Policy & Practice


Programs Cut Smoking Rates

State tobacco control programs are effective at cutting adult smoking rates, according to researchers at the Centers for Disease Control and Prevention and RTI International. The researchers observed a decline in the prevalence of adult smoking, from more than 29% in 1985 to less than 19% in 2003. Among individual states, declines in adult smoking prevalence were directly related to increases in state per-person investments in tobacco control programs. Such programs use educational, clinical, regulatory, economic, and social strategies to establish smoke-free policies and social norms, to help tobacco users to quit, and to prevent people from starting to smoke. The study was published in the February issue of American Journal of Public Health.

Individual Mandates Necessary

Unless the United States adopts a single-payer health system, it will not be possible to achieve universal coverage without a mandate that requires individuals to purchase health insurance, a new report from the Urban Institute concluded. A system that encouraged but did not require people to get health insurance would tend to enroll disproportionate numbers of individuals with higher cost health problems, the report said, noting that this could create high premiums and instability in the insurance pools that enroll those individuals. Also, the government would have difficulty redirecting current spending on the uninsured to offset some of the cost associated with a new program without universal coverage, according to the report, “Do Individual Mandates Matter?”

Recertification Could Improve Care

The quality of care provided to patients with hypertension appears to erode as the time since the physician's last board certification increases, a study published online in Circulation found. The researchers analyzed treatment of more than 8,000 patients with hypertension and comorbid diabetes who were treated by 301 internists, looking at patient visits with documented blood pressure of at least 130/85 mm Hg. The frequency of pharmacologic antihypertensive treatment intensification decreased from about 27% for physicians who were board certified the previous year to about 7% for those who were board certified 31 years before the visit. For physicians recertified more than 10 years ago, the treatment intensification rate was about 22%, compared with 17% for those recertified in the last decade.

Part D Costs Drop

The projected cost of providing Medicare beneficiaries with a prescription drug benefit through private health plans has dropped again, according to the Centers for Medicare and Medicaid Services. CMS said in its fiscal year 2009 budget documents that the overall projected cost of the Part D drug benefit is $117 billion lower over the next 10 years than it estimated last summer. The difference results from the slowing of drug cost trends, lower estimates of plan spending, and higher rebates from drug manufacturers, CMS said. Compared with original projections, the net Medicare cost of the drug benefit will be $243.7 billion lower over the 10 years ending in 2013.

Patient Safety Goals Updated

The Joint Commission has released a preliminary version of its 2009 National Patient Safety Goals for hospitals and critical care facilities, and is seeking to add several new requirements to its list of priorities. According to the draft, the commission would like to add a requirement specifically highlighting the need to eliminate transfusion errors related to patient misidentification. In addition, the commission would add a requirement that acute care facilities implement best practices to prevent the spread of multiple drug-resistant organisms. Last, the draft specifies new requirements for using best practices to prevent catheter-associated bloodstream infections and surgical site infections, and also refines points to work toward the commission's goal of reconciling patient medications across the care continuum.

Top 10 Cost Half a Trillion

The nation's 10 most expensive medical conditions cost about $500 billion to treat in 2005, according to the Agency for Healthcare Research and Quality. Heart disease topped the list at $76 billion, with trauma second at $72 billion, and cancer third at $70 billion. Mental illness, including depression, cost $56 billion, and asthma and chronic obstructive pulmonary disease cost $54 billion. Hypertension cost $42 billion to treat, type 2 diabetes cost $34 billion, and osteoarthritis/joint diseases also cost $34 billion. Back problems and normal childbirth rounded out the list at $32 billion each. The agency counted money spent on office visits, clinic and emergency department use, hospital stays, home health care, and prescription medicines.

CMS May Cover Artificial Heart

CMS has proposed covering artificial heart devices in Medicare beneficiaries who are enrolled in Food and Drug Administration-approved studies, reversing a 20-year-old policy. The use of artificial heart technology has not been available to Medicare beneficiaries because of a 1986 noncoverage policy. But since that policy was implemented, two artificial heart manufacturers have run clinical trials studying the safety and health outcomes of using their devices, CMS said. The agency said that it now believes there is sufficient scientific evidence on the use of artificial hearts to allow coverage of these devices for beneficiaries “in the carefully controlled clinical environment of an FDA-approved study.” A final coverage determination is expected in May.

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