but inadequate coverage), while 5% (3.4 million) were uninsured, and 10% (7.6 million) were sometimes insured. In contrast, 66% (48.2 million) were fully insured.

Children with private insurance were twice as likely to be underinsured as those with public insurance, for example coverage under either Medicaid or a State Children’s Health Insurance Program (SCHIP), they wrote. Inadequate coverage of charges was the most common source of underinsurance, accounting for 12.1 million children.

Certain groups of insured children were more likely to be underinsured: those older than 6 years, Hispanic and black children, those in the Midwest, and those who had special health care needs.

Underinsured children had no access to a medical home on the same scale as their sometimes insured peers – 55% and 58% respectively. Dr. Kogan and colleagues found a similar situation regarding access to specialty care: 26% of underinsured children had difficulty obtaining specialist care, compared with 29% of sometimes insured children and 25% of uninsured children.

While attention has been focused on the woes of adult underinsurance, less has been paid to childhood underinsurance, according to Dr. Kogan, who added that it is not clear whether the number of uninsured children has been on the rise over the years, because there are no similar studies for comparison.

As implementation of the Affordable Care Act continues, “it may be worthwhile to consider not only the number of uninsured children in the United States but also the adequacy of coverage for those with current insurance,” wrote Dr. Kogan and colleagues.

The study is limited in several ways, the authors wrote. Because the study design was cross-sectional, it is difficult to establish the direction of causality. In addition, the data excludes children in institutions. And, because the study is based on data collected in a phone survey, it is subject to biases, “including the exclusion of household without landlines.”

“What I would hope from policymakers is that they would be aware that this problem is more prevalent than the number of uninsured kids and to take that into account in the future policy considerations,” Dr. Kogan wrote, noting that HRSA plans on repeating the study within the next few years.

In an accompanying editorial, Dr. James Perrin of the MGH Center for Child and Adolescent Health Policy, Boston, noted that the study offers “compelling evidence that underinsured children face major problems in obtaining both the appropriate quality of care and access to that care. Implementation of the Affordable Care Act offers important opportunities to address the problem of underinsurance.”

He added, however, that “the Affordable Care Act may leave chronically ill children with CHIP coverage and newly insured Medicaid population underinsured.” While expansion of benefits is unlikely, “CHIP and the new Medicaid could offer such benefits to persons meeting certain disability criteria [and potentially offer a better federal match to encourage states to include these benefits].”

The study authors and Dr. Perrin disclosed that they have no relevant conflicts of interest.

Patients with diabetes who have a confrontational coping style or who are depressed may be more likely to have impaired healing of their foot ulcers, based on findings from a prospective observational study.

“Psychological interventions that reduce depression and promote effective coping could significantly improve healing rates in this patient group,” wrote Dr. Kavita Vedhara of the University of Nottingham (England) and colleagues.

On average, 4%-10% of diabetic patients with diabetes mellitus have foot ulceration. “The emotional, physical, and financial costs are considerable, with foot ulcer patients reporting greater depression and poorer quality of life,” the authors wrote. Meanwhile, the complications cost the health care system millions of dollars, the researchers added (Diabetologia 2010;53:1590-8).

For 24 weeks, the investigators assessed 93 patients – 68 men with a mean age of 60 years – with neuropathic or neuroischemic diabetic foot ulcers. The patients were recruited from podiatry clinics between 2002 and 2008.

Clinical and demographic determinants of healing, psychological distress, coping styles, salivary cortisol, and levels of two types of matrix metalloproteinases were evaluated at baseline. The ulcers were assessed at 6, 12, and 24 weeks post baseline.

Of the patients with complete data for the primary analysis, 56 had a healed ulcer by week 24, and 37 remained unhealed. Of the unhealed patients, 14 had an amputation and 3 died during the follow-up period.

The primary analysis showed that the patients who had a tendency toward confrontational coping were less likely to have a healed ulcer by week 24. The results also showed that patients who exhibited clinical depression had smaller changes in ulcer size over time. In addition, patients with unhealed ulcers had lower levels of evening cortisol; higher levels of pro-MMP2, a type of matrix metalloproteinase; and a greater cortisol awakening response at baseline.

“The present study suggests that depression and coping style are associated with a greater likelihood of diabetic foot ulcers not healing over a 6-month period, albeit through seemingly independent pathways, and that cortisol and pro-MMP2 may be among the mechanisms underlying these relationships,” the researchers wrote.

The study was limited by the sample size and by the fact that the assessment of wound size was restricted to the surface of the wounds and did not include measures below the skin.

Because the study is one of the few to investigate the relationship between stress and healing of diabetic foot ulcers, the authors concluded that more research is needed to “elucidate these mechanisms and to develop interventions, in particular those geared to modifying coping style and distress ... in order to improve clinical outcomes in this patient group.”

The investigators reported having no conflicts of interest.

Patients with diabetes who have a confrontational coping style or who are depressed may be more likely to have impaired healing of their foot ulcers, based on findings from a prospective observational study.

“Psychological interventions that reduce depression and promote effective coping could significantly improve healing rates in this patient group,” wrote Dr. Kavita Vedhara of the University of Nottingham (England) and colleagues.

On average, 4%-10% of diabetic patients with diabetes mellitus have foot ulceration. “The emotional, physical, and financial costs are considerable, with foot ulcer patients reporting greater depression and poorer quality of life,” the authors wrote. Meanwhile, the complications cost the health care system millions of dollars, the researchers added (Diabetologia 2010;53:1590-8).

For 24 weeks, the investigators assessed 93 patients – 68 men with a mean age of 60 years – with neuropathic or neuroischemic diabetic foot ulcers. The patients were recruited from podiatry clinics between 2002 and 2008.

Clinical and demographic determinants of healing, psychological distress, coping styles, salivary cortisol, and levels of two types of matrix metalloproteinases were evaluated at baseline. The ulcers were assessed at 6, 12, and 24 weeks post baseline.

Of the patients with complete data for the primary analysis, 56 had a healed ulcer by week 24, and 37 remained unhealed. Of the unhealed patients, 14 had an amputation and 3 died during the follow-up period.

The primary analysis showed that the patients who had a tendency toward confrontational coping were less likely to have a healed ulcer by week 24. The results also showed that patients who exhibited clinical depression had smaller changes in ulcer size over time. In addition, patients with unhealed ulcers had lower levels of evening cortisol; higher levels of pro-MMP2, a type of matrix metalloproteinase; and a greater cortisol awakening response at baseline.

“The present study suggests that depression and coping style are associated with a greater likelihood of diabetic foot ulcers not healing over a 6-month period, albeit through seemingly independent pathways, and that cortisol and pro-MMP2 may be among the mechanisms underlying these relationships,” the researchers wrote.

The study was limited by the sample size and by the fact that the assessment of wound size was restricted to the surface of the wounds and did not include measures below the skin.

Because the study is one of the few to investigate the relationship between stress and healing of diabetic foot ulcers, the authors concluded that more research is needed to “elucidate these mechanisms and to develop interventions, in particular those geared to modifying coping style and distress ... in order to improve clinical outcomes in this patient group.”

The investigators reported having no conflicts of interest.

Patients with diabetes who have a confrontational coping style or who are depressed may be more likely to have impaired healing of their foot ulcers, based on findings from a prospective observational study.

“Psychological interventions that reduce depression and promote effective coping could significantly improve healing rates in this patient group,” wrote Dr. Kavita Vedhara of the University of Nottingham (England) and colleagues.

On average, 4%-10% of diabetic patients with diabetes mellitus have foot ulceration. “The emotional, physical, and financial costs are considerable, with foot ulcer patients reporting greater depression and poorer quality of life,” the authors wrote. Meanwhile, the complications cost the health care system millions of dollars, the researchers added (Diabetologia 2010;53:1590-8).

For 24 weeks, the investigators assessed 93 patients – 68 men with a mean age of 60 years – with neuropathic or neuroischemic diabetic foot ulcers. The patients were recruited from podiatry clinics between 2002 and 2008.

Clinical and demographic determinants of healing, psychological distress, coping styles, salivary cortisol, and levels of two types of matrix metalloproteinases were evaluated at baseline. The ulcers were assessed at 6, 12, and 24 weeks post baseline.

Of the patients with complete data for the primary analysis, 56 had a healed ulcer by week 24, and 37 remained unhealed. Of the unhealed patients, 14 had an amputation and 3 died during the follow-up period.

The primary analysis showed that the patients who had a tendency toward confrontational coping were less likely to have a healed ulcer by week 24. The results also showed that patients who exhibited clinical depression had smaller changes in ulcer size over time. In addition, patients with unhealed ulcers had lower levels of evening cortisol; higher levels of pro-MMP2, a type of matrix metalloproteinase; and a greater cortisol awakening response at baseline.

“The present study suggests that depression and coping style are associated with a greater likelihood of diabetic foot ulcers not healing over a 6-month period, albeit through seemingly independent pathways, and that cortisol and pro-MMP2 may be among the mechanisms underlying these relationships,” the researchers wrote.

The study was limited by the sample size and by the fact that the assessment of wound size was restricted to the surface of the wounds and did not include measures below the skin.

Because the study is one of the few to investigate the relationship between stress and healing of diabetic foot ulcers, the authors concluded that more research is needed to “elucidate these mechanisms and to develop interventions, in particular those geared to modifying coping style and distress ... in order to improve clinical outcomes in this patient group.”

The investigators reported having no conflicts of interest.

Dermatologists now can gauge and choose their electronic health record software better because of a new certification program.

The certification was recently launched by the nonprofit group Certification Commission for Health Information Technology (CCHIT). Electronic health record (EHR) vendors will have to tweak their software to fit the needs of dermatologists to get the appropriate CCHIT certification.

That's good news for dermatologists such as Dr. Mark D. Kaufmann, cochair of the dermatology work group at CCHIT.

"Dermatologists kind of felt left out for many years [when it came to] certification from EHR vendors," said Dr. Kaufmann, of the department of dermatology at Mount Sinai School of Medicine in New York. That's "mostly because we felt like we had requirements that weren't met," he said. Those needs range from the language used to describe lesions, to the need for annotating graphics, pictures and drawings, to the ability to compare pre- and postop photos side by side, Dr. Kaufmann said.

The certification is a win-win for both sides, said Sue Reber, marketing director of CCHIT. Dermatologists can have more confidence in the EHR vendors, and the vendors will be able to market their services better to dermatologists.

Dr. Kaufmann said that although there is some resistance to EHR among the older dermatologists, the young graduating doctors almost demand the technology before joining a practice.

Meanwhile, the government is providing incentives for physicians to implement EHR.

Along with the dermatology certification, CCHIT launched certifications in behavioral health, and long-term and postacute care.

For more information, visit www. cchit.org.

Dermatologists now can gauge and choose their electronic health record software better because of a new certification program.

The certification was recently launched by the nonprofit group Certification Commission for Health Information Technology (CCHIT). Electronic health record (EHR) vendors will have to tweak their software to fit the needs of dermatologists to get the appropriate CCHIT certification.

That's good news for dermatologists such as Dr. Mark D. Kaufmann, cochair of the dermatology work group at CCHIT.

"Dermatologists kind of felt left out for many years [when it came to] certification from EHR vendors," said Dr. Kaufmann, of the department of dermatology at Mount Sinai School of Medicine in New York. That's "mostly because we felt like we had requirements that weren't met," he said. Those needs range from the language used to describe lesions, to the need for annotating graphics, pictures and drawings, to the ability to compare pre- and postop photos side by side, Dr. Kaufmann said.

The certification is a win-win for both sides, said Sue Reber, marketing director of CCHIT. Dermatologists can have more confidence in the EHR vendors, and the vendors will be able to market their services better to dermatologists.

Dr. Kaufmann said that although there is some resistance to EHR among the older dermatologists, the young graduating doctors almost demand the technology before joining a practice.

Meanwhile, the government is providing incentives for physicians to implement EHR.

Along with the dermatology certification, CCHIT launched certifications in behavioral health, and long-term and postacute care.

For more information, visit www. cchit.org.

Dermatologists now can gauge and choose their electronic health record software better because of a new certification program.

The certification was recently launched by the nonprofit group Certification Commission for Health Information Technology (CCHIT). Electronic health record (EHR) vendors will have to tweak their software to fit the needs of dermatologists to get the appropriate CCHIT certification.

That's good news for dermatologists such as Dr. Mark D. Kaufmann, cochair of the dermatology work group at CCHIT.

"Dermatologists kind of felt left out for many years [when it came to] certification from EHR vendors," said Dr. Kaufmann, of the department of dermatology at Mount Sinai School of Medicine in New York. That's "mostly because we felt like we had requirements that weren't met," he said. Those needs range from the language used to describe lesions, to the need for annotating graphics, pictures and drawings, to the ability to compare pre- and postop photos side by side, Dr. Kaufmann said.

The certification is a win-win for both sides, said Sue Reber, marketing director of CCHIT. Dermatologists can have more confidence in the EHR vendors, and the vendors will be able to market their services better to dermatologists.

Dr. Kaufmann said that although there is some resistance to EHR among the older dermatologists, the young graduating doctors almost demand the technology before joining a practice.

Meanwhile, the government is providing incentives for physicians to implement EHR.

Along with the dermatology certification, CCHIT launched certifications in behavioral health, and long-term and postacute care.

For more information, visit www. cchit.org.

Major Finding: The health care systems of six other industrial countries outranked the U.S. system in measures including quality, efficiency, patient safety, access to care, and equity.

Data Source: National mortality data and the Commonwealth Fund International Health Policy Surveys of 2007, 2008, and 2009.

Disclosures: The report was funded by the Commonwealth Fund.

A lack of universal health insurance was cited as one of the reasons the United States' health care system was ranked last behind six other industrialized nations on measures of quality, efficiency, patient safety, access to care, and equity in a new report by the Commonwealth Fund.

Although the United States spends the most overall on health care, it fails to provide access for low-income individuals, wrote the study authors. Furthermore, unlike their counterparts in other industrialized countries, U.S. patients usually don't have a medical home.

The United States ranked first, however, on areas such as preventive care, wait time for specialist care, and nonemergency surgical care.

One measure on which the United States ranked a “clear last” is equity, according to the study. Compared with their counterparts in the other six countries studied—Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom—low-income patients in the United States are less likely to visit a physician when they're sick, see a dentist, or receive recommended tests, treatments, or follow-up care.

“When a country fails to meet the needs of the most vulnerable, it also fails to meet the needs of the average citizen,” the report stated. The United States “should devote far greater attention to seeing a health system that works well for all Americans.”

The report is the result of a compilation of mortality data from seven countries and surveys of approximately 21,000 adults and 6,700 physicians regarding their experiences with care and their ratings of various dimensions of care. The study authors said that despite the differences among the countries, measures such as access to care and emergency department visits are universal.

The findings indicate that U.S. physicians and patients believe that given the amount of money spent on health care, the country could have a better health care system. The study authors expressed hope that the health reform laws and their promise of increased Medicare and Medicaid payments would encourage more medical students to choose primary care.

“These findings are clearly disappointing for U.S. patients and their families,” Karen Davis, Commonwealth Fund president, said at a press briefing. “Fortunately, the recently enacted health reform legislation holds substantial promise for transforming the U.S. health care system into a more effective, efficient, and patient-centered system.”

The Commonwealth Fund report, “Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally,”updates information that was last published in 2007, when the United States also ranked at the bottom overall.

Major Finding: The health care systems of six other industrial countries outranked the U.S. system in measures including quality, efficiency, patient safety, access to care, and equity.

Data Source: National mortality data and the Commonwealth Fund International Health Policy Surveys of 2007, 2008, and 2009.

Disclosures: The report was funded by the Commonwealth Fund.

A lack of universal health insurance was cited as one of the reasons the United States' health care system was ranked last behind six other industrialized nations on measures of quality, efficiency, patient safety, access to care, and equity in a new report by the Commonwealth Fund.

Although the United States spends the most overall on health care, it fails to provide access for low-income individuals, wrote the study authors. Furthermore, unlike their counterparts in other industrialized countries, U.S. patients usually don't have a medical home.

The United States ranked first, however, on areas such as preventive care, wait time for specialist care, and nonemergency surgical care.

One measure on which the United States ranked a “clear last” is equity, according to the study. Compared with their counterparts in the other six countries studied—Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom—low-income patients in the United States are less likely to visit a physician when they're sick, see a dentist, or receive recommended tests, treatments, or follow-up care.

“When a country fails to meet the needs of the most vulnerable, it also fails to meet the needs of the average citizen,” the report stated. The United States “should devote far greater attention to seeing a health system that works well for all Americans.”

The report is the result of a compilation of mortality data from seven countries and surveys of approximately 21,000 adults and 6,700 physicians regarding their experiences with care and their ratings of various dimensions of care. The study authors said that despite the differences among the countries, measures such as access to care and emergency department visits are universal.

The findings indicate that U.S. physicians and patients believe that given the amount of money spent on health care, the country could have a better health care system. The study authors expressed hope that the health reform laws and their promise of increased Medicare and Medicaid payments would encourage more medical students to choose primary care.

“These findings are clearly disappointing for U.S. patients and their families,” Karen Davis, Commonwealth Fund president, said at a press briefing. “Fortunately, the recently enacted health reform legislation holds substantial promise for transforming the U.S. health care system into a more effective, efficient, and patient-centered system.”

The Commonwealth Fund report, “Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally,”updates information that was last published in 2007, when the United States also ranked at the bottom overall.

Major Finding: The health care systems of six other industrial countries outranked the U.S. system in measures including quality, efficiency, patient safety, access to care, and equity.

Data Source: National mortality data and the Commonwealth Fund International Health Policy Surveys of 2007, 2008, and 2009.

Disclosures: The report was funded by the Commonwealth Fund.

A lack of universal health insurance was cited as one of the reasons the United States' health care system was ranked last behind six other industrialized nations on measures of quality, efficiency, patient safety, access to care, and equity in a new report by the Commonwealth Fund.

Although the United States spends the most overall on health care, it fails to provide access for low-income individuals, wrote the study authors. Furthermore, unlike their counterparts in other industrialized countries, U.S. patients usually don't have a medical home.

The United States ranked first, however, on areas such as preventive care, wait time for specialist care, and nonemergency surgical care.

One measure on which the United States ranked a “clear last” is equity, according to the study. Compared with their counterparts in the other six countries studied—Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom—low-income patients in the United States are less likely to visit a physician when they're sick, see a dentist, or receive recommended tests, treatments, or follow-up care.

“When a country fails to meet the needs of the most vulnerable, it also fails to meet the needs of the average citizen,” the report stated. The United States “should devote far greater attention to seeing a health system that works well for all Americans.”

The report is the result of a compilation of mortality data from seven countries and surveys of approximately 21,000 adults and 6,700 physicians regarding their experiences with care and their ratings of various dimensions of care. The study authors said that despite the differences among the countries, measures such as access to care and emergency department visits are universal.

The findings indicate that U.S. physicians and patients believe that given the amount of money spent on health care, the country could have a better health care system. The study authors expressed hope that the health reform laws and their promise of increased Medicare and Medicaid payments would encourage more medical students to choose primary care.

“These findings are clearly disappointing for U.S. patients and their families,” Karen Davis, Commonwealth Fund president, said at a press briefing. “Fortunately, the recently enacted health reform legislation holds substantial promise for transforming the U.S. health care system into a more effective, efficient, and patient-centered system.”

The Commonwealth Fund report, “Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally,”updates information that was last published in 2007, when the United States also ranked at the bottom overall.

Physicians once again find themselves staring at significantly lower Medicare fees for next year, based yet again on the Medicare Sustainable Growth Rate formula.

Under a stop-gap law passed in June, doctors currently are receiving a 2.2% increase in Medicare payments—but only through Nov. 30. In the absence of Congressional action, that increase will be rolled back and the prior pay cut of approximately 21% will go into effect for the month of December.

For 2011, the proposed rule projects an additional 6.1% cut, starting on Jan. 1. “This means that under current law—that is, in the absence of additional legislative action—if a service is performed on Nov. 1 and Jan. 1, the payment for Jan. 1 will be about 30% lower” than the Nov. 1 payment, explained Ellen Griffith-Cohen, a spokesperson for the Centers for Medicare and Medicaid Services.

Associations and policy makers say that they expect Congress to once again address the pay cut before it goes into effect on Nov. 30. But there is a consensus that the temporary fixes are no longer the answer.

The American Academy of Pediatrics fully supports the American Medical Association and other groups in wanting the SGR fixed, said Dr. Marion Burton, the academy's president-elect.

Dr. Burton, who is a practicing pediatrician in Columbia, S.C., said that although pediatricians don't have many Medicare patients, Medicare payment rates greatly affect them because many Medicaid agencies, Medicaid management companies, and commercial and government payers set their rates on the basis of Medicare's fee schedule. “So if the reduction were to come into play, that would affect pediatricians and the patients they care for.”

There are provisions in the Affordable Care Act which increase the Medicaid payment rates to Medicare's level, but Dr. Burton said the increases won't be much if Medicare rates decline. Meanwhile, both Democrats and Republicans in Congress are vying to be the party to fix the SGR formula. But there's doubt about any change in the Medicare payment system this year.

Back in June, when the House passed the 6-month SGR delay, Rep. Frank Pallone (D-N.J.) addressed the Republicans when they spoke of a permanent fix.

“When you talk about how we have a problem, well, I don't see you helping us out,” he said.

“Don't kid those doctors and make them think you're going to vote for a permanent fix. You're never going to do it. You're not helping at all.”

By law, CMS officials are required to adjust physician payments according to the SGR formula, which calculates physician payments based in part on the gross domestic product.

Over the years, Congress has stepped in to eliminate scheduled pay cuts under the formula. However, because the SGR formula has not been altered, physicians will soon face significant pay cuts unless Congress acts to change or replace the SGR.

CMS officials have repeatedly stressed their commitment to work with Congress to change the payment update formula for physicians' services, Ms. Griffith-Cohen of CMS said.

Without Congressional action, Ms. Griffith-Cohen explained, Medicare is required to follow the SGR formula.

Dr. Ardis Hoven, chairman of the AMA Board of Trustees, said in a statement that the “current index is woefully outdated and understates the growing gap between Medicare payments and the cost of caring for seniors.”

But according to the AMA, the 1,250-page proposed rule has some bright spots.

Dr. Hoven said in her statement that she was pleased to see in the rule “that there is a consensus on the need to update the government index of medical practice costs to reflect the current cost.”

According to the proposed rule, CMS intends to convene a technical panel to review all aspects of the Medicare Economic Index.

The rule is open for comment until Aug. 24. To comment, visit www.regulations.gov

Physicians once again find themselves staring at significantly lower Medicare fees for next year, based yet again on the Medicare Sustainable Growth Rate formula.

Under a stop-gap law passed in June, doctors currently are receiving a 2.2% increase in Medicare payments—but only through Nov. 30. In the absence of Congressional action, that increase will be rolled back and the prior pay cut of approximately 21% will go into effect for the month of December.

For 2011, the proposed rule projects an additional 6.1% cut, starting on Jan. 1. “This means that under current law—that is, in the absence of additional legislative action—if a service is performed on Nov. 1 and Jan. 1, the payment for Jan. 1 will be about 30% lower” than the Nov. 1 payment, explained Ellen Griffith-Cohen, a spokesperson for the Centers for Medicare and Medicaid Services.

Associations and policy makers say that they expect Congress to once again address the pay cut before it goes into effect on Nov. 30. But there is a consensus that the temporary fixes are no longer the answer.

The American Academy of Pediatrics fully supports the American Medical Association and other groups in wanting the SGR fixed, said Dr. Marion Burton, the academy's president-elect.

Dr. Burton, who is a practicing pediatrician in Columbia, S.C., said that although pediatricians don't have many Medicare patients, Medicare payment rates greatly affect them because many Medicaid agencies, Medicaid management companies, and commercial and government payers set their rates on the basis of Medicare's fee schedule. “So if the reduction were to come into play, that would affect pediatricians and the patients they care for.”

There are provisions in the Affordable Care Act which increase the Medicaid payment rates to Medicare's level, but Dr. Burton said the increases won't be much if Medicare rates decline. Meanwhile, both Democrats and Republicans in Congress are vying to be the party to fix the SGR formula. But there's doubt about any change in the Medicare payment system this year.

Back in June, when the House passed the 6-month SGR delay, Rep. Frank Pallone (D-N.J.) addressed the Republicans when they spoke of a permanent fix.

“When you talk about how we have a problem, well, I don't see you helping us out,” he said.

“Don't kid those doctors and make them think you're going to vote for a permanent fix. You're never going to do it. You're not helping at all.”

By law, CMS officials are required to adjust physician payments according to the SGR formula, which calculates physician payments based in part on the gross domestic product.

Over the years, Congress has stepped in to eliminate scheduled pay cuts under the formula. However, because the SGR formula has not been altered, physicians will soon face significant pay cuts unless Congress acts to change or replace the SGR.

CMS officials have repeatedly stressed their commitment to work with Congress to change the payment update formula for physicians' services, Ms. Griffith-Cohen of CMS said.

Without Congressional action, Ms. Griffith-Cohen explained, Medicare is required to follow the SGR formula.

Dr. Ardis Hoven, chairman of the AMA Board of Trustees, said in a statement that the “current index is woefully outdated and understates the growing gap between Medicare payments and the cost of caring for seniors.”

But according to the AMA, the 1,250-page proposed rule has some bright spots.

Dr. Hoven said in her statement that she was pleased to see in the rule “that there is a consensus on the need to update the government index of medical practice costs to reflect the current cost.”

According to the proposed rule, CMS intends to convene a technical panel to review all aspects of the Medicare Economic Index.

The rule is open for comment until Aug. 24. To comment, visit www.regulations.gov

Physicians once again find themselves staring at significantly lower Medicare fees for next year, based yet again on the Medicare Sustainable Growth Rate formula.

Under a stop-gap law passed in June, doctors currently are receiving a 2.2% increase in Medicare payments—but only through Nov. 30. In the absence of Congressional action, that increase will be rolled back and the prior pay cut of approximately 21% will go into effect for the month of December.

For 2011, the proposed rule projects an additional 6.1% cut, starting on Jan. 1. “This means that under current law—that is, in the absence of additional legislative action—if a service is performed on Nov. 1 and Jan. 1, the payment for Jan. 1 will be about 30% lower” than the Nov. 1 payment, explained Ellen Griffith-Cohen, a spokesperson for the Centers for Medicare and Medicaid Services.

Associations and policy makers say that they expect Congress to once again address the pay cut before it goes into effect on Nov. 30. But there is a consensus that the temporary fixes are no longer the answer.

The American Academy of Pediatrics fully supports the American Medical Association and other groups in wanting the SGR fixed, said Dr. Marion Burton, the academy's president-elect.

Dr. Burton, who is a practicing pediatrician in Columbia, S.C., said that although pediatricians don't have many Medicare patients, Medicare payment rates greatly affect them because many Medicaid agencies, Medicaid management companies, and commercial and government payers set their rates on the basis of Medicare's fee schedule. “So if the reduction were to come into play, that would affect pediatricians and the patients they care for.”

There are provisions in the Affordable Care Act which increase the Medicaid payment rates to Medicare's level, but Dr. Burton said the increases won't be much if Medicare rates decline. Meanwhile, both Democrats and Republicans in Congress are vying to be the party to fix the SGR formula. But there's doubt about any change in the Medicare payment system this year.

Back in June, when the House passed the 6-month SGR delay, Rep. Frank Pallone (D-N.J.) addressed the Republicans when they spoke of a permanent fix.

“When you talk about how we have a problem, well, I don't see you helping us out,” he said.

“Don't kid those doctors and make them think you're going to vote for a permanent fix. You're never going to do it. You're not helping at all.”

By law, CMS officials are required to adjust physician payments according to the SGR formula, which calculates physician payments based in part on the gross domestic product.

Over the years, Congress has stepped in to eliminate scheduled pay cuts under the formula. However, because the SGR formula has not been altered, physicians will soon face significant pay cuts unless Congress acts to change or replace the SGR.

CMS officials have repeatedly stressed their commitment to work with Congress to change the payment update formula for physicians' services, Ms. Griffith-Cohen of CMS said.

Without Congressional action, Ms. Griffith-Cohen explained, Medicare is required to follow the SGR formula.

Dr. Ardis Hoven, chairman of the AMA Board of Trustees, said in a statement that the “current index is woefully outdated and understates the growing gap between Medicare payments and the cost of caring for seniors.”

But according to the AMA, the 1,250-page proposed rule has some bright spots.

Dr. Hoven said in her statement that she was pleased to see in the rule “that there is a consensus on the need to update the government index of medical practice costs to reflect the current cost.”

According to the proposed rule, CMS intends to convene a technical panel to review all aspects of the Medicare Economic Index.

The rule is open for comment until Aug. 24. To comment, visit www.regulations.gov

Major Finding: The U.S. health care system ranked last, compared with six other industrialized countries, in measures such as quality, efficiency, patient safety, access to care, and equity.

Data Source: National mortality data as well as the Commonwealth Fund International Health Policy Surveys of 2007, 2008, and 2009.

Disclosures: The report was funded by the Commonwealth Fund.

The U.S. health care system ranked last, compared with six other industrialized nations, on measures of quality, efficiency, patient safety, access to care, and equity, according to a new report by the Commonwealth Fund.

One of the main reasons for the low ranking is the lack of universal health insurance, according to the report. Although the United States spends the most overall on health care, it fails to provide access for low-income individuals. Furthermore, unlike their counterparts in other industrialized countries, U.S. patients usually don't have a medical home.

The United States ranked first, however, on areas such as preventive care, wait time for specialist care, and nonemergency surgical care.

One measure on which the United States ranked a “clear last” is equity, according to the study. Compared with their counterparts in the other six countries studied—Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom—low-income patients in the United States are less likely to visit a physician when they're sick, see a dentist, or receive recommended tests, treatments, or follow-up care.

“When a country fails to meet the needs of the most vulnerable, it also fails to meet the needs of the average citizen,” according to the report. The United States “should devote far greater attention to seeing a health system that works well for all Americans.”

The report is the result of a compilation of mortality data from seven countries and surveys of approximately 21,000 adults and 6,700 physicians regarding their experiences with care and their ratings of various dimensions of care.

The study authors said that despite the differences among the countries, measures such as access to care and emergency department visits are universal.

The findings indicate that U.S. physicians and patients believe that given the amount of money spent on health care, the country could have a better health care system, according to the study.

The study authors expressed hope that the health reform laws and their promise of increased Medicare and Medicaid payments would encourage more medical students to choose primary care as one way to improve health system performance for all U.S. patients.

“These findings are clearly disappointing for U.S. patients and their families,” Karen Davis, the president of the Commonwealth Fund, said during a press briefing on the study.

“Fortunately, the recently enacted health reform legislation holds substantial promise for transforming the U.S. health care system into a more effective, efficient, and patient-centered system.”

The Commonwealth Fund report, “Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally,” updates information that was last published in 2007, when the United States also ranked at the bottom overall.

Major Finding: The U.S. health care system ranked last, compared with six other industrialized countries, in measures such as quality, efficiency, patient safety, access to care, and equity.

Data Source: National mortality data as well as the Commonwealth Fund International Health Policy Surveys of 2007, 2008, and 2009.

Disclosures: The report was funded by the Commonwealth Fund.

The U.S. health care system ranked last, compared with six other industrialized nations, on measures of quality, efficiency, patient safety, access to care, and equity, according to a new report by the Commonwealth Fund.

One of the main reasons for the low ranking is the lack of universal health insurance, according to the report. Although the United States spends the most overall on health care, it fails to provide access for low-income individuals. Furthermore, unlike their counterparts in other industrialized countries, U.S. patients usually don't have a medical home.

The United States ranked first, however, on areas such as preventive care, wait time for specialist care, and nonemergency surgical care.

One measure on which the United States ranked a “clear last” is equity, according to the study. Compared with their counterparts in the other six countries studied—Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom—low-income patients in the United States are less likely to visit a physician when they're sick, see a dentist, or receive recommended tests, treatments, or follow-up care.

“When a country fails to meet the needs of the most vulnerable, it also fails to meet the needs of the average citizen,” according to the report. The United States “should devote far greater attention to seeing a health system that works well for all Americans.”

The report is the result of a compilation of mortality data from seven countries and surveys of approximately 21,000 adults and 6,700 physicians regarding their experiences with care and their ratings of various dimensions of care.

The study authors said that despite the differences among the countries, measures such as access to care and emergency department visits are universal.

The findings indicate that U.S. physicians and patients believe that given the amount of money spent on health care, the country could have a better health care system, according to the study.

The study authors expressed hope that the health reform laws and their promise of increased Medicare and Medicaid payments would encourage more medical students to choose primary care as one way to improve health system performance for all U.S. patients.

“These findings are clearly disappointing for U.S. patients and their families,” Karen Davis, the president of the Commonwealth Fund, said during a press briefing on the study.

“Fortunately, the recently enacted health reform legislation holds substantial promise for transforming the U.S. health care system into a more effective, efficient, and patient-centered system.”

The Commonwealth Fund report, “Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally,” updates information that was last published in 2007, when the United States also ranked at the bottom overall.

Major Finding: The U.S. health care system ranked last, compared with six other industrialized countries, in measures such as quality, efficiency, patient safety, access to care, and equity.

Data Source: National mortality data as well as the Commonwealth Fund International Health Policy Surveys of 2007, 2008, and 2009.

Disclosures: The report was funded by the Commonwealth Fund.

The U.S. health care system ranked last, compared with six other industrialized nations, on measures of quality, efficiency, patient safety, access to care, and equity, according to a new report by the Commonwealth Fund.

One of the main reasons for the low ranking is the lack of universal health insurance, according to the report. Although the United States spends the most overall on health care, it fails to provide access for low-income individuals. Furthermore, unlike their counterparts in other industrialized countries, U.S. patients usually don't have a medical home.

The United States ranked first, however, on areas such as preventive care, wait time for specialist care, and nonemergency surgical care.

One measure on which the United States ranked a “clear last” is equity, according to the study. Compared with their counterparts in the other six countries studied—Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom—low-income patients in the United States are less likely to visit a physician when they're sick, see a dentist, or receive recommended tests, treatments, or follow-up care.

“When a country fails to meet the needs of the most vulnerable, it also fails to meet the needs of the average citizen,” according to the report. The United States “should devote far greater attention to seeing a health system that works well for all Americans.”

The report is the result of a compilation of mortality data from seven countries and surveys of approximately 21,000 adults and 6,700 physicians regarding their experiences with care and their ratings of various dimensions of care.

The study authors said that despite the differences among the countries, measures such as access to care and emergency department visits are universal.

The findings indicate that U.S. physicians and patients believe that given the amount of money spent on health care, the country could have a better health care system, according to the study.

The study authors expressed hope that the health reform laws and their promise of increased Medicare and Medicaid payments would encourage more medical students to choose primary care as one way to improve health system performance for all U.S. patients.

“These findings are clearly disappointing for U.S. patients and their families,” Karen Davis, the president of the Commonwealth Fund, said during a press briefing on the study.

“Fortunately, the recently enacted health reform legislation holds substantial promise for transforming the U.S. health care system into a more effective, efficient, and patient-centered system.”

The Commonwealth Fund report, “Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally,” updates information that was last published in 2007, when the United States also ranked at the bottom overall.

Physicians once again find themselves staring at significantly lower Medicare fees for next year, based yet again on the Medicare Sustainable Growth Rate formula.

Under a stop-gap law passed in June, doctors are receiving a 2.2% increase in Medicare payments–but only through Nov. 30. In the absence of congressional action, that increase will be rolled back and the prior pay cut of approximately 21% will go into effect for the month of December.

For 2011, the proposed rule projects an additional 6.1% cut, starting on Jan. 1. “This means that under current law–that is, in the absence of additional legislative action–if a service is performed on Nov. 1 and Jan. 1, the payment for Jan. 1 will be about 30% lower” than the Nov. 1 payment, said Ellen Griffith-Cohen, a spokesperson for the Centers for Medicare and Medicaid Services.

Associations and policy makers say they expect Congress to once again address the pay cut before it goes into effect Nov. 30. But a consensus exists that the temporary fixes are no longer the answer.

“The APA is extremely concerned about the impending Medicare cuts, as we have been all along,” Nicholas Meyers, director of the American Psychiatric Association's department of government relations, wrote in a statement. “We have told Congress and the administration that these cuts and the uncertainty associated with these short term fixes are unacceptable and that a permanent solution must be reached.”

Meanwhile, both Democrats and Republicans in Congress are vying to be the party to fix the SGR formula. But there's doubt about any change in the Medicare payment system this year.

“I don't see anybody working on it hard enough right now to think that there's actually going to be a solution that's on the floor of the House right before or after the election,” Rep. Michael Burgess (R-Tex.) said at a recent Congressional Health Care Caucus forum. “That's just not going to happen.

“We'll probably do some other temporary patch to get into the next Congress,” said Rep. Burgess, who is an ob.gyn. He added that he hoped that the new majority in Congress will be Republican. “If we're going to show that we're different as a governing body in a new majority after the first of the year, we've got to fix this.”

In June, when the House passed the 6-month SGR delay, Rep. Frank Pallone (D-N.J.) addressed the Republicans when they spoke of a permanent fix: “When you talk about how we have a problem, well, I don't see you helping us out,” he said. “Don't kid those doctors and make them think you're going to vote for a permanent fix. You're never going to do it.”

The rule is open for comment until Aug. 24. To comment, visit www.regulations.gov

Physicians once again find themselves staring at significantly lower Medicare fees for next year, based yet again on the Medicare Sustainable Growth Rate formula.

Under a stop-gap law passed in June, doctors are receiving a 2.2% increase in Medicare payments–but only through Nov. 30. In the absence of congressional action, that increase will be rolled back and the prior pay cut of approximately 21% will go into effect for the month of December.

For 2011, the proposed rule projects an additional 6.1% cut, starting on Jan. 1. “This means that under current law–that is, in the absence of additional legislative action–if a service is performed on Nov. 1 and Jan. 1, the payment for Jan. 1 will be about 30% lower” than the Nov. 1 payment, said Ellen Griffith-Cohen, a spokesperson for the Centers for Medicare and Medicaid Services.

Associations and policy makers say they expect Congress to once again address the pay cut before it goes into effect Nov. 30. But a consensus exists that the temporary fixes are no longer the answer.

“The APA is extremely concerned about the impending Medicare cuts, as we have been all along,” Nicholas Meyers, director of the American Psychiatric Association's department of government relations, wrote in a statement. “We have told Congress and the administration that these cuts and the uncertainty associated with these short term fixes are unacceptable and that a permanent solution must be reached.”

Meanwhile, both Democrats and Republicans in Congress are vying to be the party to fix the SGR formula. But there's doubt about any change in the Medicare payment system this year.

“I don't see anybody working on it hard enough right now to think that there's actually going to be a solution that's on the floor of the House right before or after the election,” Rep. Michael Burgess (R-Tex.) said at a recent Congressional Health Care Caucus forum. “That's just not going to happen.

“We'll probably do some other temporary patch to get into the next Congress,” said Rep. Burgess, who is an ob.gyn. He added that he hoped that the new majority in Congress will be Republican. “If we're going to show that we're different as a governing body in a new majority after the first of the year, we've got to fix this.”

In June, when the House passed the 6-month SGR delay, Rep. Frank Pallone (D-N.J.) addressed the Republicans when they spoke of a permanent fix: “When you talk about how we have a problem, well, I don't see you helping us out,” he said. “Don't kid those doctors and make them think you're going to vote for a permanent fix. You're never going to do it.”

The rule is open for comment until Aug. 24. To comment, visit www.regulations.gov

Physicians once again find themselves staring at significantly lower Medicare fees for next year, based yet again on the Medicare Sustainable Growth Rate formula.

Under a stop-gap law passed in June, doctors are receiving a 2.2% increase in Medicare payments–but only through Nov. 30. In the absence of congressional action, that increase will be rolled back and the prior pay cut of approximately 21% will go into effect for the month of December.

For 2011, the proposed rule projects an additional 6.1% cut, starting on Jan. 1. “This means that under current law–that is, in the absence of additional legislative action–if a service is performed on Nov. 1 and Jan. 1, the payment for Jan. 1 will be about 30% lower” than the Nov. 1 payment, said Ellen Griffith-Cohen, a spokesperson for the Centers for Medicare and Medicaid Services.

Associations and policy makers say they expect Congress to once again address the pay cut before it goes into effect Nov. 30. But a consensus exists that the temporary fixes are no longer the answer.

“The APA is extremely concerned about the impending Medicare cuts, as we have been all along,” Nicholas Meyers, director of the American Psychiatric Association's department of government relations, wrote in a statement. “We have told Congress and the administration that these cuts and the uncertainty associated with these short term fixes are unacceptable and that a permanent solution must be reached.”

Meanwhile, both Democrats and Republicans in Congress are vying to be the party to fix the SGR formula. But there's doubt about any change in the Medicare payment system this year.

“I don't see anybody working on it hard enough right now to think that there's actually going to be a solution that's on the floor of the House right before or after the election,” Rep. Michael Burgess (R-Tex.) said at a recent Congressional Health Care Caucus forum. “That's just not going to happen.

“We'll probably do some other temporary patch to get into the next Congress,” said Rep. Burgess, who is an ob.gyn. He added that he hoped that the new majority in Congress will be Republican. “If we're going to show that we're different as a governing body in a new majority after the first of the year, we've got to fix this.”

In June, when the House passed the 6-month SGR delay, Rep. Frank Pallone (D-N.J.) addressed the Republicans when they spoke of a permanent fix: “When you talk about how we have a problem, well, I don't see you helping us out,” he said. “Don't kid those doctors and make them think you're going to vote for a permanent fix. You're never going to do it.”

The rule is open for comment until Aug. 24. To comment, visit www.regulations.gov

The U.S. health care system ranked last, compared with several other industrialized nations, on measures of quality, efficiency, patient safety, access to care, and equity, according to a new report by the Commonwealth Fund.

One of the main reasons for the low ranking is the lack of universal health insurance, according to the report. Although the United States spends the most overall on health care, it fails to provide access for low-income individuals. Furthermore, unlike their counterparts in other industrialized countries, U.S. patients usually don't have a medical home.

The United States ranked first, however, on areas such as preventive care and wait time for specialist care.

One measure on which the United States ranked a “clear last” is equity, according to the study. Compared with their counterparts in Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom, low-income patients in the United States are less likely to visit a physician when they're sick, see a dentist, or receive recommended tests, treatments, or follow-up care.

“When a country fails to meet the needs of the most vulnerable, it also fails to meet the needs of the average citizen,” according to the report. The United States “should devote far greater attention to seeing a health system that works well for all Americans.”

The report is the result of a compilation of mortality data from several countries and surveys of about 21,000 adults and 6,700 physicians regarding their experiences with care and their ratings of various dimensions of care. The study authors said that despite the differences among the countries, measures such as access to care and emergency department visits are universal.

The U.S. health care system ranked last, compared with several other industrialized nations, on measures of quality, efficiency, patient safety, access to care, and equity, according to a new report by the Commonwealth Fund.

One of the main reasons for the low ranking is the lack of universal health insurance, according to the report. Although the United States spends the most overall on health care, it fails to provide access for low-income individuals. Furthermore, unlike their counterparts in other industrialized countries, U.S. patients usually don't have a medical home.

The United States ranked first, however, on areas such as preventive care and wait time for specialist care.

One measure on which the United States ranked a “clear last” is equity, according to the study. Compared with their counterparts in Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom, low-income patients in the United States are less likely to visit a physician when they're sick, see a dentist, or receive recommended tests, treatments, or follow-up care.

“When a country fails to meet the needs of the most vulnerable, it also fails to meet the needs of the average citizen,” according to the report. The United States “should devote far greater attention to seeing a health system that works well for all Americans.”

The report is the result of a compilation of mortality data from several countries and surveys of about 21,000 adults and 6,700 physicians regarding their experiences with care and their ratings of various dimensions of care. The study authors said that despite the differences among the countries, measures such as access to care and emergency department visits are universal.

The U.S. health care system ranked last, compared with several other industrialized nations, on measures of quality, efficiency, patient safety, access to care, and equity, according to a new report by the Commonwealth Fund.

One of the main reasons for the low ranking is the lack of universal health insurance, according to the report. Although the United States spends the most overall on health care, it fails to provide access for low-income individuals. Furthermore, unlike their counterparts in other industrialized countries, U.S. patients usually don't have a medical home.

The United States ranked first, however, on areas such as preventive care and wait time for specialist care.

One measure on which the United States ranked a “clear last” is equity, according to the study. Compared with their counterparts in Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom, low-income patients in the United States are less likely to visit a physician when they're sick, see a dentist, or receive recommended tests, treatments, or follow-up care.

“When a country fails to meet the needs of the most vulnerable, it also fails to meet the needs of the average citizen,” according to the report. The United States “should devote far greater attention to seeing a health system that works well for all Americans.”

The report is the result of a compilation of mortality data from several countries and surveys of about 21,000 adults and 6,700 physicians regarding their experiences with care and their ratings of various dimensions of care. The study authors said that despite the differences among the countries, measures such as access to care and emergency department visits are universal.

Gone are the large white boards at the emergency room of Inova Fair Oaks Hospital in Fairfax, Va. Two large flat-screen computer monitors have taken their place. The patient information displayed on the screens is constantly updated through small tablets cradled in the arms of physicians and nurses.

If you ask the emergency department staff, they will tell you they can't imagine having to go back to paper.

Going from paper to the electronic system wasn't an overnight process. It took time. It took training. And it cost money. But it has paid off by improving efficiency, quality, and throughput, say officials at Inova Health System, of which Inova Fair Oaks is a part.

The health system was named as one of the most wired hospitals in the nation by Hospitals & Health Networks' annual most wired survey.

The 99 hospitals and health systems that made the unranked list were recognized in the categories of most improved, most wired, most wireless, and most wired in small and rural settings.

The list is the result of 555 submitted surveys, which were filled out voluntarily by the institutions and represent 1,280 hospitals (22% of U.S. hospitals). The survey, conducted since 1999, aims to benchmark hospitals' progress in information technology. The hospitals were recognized for achievement of IT applications in the areas of clinical quality and safety, care continuum, infrastructure, and business and administrative management.

The 2010 survey shows, for example, that the most wired hospitals are further along (82%) than other hospitals (51%) in deploying computerized provider order entry (CPOE) systems.

Under the Health Information Technology for Economic and Clinical Health Act, hospitals are incentivized to use electronic health record (EHR) systems in a meaningful way with financial bonuses through 2016. Yet, experts say that much more work needs to be done before the majority of hospitals will achieve the HITECH goal by then.

When hospitals do comply, however, the benefits are great on the practice side, according to Geoff Brown, Inova Health System's chief information officer. Implementing the right electronic systems can help improve quality of care and efficiency at the hospitals, he said.

This is especially true for hospitalists, who tend to care for a variety of patients. Having to view the patients' information and status quickly can be laborious on paper. An electronic system that displays the patient history, allergies, and medications can be a lot more helpful, he said.

So what does it mean to be an ideal wired hospital?

Dr. Franklin Michota, director of academic affairs in the hospital medicine department of the Cleveland Clinic, said that it starts from a patient-focused perspective: electronic medical records that are available to everyone who sees the patient, information that a patient can access, patients' ability to log their diet and exercise in a system, and patients' ability to communicate with their health care provider.

In other words, “all information, all vital signs, all notes, and all orders are paperless,” Dr. Michota said. And for a truly efficient hospital, that system is integrated with billing, supply chain, and other systems such as the regulatory requirements.

But the nation's health care systems and providers—big and small—have a long way to go before achieving that ideal, said Dr. Michota.

While the financial sector has long had online banking and national and international access to ATMs, hospitals in the same city are still unable to connect with each other, much less connect to hospitals and doctors' offices elsewhere in their state or across the nation.

That's mostly due to lack of standardization, according to Dr. Michota. Hospitals tend to tailor their electronic tools to meet the needs of their specific system of care. As a result, there isn't a standard EHR system that hospitals can buy and implement.

Dr. Michota expressed doubt about the incentives in HITECH for hospitals to get wired. “They say you've got to figure out a way to do it, and if you do it, you might get a few carrots. They haven't made a good business case for hospitals to do this.”

Others are more hopeful. Mr. Brown of Inova said that there is the incentive to boost physician recruitment. Many graduating residents won't join a health system or practice that's not wired, he said.

Dr. Michota said he wasn't convinced that being a wired hospital is a major selling point. Some doctors may prefer to work with a wired hospital, and “some physicians who like paper may run away from wired hospital.” Yet, he added, being a wired hospital “may be a marker for a well-organized and well-managed system.”

To see the list, visit www.hhnmag.com/hhmag_app/gateFold/pages/JULY10.jsp

Gone are the large white boards at the emergency room of Inova Fair Oaks Hospital in Fairfax, Va. Two large flat-screen computer monitors have taken their place. The patient information displayed on the screens is constantly updated through small tablets cradled in the arms of physicians and nurses.

If you ask the emergency department staff, they will tell you they can't imagine having to go back to paper.

Going from paper to the electronic system wasn't an overnight process. It took time. It took training. And it cost money. But it has paid off by improving efficiency, quality, and throughput, say officials at Inova Health System, of which Inova Fair Oaks is a part.

The health system was named as one of the most wired hospitals in the nation by Hospitals & Health Networks' annual most wired survey.

The 99 hospitals and health systems that made the unranked list were recognized in the categories of most improved, most wired, most wireless, and most wired in small and rural settings.

The list is the result of 555 submitted surveys, which were filled out voluntarily by the institutions and represent 1,280 hospitals (22% of U.S. hospitals). The survey, conducted since 1999, aims to benchmark hospitals' progress in information technology. The hospitals were recognized for achievement of IT applications in the areas of clinical quality and safety, care continuum, infrastructure, and business and administrative management.

The 2010 survey shows, for example, that the most wired hospitals are further along (82%) than other hospitals (51%) in deploying computerized provider order entry (CPOE) systems.

Under the Health Information Technology for Economic and Clinical Health Act, hospitals are incentivized to use electronic health record (EHR) systems in a meaningful way with financial bonuses through 2016. Yet, experts say that much more work needs to be done before the majority of hospitals will achieve the HITECH goal by then.

When hospitals do comply, however, the benefits are great on the practice side, according to Geoff Brown, Inova Health System's chief information officer. Implementing the right electronic systems can help improve quality of care and efficiency at the hospitals, he said.

This is especially true for hospitalists, who tend to care for a variety of patients. Having to view the patients' information and status quickly can be laborious on paper. An electronic system that displays the patient history, allergies, and medications can be a lot more helpful, he said.

So what does it mean to be an ideal wired hospital?

Dr. Franklin Michota, director of academic affairs in the hospital medicine department of the Cleveland Clinic, said that it starts from a patient-focused perspective: electronic medical records that are available to everyone who sees the patient, information that a patient can access, patients' ability to log their diet and exercise in a system, and patients' ability to communicate with their health care provider.

In other words, “all information, all vital signs, all notes, and all orders are paperless,” Dr. Michota said. And for a truly efficient hospital, that system is integrated with billing, supply chain, and other systems such as the regulatory requirements.

But the nation's health care systems and providers—big and small—have a long way to go before achieving that ideal, said Dr. Michota.

While the financial sector has long had online banking and national and international access to ATMs, hospitals in the same city are still unable to connect with each other, much less connect to hospitals and doctors' offices elsewhere in their state or across the nation.

That's mostly due to lack of standardization, according to Dr. Michota. Hospitals tend to tailor their electronic tools to meet the needs of their specific system of care. As a result, there isn't a standard EHR system that hospitals can buy and implement.

Dr. Michota expressed doubt about the incentives in HITECH for hospitals to get wired. “They say you've got to figure out a way to do it, and if you do it, you might get a few carrots. They haven't made a good business case for hospitals to do this.”

Others are more hopeful. Mr. Brown of Inova said that there is the incentive to boost physician recruitment. Many graduating residents won't join a health system or practice that's not wired, he said.

Dr. Michota said he wasn't convinced that being a wired hospital is a major selling point. Some doctors may prefer to work with a wired hospital, and “some physicians who like paper may run away from wired hospital.” Yet, he added, being a wired hospital “may be a marker for a well-organized and well-managed system.”

To see the list, visit www.hhnmag.com/hhmag_app/gateFold/pages/JULY10.jsp

Gone are the large white boards at the emergency room of Inova Fair Oaks Hospital in Fairfax, Va. Two large flat-screen computer monitors have taken their place. The patient information displayed on the screens is constantly updated through small tablets cradled in the arms of physicians and nurses.

If you ask the emergency department staff, they will tell you they can't imagine having to go back to paper.

Going from paper to the electronic system wasn't an overnight process. It took time. It took training. And it cost money. But it has paid off by improving efficiency, quality, and throughput, say officials at Inova Health System, of which Inova Fair Oaks is a part.

The health system was named as one of the most wired hospitals in the nation by Hospitals & Health Networks' annual most wired survey.

The 99 hospitals and health systems that made the unranked list were recognized in the categories of most improved, most wired, most wireless, and most wired in small and rural settings.

The list is the result of 555 submitted surveys, which were filled out voluntarily by the institutions and represent 1,280 hospitals (22% of U.S. hospitals). The survey, conducted since 1999, aims to benchmark hospitals' progress in information technology. The hospitals were recognized for achievement of IT applications in the areas of clinical quality and safety, care continuum, infrastructure, and business and administrative management.

The 2010 survey shows, for example, that the most wired hospitals are further along (82%) than other hospitals (51%) in deploying computerized provider order entry (CPOE) systems.

Under the Health Information Technology for Economic and Clinical Health Act, hospitals are incentivized to use electronic health record (EHR) systems in a meaningful way with financial bonuses through 2016. Yet, experts say that much more work needs to be done before the majority of hospitals will achieve the HITECH goal by then.

When hospitals do comply, however, the benefits are great on the practice side, according to Geoff Brown, Inova Health System's chief information officer. Implementing the right electronic systems can help improve quality of care and efficiency at the hospitals, he said.

This is especially true for hospitalists, who tend to care for a variety of patients. Having to view the patients' information and status quickly can be laborious on paper. An electronic system that displays the patient history, allergies, and medications can be a lot more helpful, he said.

So what does it mean to be an ideal wired hospital?

Dr. Franklin Michota, director of academic affairs in the hospital medicine department of the Cleveland Clinic, said that it starts from a patient-focused perspective: electronic medical records that are available to everyone who sees the patient, information that a patient can access, patients' ability to log their diet and exercise in a system, and patients' ability to communicate with their health care provider.

In other words, “all information, all vital signs, all notes, and all orders are paperless,” Dr. Michota said. And for a truly efficient hospital, that system is integrated with billing, supply chain, and other systems such as the regulatory requirements.

But the nation's health care systems and providers—big and small—have a long way to go before achieving that ideal, said Dr. Michota.

While the financial sector has long had online banking and national and international access to ATMs, hospitals in the same city are still unable to connect with each other, much less connect to hospitals and doctors' offices elsewhere in their state or across the nation.

That's mostly due to lack of standardization, according to Dr. Michota. Hospitals tend to tailor their electronic tools to meet the needs of their specific system of care. As a result, there isn't a standard EHR system that hospitals can buy and implement.

Dr. Michota expressed doubt about the incentives in HITECH for hospitals to get wired. “They say you've got to figure out a way to do it, and if you do it, you might get a few carrots. They haven't made a good business case for hospitals to do this.”

Others are more hopeful. Mr. Brown of Inova said that there is the incentive to boost physician recruitment. Many graduating residents won't join a health system or practice that's not wired, he said.

Dr. Michota said he wasn't convinced that being a wired hospital is a major selling point. Some doctors may prefer to work with a wired hospital, and “some physicians who like paper may run away from wired hospital.” Yet, he added, being a wired hospital “may be a marker for a well-organized and well-managed system.”

To see the list, visit www.hhnmag.com/hhmag_app/gateFold/pages/JULY10.jsp