Government and Regulations

In a follow-up review, the VA Office of Inspector General (OIG) determined that the Veterans Benefits Management System (VBMS) has been only “partially effective” in its management of cost, performance, and scheduling. The OIG noted that despite the VMBS spending increase from $579 million in September 2009 to about $1.3 billion in January 2015, VA could not ensure an effective return on investment.

Related: Budget Hole Narrowly Averted for VA

Although the September 2, 2015, OIG report was unable to accurately distinguish how many of the more than 307,000 records for veterans reported as deceased by the Social Security Administration had applied for health care benefits, it did substantiate the allegation that employees were manipulating data to make the backlog appear much smaller than it was. The OIG reported that employees incorrectly marked unprocessed applications as completed and possibly deleted 10,000 or more transactions from the Workload Reporting and Productivity tool over the past 5 years.

Related: Obama and McDonald Call on Congress to Give VA Flexibility

Deputy Inspector General Linda A. Halliday stated, “As this issue demonstrates, whistleblowers have proven to be a valuable information source to pursue accountability and corrective actions in VA programs.”

Among its most critical recommendations, the OIG seeks results from the Office of Information and Technology, in conjunction with the Under Secretary for Benefits, to define and stabilize system and business requirements, address system performance problems, deploy required functionality to process claims end-to-end, and institute metrics needed to identify and ensure progress toward meeting stated goals.

Related: Reducing Wait Time in the Emergency Department

The VA goals included a 98% claims processing accuracy and elimination of the disability claims backlog by the end of 2015.

In a follow-up review, the VA Office of Inspector General (OIG) determined that the Veterans Benefits Management System (VBMS) has been only “partially effective” in its management of cost, performance, and scheduling. The OIG noted that despite the VMBS spending increase from $579 million in September 2009 to about $1.3 billion in January 2015, VA could not ensure an effective return on investment.

Related: Budget Hole Narrowly Averted for VA

Although the September 2, 2015, OIG report was unable to accurately distinguish how many of the more than 307,000 records for veterans reported as deceased by the Social Security Administration had applied for health care benefits, it did substantiate the allegation that employees were manipulating data to make the backlog appear much smaller than it was. The OIG reported that employees incorrectly marked unprocessed applications as completed and possibly deleted 10,000 or more transactions from the Workload Reporting and Productivity tool over the past 5 years.

Related: Obama and McDonald Call on Congress to Give VA Flexibility

Deputy Inspector General Linda A. Halliday stated, “As this issue demonstrates, whistleblowers have proven to be a valuable information source to pursue accountability and corrective actions in VA programs.”

Among its most critical recommendations, the OIG seeks results from the Office of Information and Technology, in conjunction with the Under Secretary for Benefits, to define and stabilize system and business requirements, address system performance problems, deploy required functionality to process claims end-to-end, and institute metrics needed to identify and ensure progress toward meeting stated goals.

Related: Reducing Wait Time in the Emergency Department

The VA goals included a 98% claims processing accuracy and elimination of the disability claims backlog by the end of 2015.

In a follow-up review, the VA Office of Inspector General (OIG) determined that the Veterans Benefits Management System (VBMS) has been only “partially effective” in its management of cost, performance, and scheduling. The OIG noted that despite the VMBS spending increase from $579 million in September 2009 to about $1.3 billion in January 2015, VA could not ensure an effective return on investment.

Related: Budget Hole Narrowly Averted for VA

Although the September 2, 2015, OIG report was unable to accurately distinguish how many of the more than 307,000 records for veterans reported as deceased by the Social Security Administration had applied for health care benefits, it did substantiate the allegation that employees were manipulating data to make the backlog appear much smaller than it was. The OIG reported that employees incorrectly marked unprocessed applications as completed and possibly deleted 10,000 or more transactions from the Workload Reporting and Productivity tool over the past 5 years.

Related: Obama and McDonald Call on Congress to Give VA Flexibility

Deputy Inspector General Linda A. Halliday stated, “As this issue demonstrates, whistleblowers have proven to be a valuable information source to pursue accountability and corrective actions in VA programs.”

Among its most critical recommendations, the OIG seeks results from the Office of Information and Technology, in conjunction with the Under Secretary for Benefits, to define and stabilize system and business requirements, address system performance problems, deploy required functionality to process claims end-to-end, and institute metrics needed to identify and ensure progress toward meeting stated goals.

Related: Reducing Wait Time in the Emergency Department

The VA goals included a 98% claims processing accuracy and elimination of the disability claims backlog by the end of 2015.

Two innovative products under development with DoD funding promise a stunning transformation in the way burns are treated and how they heal.

Usual burn treatment involves harvesting healthy skin from the unburned areas of the patient’s skin, an extremely painful procedure. However, with ReCell (Avita Medical, Cambridge, United Kingdom), surgeons instead take a smaller sample of healthy skin (about the size of 1 or 2 postage stamps) and create a suspension of individual skin cells. Within 30 minutes, the suspension, which is sprayed on, can be used to treat a skin wound 80 times larger than the sample taken.

Related: Nurse-Drive Protocol Reduces HAIs in Burn Patients

ReCell speeds healing and improves the appearance of scars, the manufacturer says. The disaggregated cells behave like those at an acute wound‘s edge: The suspension introduces the cell signaling associated with wound healing across the surface area of the wound. Melanocytes included in the spray progressively deposit melanin over several months, and the normal pigmentation gradually returns.

StrataGraft (Stratatech Corporation, Madison, WI), intended for more severe burns, is a living product designed to mimic natural human skin, with both dermal and fully differentiated epidermal layers. Unlike first-generation products, the manufacturer says, this resorbable tissue is easily sutured or stapled and remains intact in the wound bed.

Related: Patients Benefit From ICU Telemedicine

In a 2014 clinical trial of 28 patients with second-degree, deep, partial-thickness burns, 27 achieved complete wound closure by day 90 with a single application of StrataGraft tissue; the 28th patient’s wound closed in the following weeks. No StrataGraft DNA was detectable at day 90, which the manufacturer says confirmed that the patients had regenerated their own skin.

StrataGraft could be lifesaving for patients whose extensive injuries don’t allow for skin grafts from their own bodies in a single procedure. Those patients must wait for the donor sites to reheal before more skin can be taken. In the meantime, their burns are covered with cadaver skin or synthetic dressings, which the body typically rejects after 2 weeks. By contrast, StrataGraft would offer a ready-to-use supply of virus-free tissue.

Related: PICCs—Are They Really Safer?

ReCell has already been used under special compassionate use dispensations on U.S. personnel wounded in Afghanistan. Wendy Dean, MD, medical advisor for the Tissue Injury and Regenerative Medicine Program Management Office, which is monitoring the progress of the 2 treatments, says they could lead to a “paradigm shift” in skin injury treatment.

Two innovative products under development with DoD funding promise a stunning transformation in the way burns are treated and how they heal.

Usual burn treatment involves harvesting healthy skin from the unburned areas of the patient’s skin, an extremely painful procedure. However, with ReCell (Avita Medical, Cambridge, United Kingdom), surgeons instead take a smaller sample of healthy skin (about the size of 1 or 2 postage stamps) and create a suspension of individual skin cells. Within 30 minutes, the suspension, which is sprayed on, can be used to treat a skin wound 80 times larger than the sample taken.

Related: Nurse-Drive Protocol Reduces HAIs in Burn Patients

ReCell speeds healing and improves the appearance of scars, the manufacturer says. The disaggregated cells behave like those at an acute wound‘s edge: The suspension introduces the cell signaling associated with wound healing across the surface area of the wound. Melanocytes included in the spray progressively deposit melanin over several months, and the normal pigmentation gradually returns.

StrataGraft (Stratatech Corporation, Madison, WI), intended for more severe burns, is a living product designed to mimic natural human skin, with both dermal and fully differentiated epidermal layers. Unlike first-generation products, the manufacturer says, this resorbable tissue is easily sutured or stapled and remains intact in the wound bed.

Related: Patients Benefit From ICU Telemedicine

In a 2014 clinical trial of 28 patients with second-degree, deep, partial-thickness burns, 27 achieved complete wound closure by day 90 with a single application of StrataGraft tissue; the 28th patient’s wound closed in the following weeks. No StrataGraft DNA was detectable at day 90, which the manufacturer says confirmed that the patients had regenerated their own skin.

StrataGraft could be lifesaving for patients whose extensive injuries don’t allow for skin grafts from their own bodies in a single procedure. Those patients must wait for the donor sites to reheal before more skin can be taken. In the meantime, their burns are covered with cadaver skin or synthetic dressings, which the body typically rejects after 2 weeks. By contrast, StrataGraft would offer a ready-to-use supply of virus-free tissue.

Related: PICCs—Are They Really Safer?

ReCell has already been used under special compassionate use dispensations on U.S. personnel wounded in Afghanistan. Wendy Dean, MD, medical advisor for the Tissue Injury and Regenerative Medicine Program Management Office, which is monitoring the progress of the 2 treatments, says they could lead to a “paradigm shift” in skin injury treatment.

Two innovative products under development with DoD funding promise a stunning transformation in the way burns are treated and how they heal.

Usual burn treatment involves harvesting healthy skin from the unburned areas of the patient’s skin, an extremely painful procedure. However, with ReCell (Avita Medical, Cambridge, United Kingdom), surgeons instead take a smaller sample of healthy skin (about the size of 1 or 2 postage stamps) and create a suspension of individual skin cells. Within 30 minutes, the suspension, which is sprayed on, can be used to treat a skin wound 80 times larger than the sample taken.

Related: Nurse-Drive Protocol Reduces HAIs in Burn Patients

ReCell speeds healing and improves the appearance of scars, the manufacturer says. The disaggregated cells behave like those at an acute wound‘s edge: The suspension introduces the cell signaling associated with wound healing across the surface area of the wound. Melanocytes included in the spray progressively deposit melanin over several months, and the normal pigmentation gradually returns.

StrataGraft (Stratatech Corporation, Madison, WI), intended for more severe burns, is a living product designed to mimic natural human skin, with both dermal and fully differentiated epidermal layers. Unlike first-generation products, the manufacturer says, this resorbable tissue is easily sutured or stapled and remains intact in the wound bed.

Related: Patients Benefit From ICU Telemedicine

In a 2014 clinical trial of 28 patients with second-degree, deep, partial-thickness burns, 27 achieved complete wound closure by day 90 with a single application of StrataGraft tissue; the 28th patient’s wound closed in the following weeks. No StrataGraft DNA was detectable at day 90, which the manufacturer says confirmed that the patients had regenerated their own skin.

StrataGraft could be lifesaving for patients whose extensive injuries don’t allow for skin grafts from their own bodies in a single procedure. Those patients must wait for the donor sites to reheal before more skin can be taken. In the meantime, their burns are covered with cadaver skin or synthetic dressings, which the body typically rejects after 2 weeks. By contrast, StrataGraft would offer a ready-to-use supply of virus-free tissue.

Related: PICCs—Are They Really Safer?

ReCell has already been used under special compassionate use dispensations on U.S. personnel wounded in Afghanistan. Wendy Dean, MD, medical advisor for the Tissue Injury and Regenerative Medicine Program Management Office, which is monitoring the progress of the 2 treatments, says they could lead to a “paradigm shift” in skin injury treatment.

After a natural disaster or manmade tragedy, many people react with heightened emotions, such as anxiety, worry, and anger, says the Substance Abuse and Mental Health Services Administration (SAMHSA) Administrator Pamela S. Hyde. Most bounce back with community and family support, she says. But those who need more help in coping with unfolding traumatic events can turn to the Disaster Distress Helpline for immediate crisis counseling.

Related: Perceived Attitudes and Staff Roles of Disaster Management at CBOCs

The helpline connects callers around the clock with trained professionals from the closest crisis-counseling center. The staff provide confidential counseling, referrals, and other needed support services to anyone experiencing psychological distress as a result of mass violence or any other tragedy affecting U.S. communities.

Sponsored by SAMHSA, the helpline complements other services provided by the HHS and the Federal Emergency Management Agency. It is available anywhere in the U.S.

Related: Pre-storm Dialysis Saves Lives

People in need can contact the helpline by calling (800) 985-5990, texting TalkWithUs to 66746, accessing http://disasterdistress.samhsa.gov, or calling TTY for deaf and hearing impaired at (800) 846-8517. The helpline is multilingual.

Related: Power to the Patients

SAMHSA also publishes a downloadable guide, Tips for Survivors: Coping With Grief After Community Violence, with advice for both individuals and communities, available at http://www.samhsa.gov.

After a natural disaster or manmade tragedy, many people react with heightened emotions, such as anxiety, worry, and anger, says the Substance Abuse and Mental Health Services Administration (SAMHSA) Administrator Pamela S. Hyde. Most bounce back with community and family support, she says. But those who need more help in coping with unfolding traumatic events can turn to the Disaster Distress Helpline for immediate crisis counseling.

Related: Perceived Attitudes and Staff Roles of Disaster Management at CBOCs

The helpline connects callers around the clock with trained professionals from the closest crisis-counseling center. The staff provide confidential counseling, referrals, and other needed support services to anyone experiencing psychological distress as a result of mass violence or any other tragedy affecting U.S. communities.

Sponsored by SAMHSA, the helpline complements other services provided by the HHS and the Federal Emergency Management Agency. It is available anywhere in the U.S.

Related: Pre-storm Dialysis Saves Lives

People in need can contact the helpline by calling (800) 985-5990, texting TalkWithUs to 66746, accessing http://disasterdistress.samhsa.gov, or calling TTY for deaf and hearing impaired at (800) 846-8517. The helpline is multilingual.

Related: Power to the Patients

SAMHSA also publishes a downloadable guide, Tips for Survivors: Coping With Grief After Community Violence, with advice for both individuals and communities, available at http://www.samhsa.gov.

After a natural disaster or manmade tragedy, many people react with heightened emotions, such as anxiety, worry, and anger, says the Substance Abuse and Mental Health Services Administration (SAMHSA) Administrator Pamela S. Hyde. Most bounce back with community and family support, she says. But those who need more help in coping with unfolding traumatic events can turn to the Disaster Distress Helpline for immediate crisis counseling.

Related: Perceived Attitudes and Staff Roles of Disaster Management at CBOCs

The helpline connects callers around the clock with trained professionals from the closest crisis-counseling center. The staff provide confidential counseling, referrals, and other needed support services to anyone experiencing psychological distress as a result of mass violence or any other tragedy affecting U.S. communities.

Sponsored by SAMHSA, the helpline complements other services provided by the HHS and the Federal Emergency Management Agency. It is available anywhere in the U.S.

Related: Pre-storm Dialysis Saves Lives

People in need can contact the helpline by calling (800) 985-5990, texting TalkWithUs to 66746, accessing http://disasterdistress.samhsa.gov, or calling TTY for deaf and hearing impaired at (800) 846-8517. The helpline is multilingual.

Related: Power to the Patients

SAMHSA also publishes a downloadable guide, Tips for Survivors: Coping With Grief After Community Violence, with advice for both individuals and communities, available at http://www.samhsa.gov.

Advancing and promoting the health needs of American Indian/Alaska Natives (AI/ANs) who are lesbian, gay, bisexual, or transgender (LGBT) was the aim of a listening session the IHS recently held. At the session, 28 participants from 6 IHS areas discussed concerns in a “dynamic and productive conversation” with senior IHS officials.

Related: DoD to Re-evaluate Transgender Policies

The session revealed 5 major themes:

• Eligibility for services—such as conception services, same-sex marriage and its impact on eligibility for services, and the ability of patients to self-identify as LGBT at IHS facilities
• Clinical services—such as hormone therapy, pre-exposure prophylaxis for HIV prevention, LGBT-inclusive care training for clinicians and IHS staff, and models of care that effectively address LGBT patient needs
• Behavioral health—inclusion of traditional healers and parents in youth suicide prevention, trauma-informed care for LGBT persons, and outreach for people facing homelessness or unstable housing
• Youth concerns—resources for young people who want to self-identify but face discrimination, wide availability of public service announcements that include LGBT voices and faces, and year-round or routine ways to include youth voices in agency-wide planning
• Organizational strategies—engaging tribes in addressing LGBT persons’ needs and continued ways for LGBT people to share their experiences and suggestions with the agency

Related: Same-Sex Couples Eligible for All VA Benefits

IHS recently closed a formal public comment period on several key dimensions of the health needs of the AI/AN LGBT communities. In a blog about the session, Robert McSwain, principal deputy director, says IHS has taken important steps toward securing “a legacy of transparent, accountable, fair, and inclusive decision-making specific to American Indian and Alaska Native LGBT individuals.”

Related: IHS Takes Aim at HIV

Advancing and promoting the health needs of American Indian/Alaska Natives (AI/ANs) who are lesbian, gay, bisexual, or transgender (LGBT) was the aim of a listening session the IHS recently held. At the session, 28 participants from 6 IHS areas discussed concerns in a “dynamic and productive conversation” with senior IHS officials.

Related: DoD to Re-evaluate Transgender Policies

The session revealed 5 major themes:

• Eligibility for services—such as conception services, same-sex marriage and its impact on eligibility for services, and the ability of patients to self-identify as LGBT at IHS facilities
• Clinical services—such as hormone therapy, pre-exposure prophylaxis for HIV prevention, LGBT-inclusive care training for clinicians and IHS staff, and models of care that effectively address LGBT patient needs
• Behavioral health—inclusion of traditional healers and parents in youth suicide prevention, trauma-informed care for LGBT persons, and outreach for people facing homelessness or unstable housing
• Youth concerns—resources for young people who want to self-identify but face discrimination, wide availability of public service announcements that include LGBT voices and faces, and year-round or routine ways to include youth voices in agency-wide planning
• Organizational strategies—engaging tribes in addressing LGBT persons’ needs and continued ways for LGBT people to share their experiences and suggestions with the agency

Related: Same-Sex Couples Eligible for All VA Benefits

IHS recently closed a formal public comment period on several key dimensions of the health needs of the AI/AN LGBT communities. In a blog about the session, Robert McSwain, principal deputy director, says IHS has taken important steps toward securing “a legacy of transparent, accountable, fair, and inclusive decision-making specific to American Indian and Alaska Native LGBT individuals.”

Related: IHS Takes Aim at HIV

Advancing and promoting the health needs of American Indian/Alaska Natives (AI/ANs) who are lesbian, gay, bisexual, or transgender (LGBT) was the aim of a listening session the IHS recently held. At the session, 28 participants from 6 IHS areas discussed concerns in a “dynamic and productive conversation” with senior IHS officials.

Related: DoD to Re-evaluate Transgender Policies

The session revealed 5 major themes:

• Eligibility for services—such as conception services, same-sex marriage and its impact on eligibility for services, and the ability of patients to self-identify as LGBT at IHS facilities
• Clinical services—such as hormone therapy, pre-exposure prophylaxis for HIV prevention, LGBT-inclusive care training for clinicians and IHS staff, and models of care that effectively address LGBT patient needs
• Behavioral health—inclusion of traditional healers and parents in youth suicide prevention, trauma-informed care for LGBT persons, and outreach for people facing homelessness or unstable housing
• Youth concerns—resources for young people who want to self-identify but face discrimination, wide availability of public service announcements that include LGBT voices and faces, and year-round or routine ways to include youth voices in agency-wide planning
• Organizational strategies—engaging tribes in addressing LGBT persons’ needs and continued ways for LGBT people to share their experiences and suggestions with the agency

Related: Same-Sex Couples Eligible for All VA Benefits

IHS recently closed a formal public comment period on several key dimensions of the health needs of the AI/AN LGBT communities. In a blog about the session, Robert McSwain, principal deputy director, says IHS has taken important steps toward securing “a legacy of transparent, accountable, fair, and inclusive decision-making specific to American Indian and Alaska Native LGBT individuals.”

Related: IHS Takes Aim at HIV

Following 2 days of closures, the Clearlake VA Clinic in California has been reopened for all medical appointments on Wednesday with limited lab service and no blood draws after 12:30 PM.

The Valley Fire broke out over the weekend, burning about 70,000 acres to date. The fire has destroyed 585 homes and claimed at least 1 life—a 72-year-old woman with multiple sclerosis, whom the Lake County Sherriff’s Department said they couldn’t reach before flames engulfed her home.

About 13,000 residents of Lake, Napa, and Sonoma counties have been displaced, some to shelters and unable to return to their communities, either due to continuing fire threat or the devastating consequences of the blaze, including downed power lines and other damaged infrastructure. These victims are now relying on community and government aid for shelter, food, water, cleaning supplies, and support services.

The American Red Cross (ACA) is offering medicines and health services, but any VA patient affected by the wildfire and requiring medication refills should call the Telephone Linked Care line at (800) 733-0502.

During a disaster, CBOCs can play an important role, according to “Perceived Attitudes and Staff Roles of Disaster Management at CBOCs,” written by Hilton and colleagues last month in Federal Practitioner. Whereas some organizations are fully equipped to respond to disasters, such as the National Guard or the ACA, others are not. This study outlined the important role of CBOCs in disaster response but admitted that significant barriers to a successful response exist and must be addressed.

Among the recurrent themes that emerged from the study were emergency preparedness barriers, including lack of staff training, tools, and direction; as well as acknowledgment of limited available resources and personal family fears: many CBOC employees said that during an emergency, they would prefer to be home caring for their families.

The VHA mandates CBOCs develop an emergency preparedness plan. To achieve this, Hilton and colleagues suggest the following:

Additional postdisaster resources, including cleanup efforts and financial relief, are available at https://www.usa.gov/disasters-and-emergencies.

Following 2 days of closures, the Clearlake VA Clinic in California has been reopened for all medical appointments on Wednesday with limited lab service and no blood draws after 12:30 PM.

The Valley Fire broke out over the weekend, burning about 70,000 acres to date. The fire has destroyed 585 homes and claimed at least 1 life—a 72-year-old woman with multiple sclerosis, whom the Lake County Sherriff’s Department said they couldn’t reach before flames engulfed her home.

About 13,000 residents of Lake, Napa, and Sonoma counties have been displaced, some to shelters and unable to return to their communities, either due to continuing fire threat or the devastating consequences of the blaze, including downed power lines and other damaged infrastructure. These victims are now relying on community and government aid for shelter, food, water, cleaning supplies, and support services.

The American Red Cross (ACA) is offering medicines and health services, but any VA patient affected by the wildfire and requiring medication refills should call the Telephone Linked Care line at (800) 733-0502.

During a disaster, CBOCs can play an important role, according to “Perceived Attitudes and Staff Roles of Disaster Management at CBOCs,” written by Hilton and colleagues last month in Federal Practitioner. Whereas some organizations are fully equipped to respond to disasters, such as the National Guard or the ACA, others are not. This study outlined the important role of CBOCs in disaster response but admitted that significant barriers to a successful response exist and must be addressed.

Among the recurrent themes that emerged from the study were emergency preparedness barriers, including lack of staff training, tools, and direction; as well as acknowledgment of limited available resources and personal family fears: many CBOC employees said that during an emergency, they would prefer to be home caring for their families.

The VHA mandates CBOCs develop an emergency preparedness plan. To achieve this, Hilton and colleagues suggest the following:

Additional postdisaster resources, including cleanup efforts and financial relief, are available at https://www.usa.gov/disasters-and-emergencies.

Following 2 days of closures, the Clearlake VA Clinic in California has been reopened for all medical appointments on Wednesday with limited lab service and no blood draws after 12:30 PM.

The Valley Fire broke out over the weekend, burning about 70,000 acres to date. The fire has destroyed 585 homes and claimed at least 1 life—a 72-year-old woman with multiple sclerosis, whom the Lake County Sherriff’s Department said they couldn’t reach before flames engulfed her home.

About 13,000 residents of Lake, Napa, and Sonoma counties have been displaced, some to shelters and unable to return to their communities, either due to continuing fire threat or the devastating consequences of the blaze, including downed power lines and other damaged infrastructure. These victims are now relying on community and government aid for shelter, food, water, cleaning supplies, and support services.

The American Red Cross (ACA) is offering medicines and health services, but any VA patient affected by the wildfire and requiring medication refills should call the Telephone Linked Care line at (800) 733-0502.

During a disaster, CBOCs can play an important role, according to “Perceived Attitudes and Staff Roles of Disaster Management at CBOCs,” written by Hilton and colleagues last month in Federal Practitioner. Whereas some organizations are fully equipped to respond to disasters, such as the National Guard or the ACA, others are not. This study outlined the important role of CBOCs in disaster response but admitted that significant barriers to a successful response exist and must be addressed.

Among the recurrent themes that emerged from the study were emergency preparedness barriers, including lack of staff training, tools, and direction; as well as acknowledgment of limited available resources and personal family fears: many CBOC employees said that during an emergency, they would prefer to be home caring for their families.

The VHA mandates CBOCs develop an emergency preparedness plan. To achieve this, Hilton and colleagues suggest the following:

Additional postdisaster resources, including cleanup efforts and financial relief, are available at https://www.usa.gov/disasters-and-emergencies.

CHICAGO – Drug- and device makers paid $3.4 billion to U.S. physicians and hospitals in the last 5 months of 2013, according to first-year data from the Centers for Medicare & Medicaid Services (CMS) Open Payments program, Dr. John Blebea reported at the annual meeting of the Midwestern Vascular Surgical Society.

The Open Payments program is the first step by the federal government toward transparency on the financial relationships between physicians and drug- and device makers and is charged with providing data that is both understandable by the public and searchable for individual physicians.

Patrice Wendling/Frontline Medical News

Under the Physician Payments Sunshine Act, a provision of the Affordable Care Act, manufacturers of drugs, medical devices, and biologics that participate in Medicare and Medicaid are required to report any payments or transfers of items with a $10 onetime value or $100 cumulative annual value to nonresident physicians and teaching hospitals.

Dr. Blebea and his colleagues at the University of Oklahoma in Tulsa sought to examine payments made to vascular specialists during the first year of the Open Payments program using data available from August 2013 to December 2013.

Nationally, 1,347 companies paid $2.9 billion (85%) to 470,000 physicians and $599 million (15%) to 1,019 hospitals during that period. Almost half of payments to physicians ($1.19 billion) was for research; $735 million was for food, travel, honoraria, and consulting services, and about one-third ($908 million) was in stock ownership or investments, Dr. Blebea said.

The investigators also looked at data from New York alone, where payments varied widely among specialties. Four vascular surgeons and one cardiologist reported ownership or investment interests totaling $1,092,025 and $98,689, respectively, but the data were skewed because one vascular surgeon had investment stock valued at $1,033,728, Dr. Blebea said.

Research grants were uncommon among the 223 vascular surgeons, 229 interventional cardiologists, and 88 radiologists and valued at just $4,250, $5,372, and $8,532.

General payments were significantly different between the three groups ($1,808,890 vs. $534,688 vs. $73,492; P less than .0001), he said. This averaged $3,196 per vascular surgeon, $1,889 per cardiologist, and $738 per radiologist. But, again there were broad variations in the data, resulting in medians of $279, $99, and $116, respectively.

One could argue that $279 isn’t a lot in terms of payments for services made or received, but a small number of vascular surgeons did receive what one could argue is a significant amount of money, Dr. Blebea said. Specifically, 8% received more than $5,000 over the 5 months, and three received more than $100,000.

“So you could ask the question: ‘Could this induce bias in scientific presentations?’ and you could answer, ‘Maybe yes, maybe no,’ ” he said. “But what about the three individuals who received more than $100,000? The answer there is that they are probably more likely to be consciously or unconsciously biased in their presentations.”

Dr. Iraklis Pipinos of the University of Nebraska, Omaha, questioned the number of specialists in the New York analysis, noting that he would expect the number of cardiologists to be four to five times that of vascular specialists.

“It’s an important point and I share your concern,” Dr. Blebea responded. “In actual fact, how people are reported in terms of their specialties is how the companies categorize you, so the data may not be completely accurate. It’s one of the challenges.”

Industry groups and professional societies have raised concerns about the incompleteness of the Open Payments data and argued that inaccuracies could harm reputations and undermine trust between patients and their physicians.

Physicians have 45 days after the data submission period to review their Open Payments data and dispute errors before the information is released publicly. Errors can be contested after the deadline has passed, with corrections made in the next reporting cycle.

Still, of the 4.3 million payments made nationally in the last 5 months of 2013, only 1,145 payments (0.02%) worth just $6.25 million were contested, Dr. Blebea reported.

“So it’s either accurate or most physicians didn’t bother to contest inaccuracies,” he said, adding, “I certainly did [contest the data] because there was an inaccuracy in what was reported for me and that was corrected, but how many people will correct these in the future? I hope everybody does.”

Of the $6.49 billion paid to physicians and hospitals in 2014, physicians have disputed only $5.06 million in general payments and $13.16 million in research payments, according to 2014 data reported by the CMS .

Dr. Daniel G. Clair, chair of vascular surgery at the Cleveland Clinic, commented that contrary to what the analysis suggests, it isn’t easy to distinguish between research dollars and nonresearch dollars and between payments made to an institution versus those made to an individual.

“I work for a facility where I am a salaried professional and contracts for some of these things are negotiated between the institution and the company. I’m completely left out of it, but because I happen to be the individual who provides services, it looks like that money is coming to me,” he said.

To provide more transparency in payments, Dr. Blebea said he would recommend quantitative disclosure of industry payments at scientific meetings and in publications with reporting of a range of payments, such as less than $1,000, $1,000-$5,000, $5,001-$10,000, and more than $10,000, rather than specific amounts.

Dr. Blebea and Dr. Pipinos reported having no relevant financial disclosures. Dr. Clair reported serving on the data and safety monitoring board for Bard, as an advisory board member for Boston Scientific and Medtronic, and as a consultant for Endologix.

pwendling@frontlinemedcom.com

CHICAGO – Drug- and device makers paid $3.4 billion to U.S. physicians and hospitals in the last 5 months of 2013, according to first-year data from the Centers for Medicare & Medicaid Services (CMS) Open Payments program, Dr. John Blebea reported at the annual meeting of the Midwestern Vascular Surgical Society.

The Open Payments program is the first step by the federal government toward transparency on the financial relationships between physicians and drug- and device makers and is charged with providing data that is both understandable by the public and searchable for individual physicians.

Patrice Wendling/Frontline Medical News

Under the Physician Payments Sunshine Act, a provision of the Affordable Care Act, manufacturers of drugs, medical devices, and biologics that participate in Medicare and Medicaid are required to report any payments or transfers of items with a $10 onetime value or $100 cumulative annual value to nonresident physicians and teaching hospitals.

Dr. Blebea and his colleagues at the University of Oklahoma in Tulsa sought to examine payments made to vascular specialists during the first year of the Open Payments program using data available from August 2013 to December 2013.

Nationally, 1,347 companies paid $2.9 billion (85%) to 470,000 physicians and $599 million (15%) to 1,019 hospitals during that period. Almost half of payments to physicians ($1.19 billion) was for research; $735 million was for food, travel, honoraria, and consulting services, and about one-third ($908 million) was in stock ownership or investments, Dr. Blebea said.

The investigators also looked at data from New York alone, where payments varied widely among specialties. Four vascular surgeons and one cardiologist reported ownership or investment interests totaling $1,092,025 and $98,689, respectively, but the data were skewed because one vascular surgeon had investment stock valued at $1,033,728, Dr. Blebea said.

Research grants were uncommon among the 223 vascular surgeons, 229 interventional cardiologists, and 88 radiologists and valued at just $4,250, $5,372, and $8,532.

General payments were significantly different between the three groups ($1,808,890 vs. $534,688 vs. $73,492; P less than .0001), he said. This averaged $3,196 per vascular surgeon, $1,889 per cardiologist, and $738 per radiologist. But, again there were broad variations in the data, resulting in medians of $279, $99, and $116, respectively.

One could argue that $279 isn’t a lot in terms of payments for services made or received, but a small number of vascular surgeons did receive what one could argue is a significant amount of money, Dr. Blebea said. Specifically, 8% received more than $5,000 over the 5 months, and three received more than $100,000.

“So you could ask the question: ‘Could this induce bias in scientific presentations?’ and you could answer, ‘Maybe yes, maybe no,’ ” he said. “But what about the three individuals who received more than $100,000? The answer there is that they are probably more likely to be consciously or unconsciously biased in their presentations.”

Dr. Iraklis Pipinos of the University of Nebraska, Omaha, questioned the number of specialists in the New York analysis, noting that he would expect the number of cardiologists to be four to five times that of vascular specialists.

“It’s an important point and I share your concern,” Dr. Blebea responded. “In actual fact, how people are reported in terms of their specialties is how the companies categorize you, so the data may not be completely accurate. It’s one of the challenges.”

Industry groups and professional societies have raised concerns about the incompleteness of the Open Payments data and argued that inaccuracies could harm reputations and undermine trust between patients and their physicians.

Physicians have 45 days after the data submission period to review their Open Payments data and dispute errors before the information is released publicly. Errors can be contested after the deadline has passed, with corrections made in the next reporting cycle.

Still, of the 4.3 million payments made nationally in the last 5 months of 2013, only 1,145 payments (0.02%) worth just $6.25 million were contested, Dr. Blebea reported.

“So it’s either accurate or most physicians didn’t bother to contest inaccuracies,” he said, adding, “I certainly did [contest the data] because there was an inaccuracy in what was reported for me and that was corrected, but how many people will correct these in the future? I hope everybody does.”

Of the $6.49 billion paid to physicians and hospitals in 2014, physicians have disputed only $5.06 million in general payments and $13.16 million in research payments, according to 2014 data reported by the CMS .

Dr. Daniel G. Clair, chair of vascular surgery at the Cleveland Clinic, commented that contrary to what the analysis suggests, it isn’t easy to distinguish between research dollars and nonresearch dollars and between payments made to an institution versus those made to an individual.

“I work for a facility where I am a salaried professional and contracts for some of these things are negotiated between the institution and the company. I’m completely left out of it, but because I happen to be the individual who provides services, it looks like that money is coming to me,” he said.

To provide more transparency in payments, Dr. Blebea said he would recommend quantitative disclosure of industry payments at scientific meetings and in publications with reporting of a range of payments, such as less than $1,000, $1,000-$5,000, $5,001-$10,000, and more than $10,000, rather than specific amounts.

Dr. Blebea and Dr. Pipinos reported having no relevant financial disclosures. Dr. Clair reported serving on the data and safety monitoring board for Bard, as an advisory board member for Boston Scientific and Medtronic, and as a consultant for Endologix.

pwendling@frontlinemedcom.com

CHICAGO – Drug- and device makers paid $3.4 billion to U.S. physicians and hospitals in the last 5 months of 2013, according to first-year data from the Centers for Medicare & Medicaid Services (CMS) Open Payments program, Dr. John Blebea reported at the annual meeting of the Midwestern Vascular Surgical Society.

The Open Payments program is the first step by the federal government toward transparency on the financial relationships between physicians and drug- and device makers and is charged with providing data that is both understandable by the public and searchable for individual physicians.

Patrice Wendling/Frontline Medical News

Under the Physician Payments Sunshine Act, a provision of the Affordable Care Act, manufacturers of drugs, medical devices, and biologics that participate in Medicare and Medicaid are required to report any payments or transfers of items with a $10 onetime value or $100 cumulative annual value to nonresident physicians and teaching hospitals.

Dr. Blebea and his colleagues at the University of Oklahoma in Tulsa sought to examine payments made to vascular specialists during the first year of the Open Payments program using data available from August 2013 to December 2013.

Nationally, 1,347 companies paid $2.9 billion (85%) to 470,000 physicians and $599 million (15%) to 1,019 hospitals during that period. Almost half of payments to physicians ($1.19 billion) was for research; $735 million was for food, travel, honoraria, and consulting services, and about one-third ($908 million) was in stock ownership or investments, Dr. Blebea said.

The investigators also looked at data from New York alone, where payments varied widely among specialties. Four vascular surgeons and one cardiologist reported ownership or investment interests totaling $1,092,025 and $98,689, respectively, but the data were skewed because one vascular surgeon had investment stock valued at $1,033,728, Dr. Blebea said.

Research grants were uncommon among the 223 vascular surgeons, 229 interventional cardiologists, and 88 radiologists and valued at just $4,250, $5,372, and $8,532.

General payments were significantly different between the three groups ($1,808,890 vs. $534,688 vs. $73,492; P less than .0001), he said. This averaged $3,196 per vascular surgeon, $1,889 per cardiologist, and $738 per radiologist. But, again there were broad variations in the data, resulting in medians of $279, $99, and $116, respectively.

One could argue that $279 isn’t a lot in terms of payments for services made or received, but a small number of vascular surgeons did receive what one could argue is a significant amount of money, Dr. Blebea said. Specifically, 8% received more than $5,000 over the 5 months, and three received more than $100,000.

“So you could ask the question: ‘Could this induce bias in scientific presentations?’ and you could answer, ‘Maybe yes, maybe no,’ ” he said. “But what about the three individuals who received more than $100,000? The answer there is that they are probably more likely to be consciously or unconsciously biased in their presentations.”

Dr. Iraklis Pipinos of the University of Nebraska, Omaha, questioned the number of specialists in the New York analysis, noting that he would expect the number of cardiologists to be four to five times that of vascular specialists.

“It’s an important point and I share your concern,” Dr. Blebea responded. “In actual fact, how people are reported in terms of their specialties is how the companies categorize you, so the data may not be completely accurate. It’s one of the challenges.”

Industry groups and professional societies have raised concerns about the incompleteness of the Open Payments data and argued that inaccuracies could harm reputations and undermine trust between patients and their physicians.

Physicians have 45 days after the data submission period to review their Open Payments data and dispute errors before the information is released publicly. Errors can be contested after the deadline has passed, with corrections made in the next reporting cycle.

Still, of the 4.3 million payments made nationally in the last 5 months of 2013, only 1,145 payments (0.02%) worth just $6.25 million were contested, Dr. Blebea reported.

“So it’s either accurate or most physicians didn’t bother to contest inaccuracies,” he said, adding, “I certainly did [contest the data] because there was an inaccuracy in what was reported for me and that was corrected, but how many people will correct these in the future? I hope everybody does.”

Of the $6.49 billion paid to physicians and hospitals in 2014, physicians have disputed only $5.06 million in general payments and $13.16 million in research payments, according to 2014 data reported by the CMS .

Dr. Daniel G. Clair, chair of vascular surgery at the Cleveland Clinic, commented that contrary to what the analysis suggests, it isn’t easy to distinguish between research dollars and nonresearch dollars and between payments made to an institution versus those made to an individual.

“I work for a facility where I am a salaried professional and contracts for some of these things are negotiated between the institution and the company. I’m completely left out of it, but because I happen to be the individual who provides services, it looks like that money is coming to me,” he said.

To provide more transparency in payments, Dr. Blebea said he would recommend quantitative disclosure of industry payments at scientific meetings and in publications with reporting of a range of payments, such as less than $1,000, $1,000-$5,000, $5,001-$10,000, and more than $10,000, rather than specific amounts.

Dr. Blebea and Dr. Pipinos reported having no relevant financial disclosures. Dr. Clair reported serving on the data and safety monitoring board for Bard, as an advisory board member for Boston Scientific and Medtronic, and as a consultant for Endologix.

pwendling@frontlinemedcom.com

The Centers for Medicare & Medicaid Services offers the lure of bonuses to health care practitioners who band together as accountable care organizations, or ACOs, to take care of patients. The financial incentives are intended to encourage these doctors, hospitals, nursing homes, and other institutions to keep patients healthy rather than primarily treat illnesses, which is what Medicare payments traditionally have rewarded. ACOs that save a substantial amount get to keep a share of the savings as a bonus.

The Obama administration touts ACOs as one of the most promising reforms in the 2010 federal health care law. The administration set a goal that by the end of 2018, half of Medicare spending currently based on the volume of procedures a doctor or hospital performs will instead be linked to quality and frugality. But so far, the ACO program generally has been a one-way street, with most doctors and hospitals happy to accept bonuses while declining to be on the hook for a share of any excessive costs run up by their patients.

Last year, Medicare paid $60 billion to 353 ACOs to take care of nearly 6 million Medicare beneficiaries. Some ACOs made significant strides in reducing use of hospitals and other costly resources. But patients at 45 percent of groups cost Medicare more than the government had projected based on their patients’ historic costs, records show. After paying bonuses to the strong performers, the ACO program resulted in a net loss of nearly $3 million to the Medicare trust fund, government records show.

©TheaDesign/thinkstockphotos.com

“It’s turning out to be tougher to transform care and realign delivery than people had expected,” said Eric Cragun, an analyst with the Advisory Board Company, a consulting group based in Washington.

Medicare officials said most ACOs are still in their infancy and that performances will improve with experience and ultimately save significant sums for Medicare while improving care for beneficiaries. “In the long run we’re shooting to achieve those goals,” Sean Cavanaugh, CMS deputy administrator, said in an interview.

Nonetheless, the results are short of what Medicare projected in 2011 as it launched the program. Those estimates anticipated the government would save between $10 million and $320 million during 2014.

‘Bearing risk is a big leap’

The ACO program’s bottom line has been hurt by the reluctance of most ACOs to accept financial responsibility for their patients. Only 7% of ACOs opted last year for a high-risk/high-reward deal in which they had the potential to earn larger bonuses but would have to reimburse the government should their patients instead cost Medicare more than expected.

The rest of the ACOs opted to avoid the potential of financial punishment even though it meant their potential bonuses would be smaller. The risk aversion proved so widespread that Medicare has given ACOs up to 6 years to participate without fear of penalties, instead of phasing out that option.

“Many of these ACOs are newly formed groups of doctors and hospitals, and bearing risk is a big leap,” Cavanaugh said.

Last year, 196 ACOs saved Medicare money, while 157 ACOs cost more than expected. Medicare ultimately did not realize any savings because it paid out bonuses to 97 ACOs, but only 3 of the costly ACOs had to repay Medicare for losses their patients incurred.

In Oregon, North Bend Medical Center ACO patients cost Medicare $9 million. Spending for those patients was 12% more than projected, the largest gap of any ACO. In Los Angeles, the government spent $20 million, or 11%, more than expected for ACO patients at Cedars-Sinai Medical Care Foundation. That was the largest amount in dollars. Both ACOs had chosen to be exempt from financial penalties.

North Bend dropped out of the program earlier this year.

Cedars-Sinai said its ACO patients ended up more expensive than other previous patients because the hospital added new physician practices specializing in cancer and heart disease, which are among the most costly conditions to treat. In a statement Thursday, Cedars said it unintentionally failed to include those patients in the comparisons it sent to Medicare and was now revising its calculations.

Even some of the ACOs that saved the most money have yet to accept financial risk. Costs for patients at Winchester Community ACO in Massachusetts were 16% less than Medicare estimated. The ACO earned a bonus of $5 million. Catharine Robertson, an executive with Winchester Hospital, said their cost-saving initiatives were created when the ACO was formed. One team at the ACO identified patients as high risk of getting sick and sought to intercede before they ended up requiring hospitalization.

“We’re absolutely thrilled with our success the last few years, but the reality is there’s a lot to learn about population-based management,” she said.

The largest bonus in dollars, $23 million, went to Memorial Hermann Accountable Care Organization in Houston, which was 11% below Medicare’s cost expectations. Christopher Lloyd, the CEO of Memorial Hermann’s ACO, credited its success to a decade’s worth of changes that improved cooperation among physicians and the hospital, as well as the creation of systems to share medical details of patients.

“The ACO when we formed it in 2012 was just an extension of what we were already doing,” Mr. Lloyd said. He said committed ACOs could make the same improvements in 3-4 years. “What took us 10 years to build does not take 10 years to replicate,” he said. Still, Memorial Hermann, like Winchester, is not yet accepting risk.

Difficulties in implementing the program

To wring overall savings for Medicare, the government faces a bind, analysts said. If Medicare makes the potential of repayments mandatory, many existing ACOs may drop out of the program and new ones are less likely to join. If the majority of ACOs continue to risk no financial repercussions, they have less incentive to save the government money. And without showing savings, it will be hard for Medicare to expand the program.

Clif Gaus, president of the National Association of ACOs, said Medicare should be making it easier for ACOs to earn bonuses as they assemble their operations. “Any start-up company, I don’t care who they are, never makes profits in the early years,” Mr. Gaus said. “Starting a health care delivery system is just as hard, if not harder, than starting a Facebook or an Amazon.”

Because Medicare sets its expectations based on national spending averages, “it’s really hard to save money in some parts of the country,” said David Muhlestein, an executive at the consulting firm Leavitt Partners based in Salt Lake City. “We’ve talked to ACOs that have joined the program, started to make changes, and decided that it’s really too much work right now.”

Sharp HealthCare, a well-regarded five-hospital system in San Diego, dropped out of the program last year after concluding it might not be able to avoid penalties. In a financial statement, Sharp said that because Medicare’s assessments are “based on national financial trend factors that are not adjusted for specific conditions that an ACO is facing in a particular region (e.g., San Diego), the model was financially detrimental to Sharp ACO.”

Jeff Goldsmith, a health industry analyst and professor at the University of Virginia who is a longtime ACO critic, said the ACO model is flawed. Consumers do not actively opt to participate in the ACOs and do not share in any savings, so they lack financial incentives to help keep costs down, he said. ACOs also have limited leverage to control the costs incurred by highly paid specialists such as surgeons and cardiologists. Patients in ACOS can still go to any doctor who accepts Medicare’s regular method of paying, in which they receive a set fee based on the nature of the service without regard to its outcome.

“Faux managed care is actually harder to do than real managed care,” Goldsmith said. The ACO program, he said, “has a bad enough reputation in the provider community that is not going to grow sufficiently to replace regular Medicare.”

The Obama administration is more optimistic. The administration said patients are benefiting with better care, as most quality measures Medicare is using to track ACO performance improved between 2013 and 2014.

CMS’s actuaries believe the ACOs are performing better than they appear when compared with the historical benchmarks that the health law established, which CMS has been using. The actuaries employed an alternative method in a report issued last spring, comparing Medicare spending trends in places with ACOs and those without, and concluded that, overall, ACOs were saving money.

Still, ACOs’ appetite for taking risk remains small. The number of ACOs opting for the largest potential bonuses and penalties has shrunk from 32 at the start of the program to 19. Rob Lazerow, an Advisory Board consultant, said, “In a world where ACOs are still optional, CMS still has to make it attractive for providers to want to participate.”

Kaiser Health News is a nonprofit national health policy news service that is part of the Henry J. Kaiser Family Foundation.

The Centers for Medicare & Medicaid Services offers the lure of bonuses to health care practitioners who band together as accountable care organizations, or ACOs, to take care of patients. The financial incentives are intended to encourage these doctors, hospitals, nursing homes, and other institutions to keep patients healthy rather than primarily treat illnesses, which is what Medicare payments traditionally have rewarded. ACOs that save a substantial amount get to keep a share of the savings as a bonus.

The Obama administration touts ACOs as one of the most promising reforms in the 2010 federal health care law. The administration set a goal that by the end of 2018, half of Medicare spending currently based on the volume of procedures a doctor or hospital performs will instead be linked to quality and frugality. But so far, the ACO program generally has been a one-way street, with most doctors and hospitals happy to accept bonuses while declining to be on the hook for a share of any excessive costs run up by their patients.

Last year, Medicare paid $60 billion to 353 ACOs to take care of nearly 6 million Medicare beneficiaries. Some ACOs made significant strides in reducing use of hospitals and other costly resources. But patients at 45 percent of groups cost Medicare more than the government had projected based on their patients’ historic costs, records show. After paying bonuses to the strong performers, the ACO program resulted in a net loss of nearly $3 million to the Medicare trust fund, government records show.

©TheaDesign/thinkstockphotos.com

“It’s turning out to be tougher to transform care and realign delivery than people had expected,” said Eric Cragun, an analyst with the Advisory Board Company, a consulting group based in Washington.

Medicare officials said most ACOs are still in their infancy and that performances will improve with experience and ultimately save significant sums for Medicare while improving care for beneficiaries. “In the long run we’re shooting to achieve those goals,” Sean Cavanaugh, CMS deputy administrator, said in an interview.

Nonetheless, the results are short of what Medicare projected in 2011 as it launched the program. Those estimates anticipated the government would save between $10 million and $320 million during 2014.

‘Bearing risk is a big leap’

The ACO program’s bottom line has been hurt by the reluctance of most ACOs to accept financial responsibility for their patients. Only 7% of ACOs opted last year for a high-risk/high-reward deal in which they had the potential to earn larger bonuses but would have to reimburse the government should their patients instead cost Medicare more than expected.

The rest of the ACOs opted to avoid the potential of financial punishment even though it meant their potential bonuses would be smaller. The risk aversion proved so widespread that Medicare has given ACOs up to 6 years to participate without fear of penalties, instead of phasing out that option.

“Many of these ACOs are newly formed groups of doctors and hospitals, and bearing risk is a big leap,” Cavanaugh said.

Last year, 196 ACOs saved Medicare money, while 157 ACOs cost more than expected. Medicare ultimately did not realize any savings because it paid out bonuses to 97 ACOs, but only 3 of the costly ACOs had to repay Medicare for losses their patients incurred.

In Oregon, North Bend Medical Center ACO patients cost Medicare $9 million. Spending for those patients was 12% more than projected, the largest gap of any ACO. In Los Angeles, the government spent $20 million, or 11%, more than expected for ACO patients at Cedars-Sinai Medical Care Foundation. That was the largest amount in dollars. Both ACOs had chosen to be exempt from financial penalties.

North Bend dropped out of the program earlier this year.

Cedars-Sinai said its ACO patients ended up more expensive than other previous patients because the hospital added new physician practices specializing in cancer and heart disease, which are among the most costly conditions to treat. In a statement Thursday, Cedars said it unintentionally failed to include those patients in the comparisons it sent to Medicare and was now revising its calculations.

Even some of the ACOs that saved the most money have yet to accept financial risk. Costs for patients at Winchester Community ACO in Massachusetts were 16% less than Medicare estimated. The ACO earned a bonus of $5 million. Catharine Robertson, an executive with Winchester Hospital, said their cost-saving initiatives were created when the ACO was formed. One team at the ACO identified patients as high risk of getting sick and sought to intercede before they ended up requiring hospitalization.

“We’re absolutely thrilled with our success the last few years, but the reality is there’s a lot to learn about population-based management,” she said.

The largest bonus in dollars, $23 million, went to Memorial Hermann Accountable Care Organization in Houston, which was 11% below Medicare’s cost expectations. Christopher Lloyd, the CEO of Memorial Hermann’s ACO, credited its success to a decade’s worth of changes that improved cooperation among physicians and the hospital, as well as the creation of systems to share medical details of patients.

“The ACO when we formed it in 2012 was just an extension of what we were already doing,” Mr. Lloyd said. He said committed ACOs could make the same improvements in 3-4 years. “What took us 10 years to build does not take 10 years to replicate,” he said. Still, Memorial Hermann, like Winchester, is not yet accepting risk.

Difficulties in implementing the program

To wring overall savings for Medicare, the government faces a bind, analysts said. If Medicare makes the potential of repayments mandatory, many existing ACOs may drop out of the program and new ones are less likely to join. If the majority of ACOs continue to risk no financial repercussions, they have less incentive to save the government money. And without showing savings, it will be hard for Medicare to expand the program.

Clif Gaus, president of the National Association of ACOs, said Medicare should be making it easier for ACOs to earn bonuses as they assemble their operations. “Any start-up company, I don’t care who they are, never makes profits in the early years,” Mr. Gaus said. “Starting a health care delivery system is just as hard, if not harder, than starting a Facebook or an Amazon.”

Because Medicare sets its expectations based on national spending averages, “it’s really hard to save money in some parts of the country,” said David Muhlestein, an executive at the consulting firm Leavitt Partners based in Salt Lake City. “We’ve talked to ACOs that have joined the program, started to make changes, and decided that it’s really too much work right now.”

Sharp HealthCare, a well-regarded five-hospital system in San Diego, dropped out of the program last year after concluding it might not be able to avoid penalties. In a financial statement, Sharp said that because Medicare’s assessments are “based on national financial trend factors that are not adjusted for specific conditions that an ACO is facing in a particular region (e.g., San Diego), the model was financially detrimental to Sharp ACO.”

Jeff Goldsmith, a health industry analyst and professor at the University of Virginia who is a longtime ACO critic, said the ACO model is flawed. Consumers do not actively opt to participate in the ACOs and do not share in any savings, so they lack financial incentives to help keep costs down, he said. ACOs also have limited leverage to control the costs incurred by highly paid specialists such as surgeons and cardiologists. Patients in ACOS can still go to any doctor who accepts Medicare’s regular method of paying, in which they receive a set fee based on the nature of the service without regard to its outcome.

“Faux managed care is actually harder to do than real managed care,” Goldsmith said. The ACO program, he said, “has a bad enough reputation in the provider community that is not going to grow sufficiently to replace regular Medicare.”

The Obama administration is more optimistic. The administration said patients are benefiting with better care, as most quality measures Medicare is using to track ACO performance improved between 2013 and 2014.

CMS’s actuaries believe the ACOs are performing better than they appear when compared with the historical benchmarks that the health law established, which CMS has been using. The actuaries employed an alternative method in a report issued last spring, comparing Medicare spending trends in places with ACOs and those without, and concluded that, overall, ACOs were saving money.

Still, ACOs’ appetite for taking risk remains small. The number of ACOs opting for the largest potential bonuses and penalties has shrunk from 32 at the start of the program to 19. Rob Lazerow, an Advisory Board consultant, said, “In a world where ACOs are still optional, CMS still has to make it attractive for providers to want to participate.”

Kaiser Health News is a nonprofit national health policy news service that is part of the Henry J. Kaiser Family Foundation.

The Centers for Medicare & Medicaid Services offers the lure of bonuses to health care practitioners who band together as accountable care organizations, or ACOs, to take care of patients. The financial incentives are intended to encourage these doctors, hospitals, nursing homes, and other institutions to keep patients healthy rather than primarily treat illnesses, which is what Medicare payments traditionally have rewarded. ACOs that save a substantial amount get to keep a share of the savings as a bonus.

The Obama administration touts ACOs as one of the most promising reforms in the 2010 federal health care law. The administration set a goal that by the end of 2018, half of Medicare spending currently based on the volume of procedures a doctor or hospital performs will instead be linked to quality and frugality. But so far, the ACO program generally has been a one-way street, with most doctors and hospitals happy to accept bonuses while declining to be on the hook for a share of any excessive costs run up by their patients.

Last year, Medicare paid $60 billion to 353 ACOs to take care of nearly 6 million Medicare beneficiaries. Some ACOs made significant strides in reducing use of hospitals and other costly resources. But patients at 45 percent of groups cost Medicare more than the government had projected based on their patients’ historic costs, records show. After paying bonuses to the strong performers, the ACO program resulted in a net loss of nearly $3 million to the Medicare trust fund, government records show.

©TheaDesign/thinkstockphotos.com

“It’s turning out to be tougher to transform care and realign delivery than people had expected,” said Eric Cragun, an analyst with the Advisory Board Company, a consulting group based in Washington.

Medicare officials said most ACOs are still in their infancy and that performances will improve with experience and ultimately save significant sums for Medicare while improving care for beneficiaries. “In the long run we’re shooting to achieve those goals,” Sean Cavanaugh, CMS deputy administrator, said in an interview.

Nonetheless, the results are short of what Medicare projected in 2011 as it launched the program. Those estimates anticipated the government would save between $10 million and $320 million during 2014.

‘Bearing risk is a big leap’

The ACO program’s bottom line has been hurt by the reluctance of most ACOs to accept financial responsibility for their patients. Only 7% of ACOs opted last year for a high-risk/high-reward deal in which they had the potential to earn larger bonuses but would have to reimburse the government should their patients instead cost Medicare more than expected.

The rest of the ACOs opted to avoid the potential of financial punishment even though it meant their potential bonuses would be smaller. The risk aversion proved so widespread that Medicare has given ACOs up to 6 years to participate without fear of penalties, instead of phasing out that option.

“Many of these ACOs are newly formed groups of doctors and hospitals, and bearing risk is a big leap,” Cavanaugh said.

Last year, 196 ACOs saved Medicare money, while 157 ACOs cost more than expected. Medicare ultimately did not realize any savings because it paid out bonuses to 97 ACOs, but only 3 of the costly ACOs had to repay Medicare for losses their patients incurred.

In Oregon, North Bend Medical Center ACO patients cost Medicare $9 million. Spending for those patients was 12% more than projected, the largest gap of any ACO. In Los Angeles, the government spent $20 million, or 11%, more than expected for ACO patients at Cedars-Sinai Medical Care Foundation. That was the largest amount in dollars. Both ACOs had chosen to be exempt from financial penalties.

North Bend dropped out of the program earlier this year.

Cedars-Sinai said its ACO patients ended up more expensive than other previous patients because the hospital added new physician practices specializing in cancer and heart disease, which are among the most costly conditions to treat. In a statement Thursday, Cedars said it unintentionally failed to include those patients in the comparisons it sent to Medicare and was now revising its calculations.

Even some of the ACOs that saved the most money have yet to accept financial risk. Costs for patients at Winchester Community ACO in Massachusetts were 16% less than Medicare estimated. The ACO earned a bonus of $5 million. Catharine Robertson, an executive with Winchester Hospital, said their cost-saving initiatives were created when the ACO was formed. One team at the ACO identified patients as high risk of getting sick and sought to intercede before they ended up requiring hospitalization.

“We’re absolutely thrilled with our success the last few years, but the reality is there’s a lot to learn about population-based management,” she said.

The largest bonus in dollars, $23 million, went to Memorial Hermann Accountable Care Organization in Houston, which was 11% below Medicare’s cost expectations. Christopher Lloyd, the CEO of Memorial Hermann’s ACO, credited its success to a decade’s worth of changes that improved cooperation among physicians and the hospital, as well as the creation of systems to share medical details of patients.

“The ACO when we formed it in 2012 was just an extension of what we were already doing,” Mr. Lloyd said. He said committed ACOs could make the same improvements in 3-4 years. “What took us 10 years to build does not take 10 years to replicate,” he said. Still, Memorial Hermann, like Winchester, is not yet accepting risk.

Difficulties in implementing the program

To wring overall savings for Medicare, the government faces a bind, analysts said. If Medicare makes the potential of repayments mandatory, many existing ACOs may drop out of the program and new ones are less likely to join. If the majority of ACOs continue to risk no financial repercussions, they have less incentive to save the government money. And without showing savings, it will be hard for Medicare to expand the program.

Clif Gaus, president of the National Association of ACOs, said Medicare should be making it easier for ACOs to earn bonuses as they assemble their operations. “Any start-up company, I don’t care who they are, never makes profits in the early years,” Mr. Gaus said. “Starting a health care delivery system is just as hard, if not harder, than starting a Facebook or an Amazon.”

Because Medicare sets its expectations based on national spending averages, “it’s really hard to save money in some parts of the country,” said David Muhlestein, an executive at the consulting firm Leavitt Partners based in Salt Lake City. “We’ve talked to ACOs that have joined the program, started to make changes, and decided that it’s really too much work right now.”

Sharp HealthCare, a well-regarded five-hospital system in San Diego, dropped out of the program last year after concluding it might not be able to avoid penalties. In a financial statement, Sharp said that because Medicare’s assessments are “based on national financial trend factors that are not adjusted for specific conditions that an ACO is facing in a particular region (e.g., San Diego), the model was financially detrimental to Sharp ACO.”

Jeff Goldsmith, a health industry analyst and professor at the University of Virginia who is a longtime ACO critic, said the ACO model is flawed. Consumers do not actively opt to participate in the ACOs and do not share in any savings, so they lack financial incentives to help keep costs down, he said. ACOs also have limited leverage to control the costs incurred by highly paid specialists such as surgeons and cardiologists. Patients in ACOS can still go to any doctor who accepts Medicare’s regular method of paying, in which they receive a set fee based on the nature of the service without regard to its outcome.

“Faux managed care is actually harder to do than real managed care,” Goldsmith said. The ACO program, he said, “has a bad enough reputation in the provider community that is not going to grow sufficiently to replace regular Medicare.”

The Obama administration is more optimistic. The administration said patients are benefiting with better care, as most quality measures Medicare is using to track ACO performance improved between 2013 and 2014.

CMS’s actuaries believe the ACOs are performing better than they appear when compared with the historical benchmarks that the health law established, which CMS has been using. The actuaries employed an alternative method in a report issued last spring, comparing Medicare spending trends in places with ACOs and those without, and concluded that, overall, ACOs were saving money.

Still, ACOs’ appetite for taking risk remains small. The number of ACOs opting for the largest potential bonuses and penalties has shrunk from 32 at the start of the program to 19. Rob Lazerow, an Advisory Board consultant, said, “In a world where ACOs are still optional, CMS still has to make it attractive for providers to want to participate.”

Kaiser Health News is a nonprofit national health policy news service that is part of the Henry J. Kaiser Family Foundation.

Most American adults have experienced pain, but a “striking number” experience severe and lasting pain, according to a new analysis of data from the 2012 National Health Interview Survey (NHIS), funded by the NIH National Center for Complementary and Integrative Health (NCCIH). The survey estimated that 126 million adults experienced some pain in the previous 3 months; 25 million had pain every day.

Related: A Multidisciplinary Chronic Pain Management Clinic in an Indian Health Service Facility.

The nearly 40 million respondents with the most severe pain were likely to have a worse health status, use more health care, and experience greater disability than those with less severe pain. However, about half of respondents with the most severe pain still rated their overall health as good or better.

Related: Pharmacist Pain E-Consults That Result in a Therapy Change

Women, older adults, and non-Hispanics were more likely to report pain; Asians were less likely. Minorities who did not choose to be interviewed in English were markedly less likely to report pain, the researchers found. The impact of gender on pain varied by race and ethnicity.

Related: Tracking Tramadol-Related ED Visits

The NHIS is an annual study of health- and illness-related experiences. A subset of 8,781 NHIS respondents answered questions about the frequency and intensity of pain in the prior 3 months. The data analysis, published in The Journal of Pain, adds a “valuable new scope” to the understanding of pain, said Josephine P. Briggs, MD, director of NCCIH. The added knowledge could help shape future research and treatment, including complementary health approaches.

Most American adults have experienced pain, but a “striking number” experience severe and lasting pain, according to a new analysis of data from the 2012 National Health Interview Survey (NHIS), funded by the NIH National Center for Complementary and Integrative Health (NCCIH). The survey estimated that 126 million adults experienced some pain in the previous 3 months; 25 million had pain every day.

Related: A Multidisciplinary Chronic Pain Management Clinic in an Indian Health Service Facility.

The nearly 40 million respondents with the most severe pain were likely to have a worse health status, use more health care, and experience greater disability than those with less severe pain. However, about half of respondents with the most severe pain still rated their overall health as good or better.

Related: Pharmacist Pain E-Consults That Result in a Therapy Change

Women, older adults, and non-Hispanics were more likely to report pain; Asians were less likely. Minorities who did not choose to be interviewed in English were markedly less likely to report pain, the researchers found. The impact of gender on pain varied by race and ethnicity.

Related: Tracking Tramadol-Related ED Visits

The NHIS is an annual study of health- and illness-related experiences. A subset of 8,781 NHIS respondents answered questions about the frequency and intensity of pain in the prior 3 months. The data analysis, published in The Journal of Pain, adds a “valuable new scope” to the understanding of pain, said Josephine P. Briggs, MD, director of NCCIH. The added knowledge could help shape future research and treatment, including complementary health approaches.

Most American adults have experienced pain, but a “striking number” experience severe and lasting pain, according to a new analysis of data from the 2012 National Health Interview Survey (NHIS), funded by the NIH National Center for Complementary and Integrative Health (NCCIH). The survey estimated that 126 million adults experienced some pain in the previous 3 months; 25 million had pain every day.

Related: A Multidisciplinary Chronic Pain Management Clinic in an Indian Health Service Facility.

The nearly 40 million respondents with the most severe pain were likely to have a worse health status, use more health care, and experience greater disability than those with less severe pain. However, about half of respondents with the most severe pain still rated their overall health as good or better.

Related: Pharmacist Pain E-Consults That Result in a Therapy Change

Women, older adults, and non-Hispanics were more likely to report pain; Asians were less likely. Minorities who did not choose to be interviewed in English were markedly less likely to report pain, the researchers found. The impact of gender on pain varied by race and ethnicity.

Related: Tracking Tramadol-Related ED Visits

The NHIS is an annual study of health- and illness-related experiences. A subset of 8,781 NHIS respondents answered questions about the frequency and intensity of pain in the prior 3 months. The data analysis, published in The Journal of Pain, adds a “valuable new scope” to the understanding of pain, said Josephine P. Briggs, MD, director of NCCIH. The added knowledge could help shape future research and treatment, including complementary health approaches.

Assessments are complete, and the Centers for Medicare & Medicaid Services has determined which physician practices will face a pay cut – officially, a “downward payment adjustment” – for failing to comply with the Physician Quality Reporting System (PQRS). Doctors have just 2 months to challenge findings that they believe were made in error to spare themselves a cut in 2016.

The pay cut will apply to individual eligible practitioners and PQRS group practices that did not satisfactorily report data on quality measures in 2014. The 2% cut will be applied to all Part B covered services, according to a Sept. 9 CMS announcement.

©Jupiterimages/thinkstockphotos.com

To learn whether they are subject to the cut, physicians can review their 2014 PQRS feedback reports, which became available Sept. 8. The reports apply to doctors who submitted quality data in calendar year 2014. Feedback reports for 2015 will be available approximately this time next year.

To challenge PQRS determinations, physicians can submit an informal review between Sept. 9 and Nov. 9 and request that the CMS reevaluate incentive eligibility and adjustment determinations. Those requests can be made through the quality reporting portal. Physicians who request a review will be contacted via email of a final decision by the CMS within 90 days of their request. All decisions will be final and there will be no further review or appeal, according to the CMS.

It should not be surprising that physicians who did not satisfactorily comply with PQRS will see a 2% pay cut next year, said David Harlow, a health law and policy attorney based in Newton, Mass. What’s unusual, however, is that the informal review process does not include an avenue for an independent evaluation, Mr. Harlow said.

“It’s CMS reviewing a CMS decision,” he said in an interview. “From a provider perspective, there might be some skepticism about the independence of that review. CMS says this is not something that is subject to further administrative or judicial review. So there’s not an appeal.”

Mr. Harlow said that he would not be surprised if physician organizations advocate for further judicial relief in the process. CMS has previously provided avenues for administrative or judicial appeals of its decisions in other programs, he noted.

In its announcement, the agency outlined the ways in which physicians could have avoided the coming pay cut. This included reporting nine measures across three domains for 50% of Medicare patients, completing the GPRO Web Interface, or reporting at least one registry measures group for 20 patients, at least 11 of whom were Medicare Part B patients. Additionally, doctors could have reported three measures across one domain for 50% of Medicare patients, or satisfactorily participated in a qualified clinical data registry.

agallegos@frontlinemedcom.com

On Twitter @legal_med

Assessments are complete, and the Centers for Medicare & Medicaid Services has determined which physician practices will face a pay cut – officially, a “downward payment adjustment” – for failing to comply with the Physician Quality Reporting System (PQRS). Doctors have just 2 months to challenge findings that they believe were made in error to spare themselves a cut in 2016.

The pay cut will apply to individual eligible practitioners and PQRS group practices that did not satisfactorily report data on quality measures in 2014. The 2% cut will be applied to all Part B covered services, according to a Sept. 9 CMS announcement.

©Jupiterimages/thinkstockphotos.com

To learn whether they are subject to the cut, physicians can review their 2014 PQRS feedback reports, which became available Sept. 8. The reports apply to doctors who submitted quality data in calendar year 2014. Feedback reports for 2015 will be available approximately this time next year.

To challenge PQRS determinations, physicians can submit an informal review between Sept. 9 and Nov. 9 and request that the CMS reevaluate incentive eligibility and adjustment determinations. Those requests can be made through the quality reporting portal. Physicians who request a review will be contacted via email of a final decision by the CMS within 90 days of their request. All decisions will be final and there will be no further review or appeal, according to the CMS.

It should not be surprising that physicians who did not satisfactorily comply with PQRS will see a 2% pay cut next year, said David Harlow, a health law and policy attorney based in Newton, Mass. What’s unusual, however, is that the informal review process does not include an avenue for an independent evaluation, Mr. Harlow said.

“It’s CMS reviewing a CMS decision,” he said in an interview. “From a provider perspective, there might be some skepticism about the independence of that review. CMS says this is not something that is subject to further administrative or judicial review. So there’s not an appeal.”

Mr. Harlow said that he would not be surprised if physician organizations advocate for further judicial relief in the process. CMS has previously provided avenues for administrative or judicial appeals of its decisions in other programs, he noted.

In its announcement, the agency outlined the ways in which physicians could have avoided the coming pay cut. This included reporting nine measures across three domains for 50% of Medicare patients, completing the GPRO Web Interface, or reporting at least one registry measures group for 20 patients, at least 11 of whom were Medicare Part B patients. Additionally, doctors could have reported three measures across one domain for 50% of Medicare patients, or satisfactorily participated in a qualified clinical data registry.

agallegos@frontlinemedcom.com

On Twitter @legal_med

Assessments are complete, and the Centers for Medicare & Medicaid Services has determined which physician practices will face a pay cut – officially, a “downward payment adjustment” – for failing to comply with the Physician Quality Reporting System (PQRS). Doctors have just 2 months to challenge findings that they believe were made in error to spare themselves a cut in 2016.

The pay cut will apply to individual eligible practitioners and PQRS group practices that did not satisfactorily report data on quality measures in 2014. The 2% cut will be applied to all Part B covered services, according to a Sept. 9 CMS announcement.

©Jupiterimages/thinkstockphotos.com

To learn whether they are subject to the cut, physicians can review their 2014 PQRS feedback reports, which became available Sept. 8. The reports apply to doctors who submitted quality data in calendar year 2014. Feedback reports for 2015 will be available approximately this time next year.

To challenge PQRS determinations, physicians can submit an informal review between Sept. 9 and Nov. 9 and request that the CMS reevaluate incentive eligibility and adjustment determinations. Those requests can be made through the quality reporting portal. Physicians who request a review will be contacted via email of a final decision by the CMS within 90 days of their request. All decisions will be final and there will be no further review or appeal, according to the CMS.

It should not be surprising that physicians who did not satisfactorily comply with PQRS will see a 2% pay cut next year, said David Harlow, a health law and policy attorney based in Newton, Mass. What’s unusual, however, is that the informal review process does not include an avenue for an independent evaluation, Mr. Harlow said.

“It’s CMS reviewing a CMS decision,” he said in an interview. “From a provider perspective, there might be some skepticism about the independence of that review. CMS says this is not something that is subject to further administrative or judicial review. So there’s not an appeal.”

Mr. Harlow said that he would not be surprised if physician organizations advocate for further judicial relief in the process. CMS has previously provided avenues for administrative or judicial appeals of its decisions in other programs, he noted.

In its announcement, the agency outlined the ways in which physicians could have avoided the coming pay cut. This included reporting nine measures across three domains for 50% of Medicare patients, completing the GPRO Web Interface, or reporting at least one registry measures group for 20 patients, at least 11 of whom were Medicare Part B patients. Additionally, doctors could have reported three measures across one domain for 50% of Medicare patients, or satisfactorily participated in a qualified clinical data registry.

agallegos@frontlinemedcom.com

On Twitter @legal_med

The rates of acute hepatitis C virus (HCV) infection have taken a turn for the worse—that is, upward. And American Indians and Alaska Natives (AI/ANs) have been particularly hard hit: In just 1 year, acute HCV infection rates jumped more than 86% among AI/ANs, according to surveillance data from the CDC. 

Related: Viral Hepatitis Awareness

It is common for hepatitis rates to vary, with steady trends punctuated by outbreak-related spikes. But the CDC says between 2010 and 2013, reported cases of HCV increased significantly by 151%. That increase is thought to reflect both “true increases in incidence and improved case ascertainment,” CDC says.

Hepatitis B virus and HCV symptoms can be unapparent and slow to develop, which is why hepatitis has been called a silent epidemic and why many people are not diagnosed. But people with HCV risk death if they abuse alcohol: Undiagnosed, the virus can be a deadly threat to ANs, who have a high prevalence of alcohol abuse.  

No vaccine is available for HCV. And, in an article for Native Health News Alliance, Hannabah Blue, a project manager at North Dakota State University’s American Indian Public Health Resource Center, says the price of treatment is too high for many Native people.

Related: Accelerated Hepatitis A and B Immunization in a Substance Abuse Treatment Program

Spreading the word about financial assistance programs could help, as could building awareness about the virus. The CDC and U.S. Preventive Services Task Force also recommend some general prevention strategies, such as one-time screening for adults born between 1945 and 1965 (about 75% of all people with HCV infection are in that age group). The FDA also has approved point-of-care tests for HCV infection, making it easier for patients to receive test results and referrals during the same health care visit.

Related: Budget Hole Narrowly Averted for VA

Continuously updated evidence-based guidance for providers caring for HCV-infected patients is available at http://www.hcvguidelines.org.

The rates of acute hepatitis C virus (HCV) infection have taken a turn for the worse—that is, upward. And American Indians and Alaska Natives (AI/ANs) have been particularly hard hit: In just 1 year, acute HCV infection rates jumped more than 86% among AI/ANs, according to surveillance data from the CDC. 

Related: Viral Hepatitis Awareness

It is common for hepatitis rates to vary, with steady trends punctuated by outbreak-related spikes. But the CDC says between 2010 and 2013, reported cases of HCV increased significantly by 151%. That increase is thought to reflect both “true increases in incidence and improved case ascertainment,” CDC says.

Hepatitis B virus and HCV symptoms can be unapparent and slow to develop, which is why hepatitis has been called a silent epidemic and why many people are not diagnosed. But people with HCV risk death if they abuse alcohol: Undiagnosed, the virus can be a deadly threat to ANs, who have a high prevalence of alcohol abuse.  

No vaccine is available for HCV. And, in an article for Native Health News Alliance, Hannabah Blue, a project manager at North Dakota State University’s American Indian Public Health Resource Center, says the price of treatment is too high for many Native people.

Related: Accelerated Hepatitis A and B Immunization in a Substance Abuse Treatment Program

Spreading the word about financial assistance programs could help, as could building awareness about the virus. The CDC and U.S. Preventive Services Task Force also recommend some general prevention strategies, such as one-time screening for adults born between 1945 and 1965 (about 75% of all people with HCV infection are in that age group). The FDA also has approved point-of-care tests for HCV infection, making it easier for patients to receive test results and referrals during the same health care visit.

Related: Budget Hole Narrowly Averted for VA

Continuously updated evidence-based guidance for providers caring for HCV-infected patients is available at http://www.hcvguidelines.org.

The rates of acute hepatitis C virus (HCV) infection have taken a turn for the worse—that is, upward. And American Indians and Alaska Natives (AI/ANs) have been particularly hard hit: In just 1 year, acute HCV infection rates jumped more than 86% among AI/ANs, according to surveillance data from the CDC. 

Related: Viral Hepatitis Awareness

It is common for hepatitis rates to vary, with steady trends punctuated by outbreak-related spikes. But the CDC says between 2010 and 2013, reported cases of HCV increased significantly by 151%. That increase is thought to reflect both “true increases in incidence and improved case ascertainment,” CDC says.

Hepatitis B virus and HCV symptoms can be unapparent and slow to develop, which is why hepatitis has been called a silent epidemic and why many people are not diagnosed. But people with HCV risk death if they abuse alcohol: Undiagnosed, the virus can be a deadly threat to ANs, who have a high prevalence of alcohol abuse.  

No vaccine is available for HCV. And, in an article for Native Health News Alliance, Hannabah Blue, a project manager at North Dakota State University’s American Indian Public Health Resource Center, says the price of treatment is too high for many Native people.

Related: Accelerated Hepatitis A and B Immunization in a Substance Abuse Treatment Program

Spreading the word about financial assistance programs could help, as could building awareness about the virus. The CDC and U.S. Preventive Services Task Force also recommend some general prevention strategies, such as one-time screening for adults born between 1945 and 1965 (about 75% of all people with HCV infection are in that age group). The FDA also has approved point-of-care tests for HCV infection, making it easier for patients to receive test results and referrals during the same health care visit.

Related: Budget Hole Narrowly Averted for VA

Continuously updated evidence-based guidance for providers caring for HCV-infected patients is available at http://www.hcvguidelines.org.