A Recent study published in the July issue of Infection Control and Hospital Epidemiology teaches children about the importance of hand-washing hygiene, while waiting in a hospital emergency department. By using a gel that glows, children can see how effective their hand washing technique actually is, and be entertained while waiting.

According to Dr. Anna Fishbein, a physician and researcher at Northwestern University’s Children’s Memorial Hospital in Chicago (and the study’s lead author): “Waiting for the doctor is usually a tiresome and unproductive experience, but we were able to turn the waiting room into an interactive education center to help kids improve their hand hygiene.”

The study relied upon 60 pediatric patients waiting for the doctor. By using Glo Germ Gel and a black light, children could see areas where direct and germs remained (the gel creates a yellow glow in these areas). After seeing the areas with a yellow glow, the children washed their hands with ordinary soap and water. After a second application of the gel under a black light, the hands of the children were cleaner, and under a four-point cleanliness scale, they went from “very dirty” to “very clean.”

“We found that using the gel alone to illustrate the areas of hands that may not be getting clean, even without verbal education, improves children’s hand hygiene,” said Dr. Mary Groll, also of Children’s Memorial and the study’s principal investigator. “Considering the importance of hand hygiene in disease prevention, the implications of this study will have lasting impact in this community’s effort to decrease the spread of illness.”

The Centers for Medicare & Medicaid Services (CMS) last week proposed regulations designed to help patients choose better-quality health care at more affordable prices. These new rules will permit the public disclosure of certain Medicare data so that it can be compiled into reports on physicians, hospitals and other health care providers. These reports will attempt to identify how good providers really are, and how much they charge.

Part of the Patient Protection and Affordable Care Act, these new regulations will promote transparency, according to CMS Administrator Donald M. Berwick, M.D. He explained: ”Making more Medicare data available can make it easier for employers and consumers to make smart decisions about their health care. Performance reports that include Medicare data will result in higher quality and more cost effective care. And making our health care system more transparent promotes competition and drives costs down.”

These new regulations will hopefully help patients and employers understand more about health care in their community as it provides the following:

• CMS would provide standardized extracts of Medicare claims data from Parts A, B, and D to entities that qualify to receive this data.  In theory, this data can only be used to evaluate performance so it can be produced in a report for the public.
• The data provided to the qualified entity will cover one or more specified geographic area(s).
• The qualified entity would pay a fee that covers the federal government’s cost connected with the enforcement of these regulations.
• To prevent mistakes, the regulations require qualified entities to share the reports confidentially with providers prior to public release.
• Publicly released reports will never contain individual patient information, but rather reports in the aggregate.

These proposed regulations are part of the Hospital Value-Based Purchasing initiative designed to reward hospitals for better quality of care and greater efficiencies with respect to Medicare. The proposed rules will also permit Medicare to pay new Accountable Care Organizations (ACOs) for improvement.

The full text of the proposed regulations can be viewed HERE.

On November 6, 1766, Sir Francis Fauquier, Governor General of His Majesty’s Colony of Virginia, gave his annual speech to the House of Burgesses. These words of the Governor General ultimately resulted in the first state psychiatric hospital:

“It is expected I should also recommend to your consideration and humanity, a poor, unhappy set of people, who are deprived o their senses and wander about the country terrifying the rest of their fellow creatures. A legal confinement and proper provision ought to be appointed for these miserable objects.”

On October 12, 1773, “The Public Hospital for Persons of Insane and Disordered Mind,” opened its doors for “idiots, lunatics and persons of unsound minds.” Later relocated to Williamsburg and renamed Eastern State Hospital, this is the oldest hospital in the United States that has exclusively treated the mentally ill. The Hospital’s first patient arrived on April 28, 1774. The patient was charged 15 pounds a year.

The institution changed names over the years, known as the “Public Hospital,” the “Lunatick Hospital,” and even the “Mad House.” The legislature officially changed the name on March 6, 1841 to Eastern Lunatic Asylum, and on February 22, 1894 to Eastern State Hospital.

On June 7, 1885, the original facility burned to the ground. Eventually rebuilt, by 1935 Eastern State Hospital has a census of 2,000 patients. Without any further space to expand, between 1937 and 1968, all patients were relocated to a new hospital inWilliamsburg. In 1985, the original hospital was rebuilt on its excavated foundations, opening to the public as a museum.

Like most mental institutions in the United States, after World War II the treatment of patients evolved as psychiatric drugs for the treatment of certain mental conditions became more available and effective. The concept of creating community-based care became known as “deinstitutionalization” in the 1960s.

In January 2011, Eastern State Hospital was criticized for what was described as “barring” its doors and turning away new patients. Since 2004, the Hospital reduced its capacity from 523 to 300 beds, with the removal of 85 beds in 2009 alone. In a report by Inspector General Douglas Bevelacqua, due to the lack of residential programs, many patients were essentially “stuck” in the hospital.  “Admissions and discharges represent the front door and the back door to a state facility, and, if either the entrance or exit is blocked, it creates pressures for the entire public sector safety net system,” Bevelacqua explained.

Although Eastern State Hospital has taken great efforts to improve the care for its patients, without a proper infrastructure to transition patients from the hospital into the community, there will always be a struggle to treat the mentally ill.

 

On November 6, 1766, Sir Francis Fauquier, Governor General of His Majesty’s Colony of Virginia, gave his annual speech to the House of Burgesses. These words of the Governor General ultimately resulted in the first state psychiatric hospital:

“It is expected I should also recommend to your consideration and humanity, a poor, unhappy set of people, who are deprived o their senses and wander about the country terrifying the rest of their fellow creatures. A legal confinement and proper provision ought to be appointed for these miserable objects.”

On October 12, 1773, “The Public Hospital for Persons of Insane and Disordered Mind,” opened its doors for “idiots, lunatics and persons of unsound minds.” Later relocated to Williamsburg and renamed Eastern State Hospital, this is the oldest hospital in the United States that has exclusively treated the mentally ill. The Hospital’s first patient arrived on April 28, 1774. The patient was charged 15 pounds a year.

The institution changed names over the years, known as the “Public Hospital,” the “Lunatick Hospital,” and even the “Mad House.” The legislature officially changed the name on March 6, 1841 to Eastern Lunatic Asylum, and on February 22, 1894 to Eastern State Hospital.

On June 7, 1885, the original facility burned to the ground. Eventually rebuilt, by 1935 Eastern State Hospital has a census of 2,000 patients. Without any further space to expand, between 1937 and 1968, all patients were relocated to a new hospital in Williamsburg. In 1985, the original hospital was rebuilt on its excavated foundations, opening to the public as a museum.

Like most mental institutions in the United States, after World War II the treatment of patients evolved as psychiatric drugs for the treatment of certain mental conditions became more available and effective. The concept of creating community-based care became known as “deinstitutionalization” in the 1960s.

In January 2011, Eastern State Hospital was criticized for what was described as “barring” its doors and turning away new patients. Since 2004, the Hospital reduced its capacity from 523 to 300 beds, with the removal of 85 beds in 2009 alone. In a report by Inspector General Douglas Bevelacqua, due to the lack of residential programs, many patients were essentially “stuck” in the hospital.  “Admissions and discharges represent the front door and the back door to a state facility, and, if either the entrance or exit is blocked, it creates pressures for the entire public sector safety net system,” Bevelacqua explained.

Although Eastern State Hospital has taken great efforts to improve the care for its patients, without a proper infrastructure to transition patients from the hospital into the community, there will always be a struggle to treat the mentally ill.

As part of its continued effort to improve patient safety and contain health care expenditures, in August 2007 the Centers for Medicare & Medicaid Services (CMS) announced it would no longer reimburse providers for “conditions that could reasonably have been prevented.” In shifting this burden to hospitals and physicians, CMS focused on a list of specific complications called “never events,” meaning they should never occur in the hospital.

Since then, CMS’s program has been adopted by private insurance companies as well, hoping to save money inside the Federal Government’s shadow. This week, CMS announced that the same rules would apply for Medicaid patients, and that hospitals and other health care providers will no longer be reimbursed for illnesses, injuries, or readmissions that should have been prevented, or in this particular instance under the Patient Protection and Affordable Care Act (PPACA), are ”reasonably preventable.”

The Medicaid list is similar to that of Medicare, including:

• transfusing the wrong blood type
• certain falls that result in injury
• fractures, or head injuries
• burns and electric shocks
• catheter-associated urinary tract infections
• surgical site infections after certain procedures, such as bariatric surgery or coronary artery bypass

Medicaid will also follow Medicare’s lead not pay for “never events,” such as performing the wrong procedure, conducting surgery on the wrong part of the patient, or even conducting the correct procedure, but on the wrong patient. CMS Administrator Donald Berwick, MD, stated in a press release. ”These steps will encourage health professionals and hospitals to reduce preventable infections and eliminate serious medical errors. As we reduce the frequency of these conditions, we will improve care for patients and bring down costs at the same time.”

The final rule is effective July 1, 2011, but CMS will permit states the option to implement between July 1, 2011 and July 1, 2012.

To see the regulations, click HERE.

 

The Department of Health and Human Services (HHS) issued today its intended regulations to modify the Privacy Rules under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The new standards relate to how these Privacy Rules account for disclosures of protected health information (PHI). HHS would like to require covered entities and business associates to account for disclosures of protected health information as it relates to treatment, payment, or even health care operations in general, provided such disclosures occur in connection with the patient’s electronic record.

An extension of the Health Information Technology for Economic and Clinical Health Act (HITECH) and HIPAA, these proposed regulations would entitle individuals to an access report identifying exactly who accessed the electronic protected health information in the particular context.   Present requirements under the Privacy Rule (45 C.F.R. § 164.528) require covered entities to make available (at an individual’s request) certain disclosures of health information.  A disclosure is defined at Section 160.103 as “the release, transfer, provision of access to, or divulging in any other manner of information outside the entity holding the information.”

For each disclosure, the accounting must include:

• The date of the disclosure
• The name (and address, if known) of the entity or person who received the protected health information
• A brief description of the information disclosed
• A brief statement of the purpose of the disclosure

Existing law, however, provides for a number of exceptions from the disclosure requirements, including:

• To carry out treatment, payment and health care operations
• Pursuant to an authorization
• For the facility’s directory or to persons involved in the individual’s care

Section 13405(c) of the Health Information Technology for Economic and Clinical Health (HITECH) Act, Title XIII of Division A and Title IV of Division B of the American Recovery and Reinvestment Act of 2009 (ARRA) provides that the exemption of the Privacy Rule for disclosures to carry out treatment, payment, and health care operations no longer applies to disclosures “through an electronic health record.” Section 13400 of the HITECH Act defines an electronic health record (“EHR”) as “an electronic record of health-related information on an individual that is created, gathered, managed, and consulted by authorized health care clinicians and staff.”

If enacted without further modifications, an individual will have a right to receive an accounting of such disclosures made during the three years prior to the request.  HHS has proposed that these new requirements take effect January 1, 2013 (for EHR systems acquired after January 1, 2009) and January 1, 2014 (for EHR systems acquired before January 1, 2009).

Additional information about these changes in patient privacy rights can be found at the Federal Register Website.

In a country of more than 311,000,000, the burdens placed on the health care system are both enormous and complex as Americans expect a fundamental right to first rate health care without much regard for its cost. The Federal Government, however, is mindful of this expense, and since 1964 the United States Department of Health and Human Services (HHS) has published an annual series of data presenting total health expenditures in the United States.

Health Care Spending

Identified as National Health Expenditure Accounts (NHEA), these estimates attempt to measure the total annual dollar amount of our nation’s health care consumption. The information also tries to identify the amount invested in the future of health care (such as medical structures, equipment, research, etc.). Some of the more significant expense categories monitored by the NHEA include:

• Hospital Care: This includes all services provided by hospitals to patients (room and board, ancillary charges, resident physicians, pharmacy, etc.), measured by total net revenue.
• Physician and Clinical Services: This includes services provided by Doctors of Medicine (M.D.) and Doctors of Osteopathy (D.O.), outpatient care, and some laboratory expenses. It also includes the professional component of hospital charges if these charges are usually billed separately.
• Other Professional Services: This includes professional services by private nurses, chiropractors, podiatrists, optometrists, and physical/occupational/speech therapists.
• Dental Services: This includes Doctors of Dental Medicine (D.M.D.), Doctors of Dental Surgery (D.D.S.), or Doctors of Dental Science (D.D.Sc.).
• Other Health, Residential, and Personal Care: This includes care provided in residential care facilities, ambulance services, and workplace health care services, among others.
• Home Health Care: This includes health care provided in freestanding home health agencies (HHAs).
• Nursing Care Facilities: This includes freestanding nursing home facilities that provide both nursing and rehabilitative services.
• Prescription Drugs: This includes the retail side of medication.
• Durable Medical Equipment: This includes in part the retail side of certain items such as surgical and orthopedic products, wheelchairs, eyeglasses, and hearing aids.
• Other Non-Durable Medical Products: This includes the retail side of non-prescription drugs and medical supplies.
• Population: The NHEA uses a modification of U.S. Census figures.
• Out-of-Pocket Payments: This includes direct spending by consumers for all health care goods and services, including any amounts not covered by insurance (such as co-payments and deductibles, but not insurance premiums).
• Health Insurance: This includes private health insurance, Medicare, Medicaid, and other such public payers.
• Private Health Insurance: This includes premiums paid to insurance companies, as well as the costs for advertising, sales commissions, rate credits, taxes, profits, etc.

Growth in U.S. National Health Expenditures (NHE)  over the next ten years is expected to be slightly higher due to the Patient Protection and Affordable Care Act (PPACA), as well as other issues. Average annual growth in NHE for 2009 through 2019 is expected to be 6.3 percent (0.2 percentage point faster than pre-reform estimates).  NHE as a portion of the nation’s Gross Domestic Product (GDP) is expected to be 19.6 percent by 2019 (or 0.3 percentage point higher than projected before reform). Incidentally, PPACA is expected to result in a lower average annual Medicare spending growth rate for 2012 through 2019 (6.2 percent). This is 1.3 percentage points lower than pre-reform estimates.

For comparison purposes, the following information was compiled for 2009:

• NHE grew 4.0% to $2.5 trillion, or $8,086 per person, and accounted for 17.6% of GDP.
• Medicare spending grew 7.9% to $502.3 billion, or 20 percent of total NHE.
• Medicaid spending grew 9.0% to $373.9 billion, or 15 percent of total NHE.
• Private health insurance spending grew 1.3% to $801.2 billion, or 32 percent of total NHE.
• Out of pocket spending grew 0.4% to $299.3 billion, or 12 percent of total NHE.
• Hospital expenditures grew 5.1% in 2009.
• Physician and clinical services expenditures grew 4.0%.
• Prescription drug spending increased 5.3%.

Health Care Oversight

To understand the scope of issues health care must face on any given day, it is important to become familiar with the building blocks that make up today’s health care hierarchy.Who is responsible for oversight?  At the top of the health care pyramid is the nation’s President, Barack Obama.  Underneath the President lies a complex organization of individuals and agencies at both the federal and state level, who make up the gargantuan structure commonly referred to as health care.  The President directly oversees the Office of the Secretary, HHS.  HHS has multiple operating divisions, including:

• Administration for Children and Families (ACF) (and the accompanying Administration for Children, Youth and Families (ACYF))
• Administration on Aging (AoA)
• Agency for Healthcare Research and Quality (AHRQ)
• Agency for Toxic Substances and Disease Registry (ATSDR)
• Centers for Disease Control and Prevention (CDC)
• Centers for Medicare & Medicaid Services (CMS)
• Food and Drug Administration (FDA)
• Health Resources and Services Administration (HRSA)
• Indian Health Service (IHS)
• National Institutes of Health (NIH) and the National Cancer Institute (NCI)
  
• Substance Abuse and Mental Health Services Administration (SAMHSA)

HHS staff divisions include:

• Assistant Secretary for Administration (ASA)
• Assistant Secretary for Financial Resources (ASFR)
• Assistant Secretary for Legislation (ASL)
• Assistant Secretary for Public Affairs (ASPA)
• Assistant Secretary for Planning and Evaluation (ASPE)
• Assistant Secretary for Preparedness and Response (ASPR)
• Center for Faith Based and Neighborhood Partnerships (CFBNP)
• Departmental Appeals Board (DAB)
• Office of Intergovernmental Affairs (IGA)
• Office of Civil Rights (OCR)
• Office on Disability (OD)
• Office of the General Counsel (OGC)
• Office of Global Health Affairs (OGHA)
• Office of the Inspector General (OIG)
• Office of Medicare Hearing and Appeals (OMHA)
• Office of National Coordinator of Health Information Technology (ONC)
• Office of the Assistant Secretary for Health (ASH)
• The Surgeon General

The Food and Drug Administration is another important agency under HHS. Protecting and promoting public health, the FDA consists of nine centers/offices, including:

• Center for Biologics Evaluation and Research (CBER) (with eight additional offices contained therein);
• Center for Devices and Radiological Health (CDRH) (with eight additional offices contained therein);
• Center for Drug Evaluation and Research (CDER) (with over twenty offices contained therein, including six offices under the Office of New Drugs);
• Center for Food Safety and Applied Nutrition (CFSAN) (with three additional main offices and nine sub-offices contained therein);
• Center for Tobacco Products Organization (CFTBO) (with seven additional offices contained therein)
• Center for Veterinary Medicine (CVM) (with six additional offices contained therein);
• National Center for Toxicological Research (NCTR) (with five additional offices contained therein);
• Office of the Commissioner (OC) (with over forty offices and sub-offices contained therein); and
• Office of Regulatory Affairs (ORA) (with nine additional offices contained therein).

Accreditation and Certification

Due to the sensitive nature of their services, hospitals must exist in a heavily regulated industry, and the Federal government is only part of the overall health care regulatory equation.  Accreditation, certification and periodic review come from a variety of both public and private sources, though the goal is generally consistent:  develop uniform standards to ensure that hospitals in the United States all operate at an acceptable safety level and deliver quality patient care in an appropriate and effective manner.

Any one healthcare institution can be subject to accreditation review at any time from entities such as the Joint Commission, Healthcare Facilities Accreditation Program (HFAP), Community Health Accreditation Program, Accreditation Commission for Health Care, The Compliance Team, or Healthcare Quality Association on Accreditation (HQAA). In October 2008, CMS approved DNV Healthcare as a third national accreditation program for hospitals seeking to participate in the Medicare program. Recently, hospitals accredited through DNV Healthcare have been added to the American Hospital Association (AHA) Guide, listing these facilities as well as those accredited by the Joint Commission and HFAP.

Each program or department is governed by its own set of rules.  For example, Joint Commission surveys hospitals by following more than 276 standards, reviewing 1,612 elements of performance.  HFAP does largely the same thing, pursuant to its 1,100 or more individual standards.  Focusing on durable medical equipment (DME), HQAA has developed its own review process, and “vows to continuously strive to set standards of the highest quality on behalf of the DME industry and business owners.”  Indeed, HQAA “listen[s] . . . act[s] . . . [and] stand[s] together and in unison to bring the whole of DME service and provision to the next level.”

There are numerous other entities participating in the certification/accreditation process, and virtually every facet of the health care system is governed and reviewed by multiple organizations.  Take the American Hospital Association, which designs and administers Certification Programs to recognize mastery of well-defined bodies of knowledge within health care management disciplines.  The Certification Commission for Healthcare Information Technology is a recognized certification body for electronic health records and their networks.  Even educational programs, general education or specialty education (such as podiatric medicine) must receive proper accreditation in a hospital setting.

California

In addition to the list above, every hospital is subject to special regulations from its own state.  Health care facilities in California are licensed, regulated, inspected, and/or certified by a number of public and private agencies at both the state and federal level, including the California Department of Public Health (CDPH).

State and federal agencies have separate jurisdictions, but there is overlap.  For example, CDPH’s License and Certification Division (“L&C”) is responsible for ensuring that hospitals comply with state law, but it also cooperates with CMS to verify that facilities accepting Medicare and Medi-Cal (Medi-Cal is California’s version of Medicaid) payments meet federal requirements.  California’s Office of Statewide Health Planning and Development (OSHPD) regulates hospital construction and administers programs which endeavor to implement the vision of “Equitable Healthcare Accessibility for California.”

These two examples serve to emphasize as well as outline the complexities of state regulations that often accompany their federal counterparts.  CDPH is divided into eight separate programs, including:

• Office of the Director, or State Public Health Officer;
• External Affairs;
• Policy and Programs;
• Center for Chronic Disease and Health Promotion;
• Center for Environmental Health;
• Center for Family Health;
• Center for Health Care Quality; and
• Center for Infectious Disease.

Like CDPH, OSHPD is one of 13 departments within California’s Health and Human Services Agency.  Made up of six separate boards and commissions, OSHPD’s mission is “to promote healthcare accessibility through leadership in analyzing California’s healthcare infrastructure, promoting a diverse and competent healthcare workforce, providing information about healthcare outcomes, assuring the safety of buildings used in providing healthcare, insuring loans to encourage the development of healthcare facilities, and facilitating development of sustained capacity for communities to address local healthcare issues.”

In the present climate of health care reform, things do change fast. The foundation that makes up the nation’s health care hierarchy, however, may take some time to understand.

 

The Patient Protection and Affordable Care Act (PPACA) intends to implement a system to monitor the quality and efficiency of health care providers. Last March, the Centers for Medicare & Medicaid Services (CMS) released proposed regulations to guide doctors, hospitals, and other health care providers as they attempt to form accountable care organizations (ACOs) under health care reform. These rules included certain provisions designed to encourage rural participation, and CMS recently provided clarification for these rural providers.

Under the general regulations, for ACOs to receive shared savings, they are required to meet a minimum savings rate (MSR). The MSR is the required percentage that ACO expenditures fall below certain standards. In the one-sided model, the MSR ranges from 2.0 percent to 3.9 percent, with variations due to the number of beneficiaries the ACO has assigned. Once the ACO meets the MSR threshold, it is eligible to share in the savings above the MSR amount. Therefore, the ACO is not eligible for “first dollar”savings. Under the one-sided model, ACOs can receive no more than 52.5 percent of their savings (50% for quality performance and up to 2.5% for including a federally qualified health center (FQHC) or rural health clinic (RHC) as a participant in the ACO).

Recognizing the need to encourage the formation of smaller ACOs in underserved rural populations, the Medicare Shared Savings Program proposed an exemption  under the one-sided model from the two percent (2%) savings threshold for ACOs with less than 10,000 beneficiaries. These ACOs would be eligible to share in the first dollar savings provided they comport with the performance standards, generate savings, and meet one of the following criteria:

• Be comprised of ACO professionals in group practice arrangements or networks of individual practices;
• 75% or more of the ACO’s beneficiaries reside in counties outside a Metropolitan Statistical Area (a geographical region with a relatively high population density at its core and close economic ties throughout the area) for the most recent year for which data is available;
• 50% or more of the ACO’s beneficiaries were assigned to the ACO because a critical access hospital (CAH) provided primary care services while billing under the optional method (Method II); or
• 50% or more of the ACO’s beneficiaries had at least one encounter with an ACO participant FQHC and/or RHC in the most recent year for which data is available.

All ACOs in the two-sided model that satisfy the requisite performance standards and generate savings in excess of the minimum threshold would also be eligible to share in savings on a first dollar basis.

The new regulations would also provide for an incentive to smaller ACOs by using a lower confidence interval. ACOs with at least 5,000 beneficiaries would have a minimum savings rate based on a 90% confidence interval.  ACOs with 50,000 beneficiaries would have a minimum savings rate based on a 99% confidence interval.

FQHCs and RHCs may not form their own ACOs under current regulations. These entities may join an ACO as an ACO participant, however, along with other organizations. Therefore, these proposed rules offer incentives to ACOs that choose to include FQHCs and RHCs in their mix.

Additional information about the Shared Savings Program can be found HERE.

 

 

 

Physicians around the nation are up in arms about some proposed legislation that may limit their communications with patients. One such measure is from Florida, where the State Legislature recently passed the “Don’t Ask” bill. It waits for the likely signature of Governor Rick Scott. Florida House Bill 155 will prohibit in part a physician or other health care professionals from asking patients or members of their families whether they own a firearm or have one in their home.

Supporters of the bill, including the National Rifle Association, contend the legislation is important to stop doctors from invading their privacy, especially when they are concerned the information may be used against them by insurance companies. According to Marion Hammer, executive director of United Sportsmen of Florida: “Simply, it’s none of their business.”

Representatives from the American Academy of Family Physicians (AAFP), American College of Physicians (ACP), and American Osteopathic Association (AOA) all agree on the importance of the physician-patient relationship, and the importance of maintaining these open channels with strict confidentiality exists at its very core.

Together, these three groups oppose any legislation — including laws relating to the possession of firearms and an office visit discussion about guns in the home –  that places limitations on the free exchange of information within the patient-physician relationship. Any restriction, according to the groups, may cause harm to the patient’s and family’s health.

The 300,000 plus physicians within these organizations firmly believe that they must have open and honest communication with patients about all aspects of health and safety. One critical aspect of this process is safety and injury prevention. By providing meaningful patient education, physicians can help improve patient well being.  The AAFP, ACP and AOA have long standing policies in support of this notion.

The AAFP is one of the largest national medical organizations, representing more than 100,300 family physicians, family medicine residents and medical students nationwide. Founded in 1947, the group’s mission is to preserve and promote the science and art of Family Medicine, and at the same time advance high-quality, cost-effective health care for everyone.

The ACP is a national organization of internists who specialize in the prevention, detection and treatment of illnesses in adults. The largest medical-specialty organization and second-largest physician group in the United States, the group’s 130,000 members include internists, internal medicine subspecialists, as well as medical students, residents, and fellows.

The AOA serves as the professional family for all osteopathic physicians (DOs) and osteopathic medical students. In addition to being the primary certifying body for DOs, the AOA is also the accrediting agency for all osteopathic medical schools, and it has federal authority to accredit hospitals through its Healthcare Facilities Accreditation Program.

AAFP President Roland Goertz, MD, MBA, explained: “The AAFP believes that patient confidentiality must be protected. Any proposal that seeks to intrude on these rights and place restrictions on what can be discussed jeopardizes a patient’s health and represents unwise governmental intrusion.”

Only in an environment of confidence and trust can a patient freely share the necessary information for a physician to understand, diagnose, and treat patients properly.  ”The American Osteopathic Association opposes any and all efforts to censor communication that occurs between patients and their physicians,” said AOA President Karen J. Nichols, DO. “Any legislation that impedes on this relationship jeopardizes the health and safety not only of our patients, but also their families.”

Representatives from the physician groups content that the proposed legislation in Florida and other states attempts to preclude physicians from asking patients about firearm ownership, thereby preventing any discussion about safe storage and handling. Historically such education has been shown to decrease the likelihood of unintentional injury or death.

“On this particular issue, ACP’s policy encourages physicians to inform patients about the dangers of keeping firearms, particularly handguns, in the home and to advise them on ways to reduce the risk of injury,’” said ACP President Virginia L. Hood, MBBS, MPH, FACP. “However, this issue is much bigger than guns, it is about whether the government or any other body should be allowed to tell physicians what they can and can’t discuss with their patients.”

Established by the Balanced Budget Act of 1997 (P.L. 105-33), the Medicare Payment Advisory Commission (MedPAC) advises the U.S. Congress on all matters of Medicare. This independent agency enjoys an expansive mandate — from advising Congress on payments to private health plans participating in the Medicare program to the assessment of access to, and quality of, Medicare treatment.

MedPAC’s 17 members are appointed to three-year terms by the Comptroller General. The commission meets publicly to discuss policy issues and prepare recommendations to Congress. MedPAC may consider information contained within staff research, presentations by policy experts, and comments from interested parties.

MedPAC issues two reports each year (March and June). The March 2011 report contains 13 chapters, including one chapter that provides context for documenting the rise in Medicare and total health care spending nationwide, another setting forth the Commission’s framework for assessing the integrity of Medicare’s payment process, nine chapters relating to Medicare payments and program integrity concerns, one chapter discussing the Medicare Advantage plans, and a final chapter on Medicare prescription drug coverage.

The entire report, consisting of more than 350 pages, can be found HERE.

The Commission’s schedule of public meetins can be found HERE.

In a recent press release announcing the newest members to the commission, Gene L. Dodaro, Acting Comptroller General of the United States and head of the U.S. Government Accountability Office (GAO) stated: “Policymakers continue to rely on MedPAC’s expert advice, and with the passage of health care reform, MedPAC’s role will continue to be particularly important. I am pleased to report that, once again, we had many qualified applicants for MedPAC. The four new individuals selected will bring impressive credentials and valuable experience and insights to the commission.”