Archive for June, 2010

A Majority of Women Didn’t Get Second Opinions Before Gynecological Surgery, Poll Says

Fifty-three percent of women who had hysterectomies did not seek second opinions before scheduling their surgeries, according to a new poll of 4,157 women by HysterSisters, an online community providing woman-to-woman support for gynecological health issues/concerns. The poll was conducted in April 2010 at www.hystersisters.com.

To encourage women to seek second opinions before a hysterectomy or any life-changing surgery, HysterSisters founder Kathy Kelley created Give Me a Second, a new awareness campaign with an online video and website at givemeasecond.com.

“Second opinions can do three important things for any woman facing a major decision about any surgery, not just hysterectomy,” says Kathy Kelley, who started HysterSisters in 1998 after her own hysterectomy. “They can give you new information, a new perspective or peace of mind. Every woman deserves a second opinion.”

Hysterectomy is the second most frequent major surgical procedure among reproductive-aged women (after c-sections). Each year approximately 600,000 women in the United States have hysterectomies, and over 60 percent of those surgeries are performed with outdated surgical methods that mean longer hospitalizations and longer recovery periods, according to research published by Obstetrics & Gynecology in November 2009. The outdated surgical method is an open abdominal incision compared to laparoscopic, vaginal and robotic-assisted methods.

Especially for women facing gynecological health concerns or disease, second opinions may result in fewer invasive surgeries, fewer hysterectomies, an increase in alternative treatments and improved quality of life for women.

“I’m passionate about minimally invasive surgeries such as laparoscopy because patients do so well,” says Dr. Lori Warren, a gynecological surgeon at Women First Obstetrics & Gynecology in Louisville, Ky. “All women facing hysterectomy need to ask their doctors ‘do I need a large incision?’ If doctors start getting the questions, more may start getting the training.”

Kelley says by asking more questions and getting second opinions, women become respectful partners with their doctors and improve the quality of their care and their outcomes. “Give Me a Second wants women to know it’s okay to talk to more than one doctor,” she says. “In fact, it’s good for your health.”

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Study: Despite High Spending, US Receives Lowest Healthcare Score

Despite the fact that the US pays more per individual for healthcare costs, it continues to score the lowest in overall healthcare benefits.

According to the latest Commonwealth Fund comparison of the US Healthcare system, the US scored either last or second to last in each major category. The competition this year was from: Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom. The US finished last overall, and practically last in each major criteria test.

Julie Rovner, from NPR News had this to say about the test, “To come up with the rankings, researchers surveyed both doctors and patients. The criteria comprised quality, access, efficiency, equity, whether people in each country lived long and productive lives, and how much each country spent per person on care.” She continues with her perspective of the results, “About the only good news for America, said Commonwealth Fund President Karen Davis, who was also the study’s lead author, is that the new health law could put the U.S. on a path towards improvement.”

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2010 Disability Claims Review: $8.1 Billion Paid to Disabled Individuals

The 2010 Long-Term Disability Claims Review, conducted by the Council for Disability Awareness (CDA), reveals that CDA member companies paid more than $8 billion in ongoing disability insurance payments to individuals during 2009. A record 627,000 disabled individuals received long-term disability insurance payments.

“The 2010 Claims Review clearly illustrates that disabilities are more common than people think, and they are on the rise,” said Barry Lundquist, president of the CDA. “Just as the economy has faltered, more responsibility is falling on the individual wage earner to make decisions about how to protect themselves and their families and to shoulder more of the cost burden. Because ultimately all financial security results from one’s income, it’s imperative that people plan and protect against an income-limiting disability.”

The CDA’s 5th Annual Long-Term Disability Claims Review analyzed private and public long-term disability claims data and identified continuing and emerging disability trends among U.S. workers. Sixteen CDA member companies, the top disability insurance companies representing more than 75 percent of the commercial disability insurance marketplace, submitted proprietary claim data for inclusion in this year’s study.

The Claims Review found that CDA member companies paid $8.1 billion in ongoing disability insurance payments to disabled individuals in 2009. CDA member companies approved long-term disability insurance benefits for 141,000 new individuals, down one percent from last year as insured lives in 2009 decreased by 2.2 percent, reflecting the impact of the broad economic picture, according the CDA.

The leading cause of disability continues to be musculoskeletal and connective tissue disorders, such as back pain and joint and muscle disorders, but cancer and nervous system claims trended up slightly from a year ago. For the first time in three years cardiovascular and circulatory problems registered increases.

Despite the record number of people receiving disability payments, the 2010 CDA Claims Review reports that roughly 100 million workers have no private income protection insurance. In addition to the decline in the number of insured, fewer employers provided group long-term disability programs in 2009.

New claim applications submitted to the Social Security Disability Insurance (SSDI) program continued to surge in 2009. More workers are applying for SSDI claim payments than at any time in history, with new applications totaling 2.8 million in 2009 — an increase of 21 percent, and by far the most ever. New SSDI claims are projected to continue to rise dramatically in 2010. Over 5 percent of the workforce, or 7.8 million workers, were receiving SSDI at the conclusion of 2009.

At the same time, the approval rate for initial SSDI claims continued to decline. The approval rate fell to 35 percent in 2009, representing a continued steady decline from 52 percent 10 years ago. The CDA Claims Review found that 31 percent of individuals receiving private group long-term disability insurance benefits did not qualify for SSDI assistance and 95 percent of claims were not job-related.

According to the Claims Review’s qualitative data, member company representatives report few effects on private disability claims resulting from the economic downturn of 2007–2009. CDA member company future concerns center on the possible impact and uncertainty of the economy, regulatory environment and the residual impact of health care reform.

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Breast Cancer Reconstruction Using Cell-Enriched Fat Grafts Shows Continued High Rates of Physician and Patient Satisfaction at 12 Months

Interim results from a breast reconstruction trial show stem and regenerative cell-enriched fat grafting resulted in a high sustained rate of physician and patient satisfaction and persistent improvements in overall outcomes of the procedure at six and 12 months.

Improvements in outcomes previously reported in 30 patients at six months were confirmed in a larger sample of 51 patients at six months. These improvements were sustained for the first 30 patients to reach the 12-month evaluation period.

The European trial, referred to as RESTORE 2, is sponsored by Cytori Therapeutics and enrolled a total of 71 patients. The fat grafts in the study were enriched with stem and regenerative cells using Cytori’s European-approved Celution® 800 System. The interim data reported today was presented at the Fifth Winchester-Jersey Masterclass in Oncoplastic Breast Surgery at the Royal Hampshire County Hospital.

Interim results from the RESTORE 2 trial demonstrated a high rate of physician and patient satisfaction at six and 12 months:

  • Overall physician satisfaction with treatment results was 84% at six months in 51 patients
  • Overall physician satisfaction with treatment results (90%) persisted in the first 30 patients at 12 months
  • Overall patient satisfaction with treatment results was 73% in 51 patients measured at six months
  • Overall patient satisfaction with treatment results (70%) persisted in the 30 patients at 12 months

“Medical research has found that untreated partial mastectomy defects negatively affects patients’ psychology and quality of life,” said Dr. Eva Weiler-Mithoff, M.D., co-principal investigator for RESTORE 2 at the Glasgow Royal Infirmary. “With reconstruction, patients are less likely to feel depressed or stigmatized and more likely to appreciate the treatment of breast cancer.”

“A woman is not cured until she is reconstructed. Unfortunately for most patients, few options are available and there is currently no accepted standard-of-care for breast reconstruction,” added Dr. Rosa Pérez Cano, co-principal investigator for RESTORE 2 and Chief of Plastic Surgery Services at Hospital Universitario Gregorio Marañón, Madrid, Spain. “These interim results are encouraging as we see consistent improvements in breast deformity, breast symmetry and tissue elasticity.”

Cell-enriched breast reconstruction is a new procedure that addresses the unmet need created by partial mastectomy. This approach uses a woman’s own fat tissue combined with her own naturally available adipose-derived stem and regenerative cells to form a ‘cell-enriched’ fat graft, which is used to reconstruct the affected breast.

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This Father’s Day, Dads Need Health Insurance

A new study by the Institute for Women’s Policy Research (IWPR) and the Center for Economic and Policy Research (CEPR) reveals some bad news for men: they are a majority of non-elderly adults in the United States who lack health insurance, according to an analysis of the 2009 March Current Population Survey.

One in five men ages 18-64 – about 21.2 million –are uninsured, compared with 17.2 million women in the same age group. This gap in coverage is consistent across various demographic groups.

The group most likely to lack health insurance is younger, unmarried men—but men are less likely to have health insurance than women at every age range.

Married men lack health insurance in greater numbers than married women before the age of 65, with 18.4 percent of married men between the ages of 26 and 34 lacking insurance.

“This disparity in health insurance between men and women is a serious problem for families,” said Dr. Heidi Hartmann, President of IWPR. “With so many men lacking health insurance, I can think of no greater gift for fathers this year than the security of knowing that they will have coverage in case of illness. Men are often bread-winners for their families, and family members often depend on them for access to health insurance.”

The data show that men stand to gain the most from health-insurance reform, with 4 million more men than women ages 18 to 64 uninsured in the United States across age and marital status.

View the Fact Sheet here: http://www.iwpr.org/pdf/A142.pdf

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HHS Secretary Kathleen Sebelius and U.S. Attorney General Eric Holder Send Letter to State Attorneys General On New Outreach and Education Efforts to Combat Medicare Fraud

U.S. Secretary of Health and Human Services Kathleen Sebelius and Attorney General of the United States Eric Holder today sent a letter to state attorneys general urging them to work with HHS and federal, state, and local law enforcement officials to mount a substantial outreach campaign to educate seniors and other Medicare beneficiaries about how to prevent scams and fraud beginning this summer. The outreach campaign is another step in the ongoing work of the Health Care Fraud Prevention Enforcement Action Team (HEAT), a cabinet-level initiative launch by HHS and DOJ in May 2009.

“We are heading into the week when our first tax-free $250 donut hole rebate checks will be mailed out to Medicare beneficiaries who have fallen into the coverage gap. Accordingly, we are especially concerned about fraud and increased activity by criminals seeking to defraud seniors – and we are seeking your help to stop it,” said Secretary Sebelius and Attorney General Holder in the letter. “Building on our record of aggressive action, we will use the new tools and resources provided by the Affordable Care Act to further crack down on fraud.”

In the letter, the Secretary and Attorney General outline education and outreach efforts where state attorneys general could make a big difference. These include efforts to cut the cut the improper payment rate, which tracks fraud, waste and abuse in the Medicare Fee for Service program, in half by 2012; a series of regional fraud prevention summits around the country over the next few months; regular health care fraud task force meetings to facilitate the exchange of information with partners in the public and private sector, and to help coordinate anti-fraud effort; HHS’s plans to double the size of the Senior Medicare Patrol and to put more boots on the ground in the fight against Medicare fraud; and a new educational media campaign this summer to educate Medicare beneficiaries about how to protect themselves against fraud.

The full letter follows.

June 8, 2010

Dear Attorney General:

It was a pleasure to have the opportunity to speak with you and your staff a few weeks ago. We wanted to send you a letter summarizing our discussions and following up with some suggestions of ways we can work together to protect the American people from health care fraud.

In the two months since the Affordable Care Act was signed into law, we have made substantial progress on providing better choices for consumers, tackling health care costs, and holding insurance companies accountable. But while we have been hard at work, scam artists and criminals continue to profit from misinformation about the Affordable Care Act.

Since early April, we have heard increasing reports about seniors being asked to provide their Social Security numbers in order to receive a “donut hole” check under the new law, raising concerns about potential identity theft scams. We have fielded consumer complaints about phony insurance policies, and our Senior Medicare Patrols have been receiving a growing number of calls from people across the country reporting potential fraud schemes.

We are heading into the week when our first tax-free $250 donut hole rebate checks will be mailed out to Medicare beneficiaries who have fallen into the coverage gap. Accordingly, we are especially concerned about fraud and increased activity by criminals seeking to defraud seniors – and we are seeking your help to stop it.

The President has asked us to reach out to you and to other federal, state, and local law enforcement officials across the country to mount a substantial outreach campaign to educate seniors and other Medicare beneficiaries about how to prevent scams and fraud. Some important components of these outreach and education efforts, where you and your staff could make a big difference, are described below.

First, the President has directed the Department of Health and Human Services (HHS) to cut the improper payment rate, which tracks fraud, waste and abuse in the Medicare Fee for Service program, in half by 2012.

Second, following on the National Health Care Fraud Summit we co-hosted in Washington earlier this year, the President has asked both our Departments to convene a series of regional fraud prevention summits around the country over the next few months. The first summit will take place in Miami on July 16. Other summits will follow in, for example, Los Angeles, Las Vegas, Detroit, Boston, New York, and Philadelphia.

These summits will bring together top federal and state officials; representatives of federal, state, and local law enforcement; representatives of our agencies; the health care provider community, such as hospitals and doctors; local businesses; the Senior Medicare Patrol; caregivers; and seniors, for a day of panels and training sessions. Your expertise and experience will be instrumental to the success of these events.

Third, at the Attorney General’s request, the Acting Deputy Attorney General has sent a memo to every United States Attorney in the country asking them to convene regular health care fraud task force meetings to facilitate the exchange of information with partners in the public and private sector, and to help coordinate anti-fraud efforts. Most of these meetings will be held quarterly, with some exceptions for smaller districts. All 93 U.S. Attorneys have been asked to put a plan into place and schedule their first meeting by August 16, 2010. We hope that you and your office will take part in these regular exchanges on effective fraud fighting strategies.

Fourth, HHS will be doubling the size of the Senior Medicare Patrol and putting more boots on the ground in the fight against Medicare fraud. Since 1997, HHS and its Administration on Aging have funded Senior Medicare Patrol projects to recruit and train retired professionals and other senior citizens about how to recognize and report instances or patterns of health care fraud. Close to three million Medicare beneficiaries have been educated since the start of the program, and more than one million one-on-one counseling sessions have taken place with seniors or their caregivers. Currently, the Senior Medicare Patrol program funds projects in every state, the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands.

Fifth, the Centers for Medicare & Medicaid Services, in conjunction with the Administration on Aging, will be launching an educational media campaign this summer to educate Medicare beneficiaries about the importance of staying vigilant with their personal Medicare information and getting the facts out about the new law so that scam artists are not able to prey on seniors.

The more we can educate the American people about fraud prevention, the better chance we have to protect taxpayer dollars and the Medicare trust fund. The Affordable Care Act also contains some important new tools and resources that will directly help law enforcement officials crack down on fraud.

As you are well aware, fraud schemes have plagued public and private health care plans for decades. Fraudsters have been stealing billions of dollars a year from Medicare, Medicaid, and private health insurers. A year ago, our Departments joined forces to combat fraud in federal health programs. Through the establishment of the Health Care Fraud Prevention Enforcement Action Team (HEAT), we have expanded special anti-fraud Medicare Fraud Strike Forces into seven cities, developed sophisticated new techniques of fraud prevention data analysis, and redirected program integrity resources to fraud hot spots.

Building on our record of aggressive action, we will use the new tools and resources provided by the Affordable Care Act to further crack down on fraud. These include new criminal and civil penalties, enhanced information technology to track and prevent fraud in the first place, and new authorities to prevent bad actors from billing Medicare and Medicaid. HHS has already issued the first set of fraud prevention regulations required under the new health law. These regulations strengthen provider enrollment requirements to ensure we have the ability to better identify, screen, and audit providers and claims.

As we do our part in Washington, we want to work closely with you and other state officials to fight fraud. In that vein, the Affordable Care Act also strengthens state officials’ ability to detect and root out Medicaid fraud. For example, the law provides new access to Medicaid data for the Secretary of HHS that will help both states and the Administration to coordinate anti-fraud activities and gives states greater incentives and flexibility in identifying and collecting Medicaid overpayments. It also helps to promote enhanced information technology to track and prevent fraud, including predictive modeling techniques that can identify abusive or fraudulent billing patterns, audits, and a shared provider database for pre-enrollment screening and post-enrollment anomaly monitoring.

Securing health care coverage, affordability, and choices for Americans requires hard work and vigilance. We stand ready to serve as a resource and partner for you as we work together to fight fraud, implement the provisions of the new health reform law, and strengthen our health care system.

Sincerely,
Eric Holder
Kathleen Sebelius
Attorney General
Secretary of Health and Human Services

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Five Steps for Making Sure a Health Crisis Doesn’t Mean Financial Ruin

A serious long-term illness or disability can have devastating, often irreversible, effects on a family’s financial well-being, according to Allsup, a nationwide provider of Social Security disability representation and Medicare plan selection services. In fact, the support of friends and family members are the most relied on financial support resources, according to a recently completed poll Allsup conducted among people with disabilities.

Specifically, the poll found that during the time people were awaiting their Social Security Disability Insurance (SSDI) benefits, they relied on the following resources for support:

Resources Tapped while Awaiting SSDI Benefits
Friends or family providing support 42%
Spouse’s income 33%
Government assistance such as Supplemental Security Income or food assistance 33%
Sale of personal items 26%
Personal savings 20%
Credit cards 17%
401(k), IRA or other retirement savings 15%
Private charitable assistance 10%
Home equity line of credit 7%

The low reliance on personal savings may be in part because most people are not financially prepared to have their employment interrupted, even briefly. For example, studies have found that more than 60 percent of workers live paycheck to paycheck, and the U.S. Department of Commerce reports that the personal savings rate in March was just 2.7 percent of after-tax income.

So, what can someone do to ease the financial risks if they are one of the millions of people who must stop working each year because of a serious health condition?

“First, have hope because there are things you can do to take control,” said Paul Gada, personal finance director for the Allsup Disability Life Planning Center.

According to Gada, seeking help is essential. “Many people are afraid and overwhelmed. Asking for help is a sign of strength and being your own best advocate can help you feel more in control.”

Among the first steps people with serious health conditions or their caregivers should take quickly are:

  • Create a financial plan. The plan should focus on establishing a budget and making certain you are spending down your assets in the least harmful way. Generally, this means using your savings or other resources before withdrawing from retirement accounts that could trigger a penalty or using high interest rate credit, which will have you paying off interest for years.

    “Sometimes it is unavoidable to use these higher cost resources, but before doing so people should actively pursue other types of public or private assistance that may be available to them,” said Gada.

  • Contact your mortgage company or landlord. As part of this, identify housing assistance programs. For example, the U.S. Department of Housing and Urban Development (HUD) has programs to assist with mortgage modifications, as well as rental assistance that can lower housing costs drastically. However, there are waiting lists, so it’s important to sign up as soon as possible.

    “People are often reluctant to reach out to their mortgage company or their landlord, they start missing payments, and the foreclosure or eviction process starts before they finally explain the situation,” says Gada. “By that time, it may be too late.”

  • Seek assistance with utilities, food and other necessities. Conserve your resources by finding assistance to help you cope. There are hundreds of federal, local and private resources available in most communities. These can range from neighborhood food pantries to federally funded programs, such as Low Income Home Energy Assistance Program (LIHEAP). Local phone companies provide reduced-rate support for home phone service. Associations such as the American Cancer Society and the National Family Caregiver Association also offer guidance.

    Many more people indicate they are considering assistance than are actually securing this assistance, according to the Allsup Disability Finance poll. Specifically, respondents reported that they had considered or attempted to get assistance from many types of programs, including:

Assistance Programs Considered or Used
Food stamps 52%
Prescription drug assistance 44%
Utility assistance 36%
Medicaid 36%
Food pantry 29%
Free health clinics 25%
Rent assistance 20%
Free meals for children (school, etc.) 12%
Local property tax exemptions 6%
Women, Infants and Children (WIC) nutrition 5%
Emergency aid (United Way, etc.) 5%

“These findings indicate that people may not understand the various programs that are available and how to apply, or they may not meet the income thresholds initially for programs with these requirements, but could later on as they spend down their assets,” said Gada. “It can be overwhelming and people too often give up. Unfortunately, this can take an even greater toll on their finances as they turn to credit cards or retirement savings because they don’t understand what programs are available to assist them.”

Allsup offers information and links to many of these resources on its website.

  • Secure healthcare coverage. Continuing medical treatment is vital. Among the options are COBRA through your former employer, a spouse’s plan or other private coverage, such as through the health insurance exchanges being established as part of the healthcare legislation enacted earlier this year. Compare plans closely to make sure you are getting the coverage needed and that you understand the costs. Additionally, if you must take expensive prescription drugs, check if the pharmaceutical company offers a prescription-drug assistance program.
  • Pursue income sources, including SSDI. If you have paid into the Social Security Disability Insurance program, you may be eligible for benefits. If you are eligible, it’s essential to apply quickly as it can take up to two years or more to be approved. Gada advises seeking help with your SSDI application to speed the process. For example, people with disabilities represented by Allsup are significantly more likely to receive SSDI benefits at the initial level.

“It’s heartbreaking to hear of people with serious illnesses and disabilities unable to work and struggling month after month to pay for food or medical costs until they’re financially wiped out,” Gada said. “It shouldn’t be that way. There are steps people can take, but they need to ask for help and know how to get it.”

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Is Obesity is a Disease of the Brain?

“Sodium-laced and commercially cooked food which make up more than 60% of the average American’s daily diet is every bit as addicting as heroin or cocaine,” says Dr. James Cocores, a leading food researcher and nationally recognized addiction expert. Dr. Cocores is Visiting Clinical Assistant Professor of Obesity Neuroscience, Department of Psychiatry, University of Florida College of Medicine & McKnight Brain Institute, Gainesville, FL.

Dr. Cocores has dedicated the past 20 years to researching the impact of food on the brain and its link to obesity. Dr. Cocores says, “At the root of overeating, poor health and obesity is the power of processed foods — most of our diet — to actually biologically and neurologically addict us to food. This happens through the exact identical process as drug addiction and takes place in the same section of the brain — the “pleasure center” or nucleus accumbens that causes heroin or cocaine addiction.

This breakthrough, that provides the first credible explanation for the obesity epidemic is described in Dr. Cocores’ landmark, white paper “The Salted Food Addiction Hypothesis may explain overeating and the obesity epidemic” published in “Medical Hypotheses” Journal (2009;73: 892-899). He is also the author of Bright Foods – Discover the Surprising Link Between Food and Learning, Memory, Mood, and Performance (amazon.com).

The underlying neurological reason that foods are addicting is actually simple: Because over salted and cooked (processed) foods—“addictive food”—yield the largest “mg” strength of opiate drug in the pleasure center of the brain, and accelerates overeating (“progression”) and calorie consumption (“tolerance”). That means hunger and appetite are symptoms of addictive food withdrawal, and the sick feeling associated with overdoing it at an all the addictive food you can eat drug-den is actually a drug overdose. Therefore, one of the solutions to Addictive Food Dependence’s most famous symptom, obesity, is a gradual addictive food detoxification employing non-addictive or medicinal foods. The result is sustained weight loss, and improvement in focus, energy and contentment.”

For years we have been trying to treat obesity as if we were dealing with fuel consumption and efficiency. “Thinking outside this fat-box requires taking extra steps plus a little round trip down the rabbit hole. We must completely refocus our efforts to understand the biology of food addiction that creates the same compulsion to overeat that’s provoked by the same mechanism (and behavior) in the brain that causes drug addiction. Understanding how the brain’s pleasure center sensitizes your brain to “abuse” or overeat certain processed foods is essential,” stated Dr. Cocores. Dr. Cocores is treating patients, consulting and writing to help guide food companies, governments and patients as they redirect their efforts to deal with the obesity epidemic in the U.S.

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Medicare to Participate in State Multi-payer Health Reform

The Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS) have invited states to apply for participation in the Multi-payer Advanced Primary Care Practice Demonstration, an initiative in which Medicare will join Medicaid and private insurers in state-based efforts to improve the delivery of primary care and lower health care costs.

“Advanced Primary Care practices are one of our most promising models for improving the quality of care and bringing down health care costs across the country,” said HHS Secretary Kathleen Sebelius. “By having Medicare participate in these demonstration projects, for the first time ever, we’ll help these innovative models spread and take another big step towards building a health care system that works better for all Americans.”

An Advanced Primary Care (APC) practice, commonly referred to as the patient-centered medical home, is a leading model for efficient management and delivery of quality health care services. APC practices promote accessible, continuous, and coordinated family-centered care utilizing a team approach and emphasizing prevention, health information technology, care coordination and shared decision making among participating patients and their providers.

The demonstration is an opportunity to assess the effect of advanced primary care practice, when supported jointly by Medicare, Medicaid, and private health plans, on:

  • The safety, effectiveness, timeliness, and efficiency of health care;
  • Assuring access and appropriate utilization of services covered by Medicare, Medicaid, and private health plans, while lowering expenditures;
  • The ability of beneficiaries to participate effectively in decisions concerning their care; and,
  • The delivery of care consistent with evidence-based guidelines.

“This demonstration will mark the first time that Medicare, Medicaid and private insurers will join in a partnership with states to transform health care delivery,” said Marilyn Tavenner, acting CMS administrator and chief operating officer. “Enabling public and private providers to work together will provide a valuable opportunity to strengthen our health care system and improve the quality of care for people with Medicare, Medicaid, and private insurance. Improved efficiencies in the system could mean providers will be able to spend more time with their patients, provide higher quality care, and better coordinate that care with other medical professionals.”

To be eligible, states will need to demonstrate that they can meet certain requirements, including having a state agency responsible for implementing the program, being ready to make payments to participating practices six months after being selected for participation, and having mechanisms in place to connect patients to community-based resources.

CMS anticipates making awards to up to six states and will perform an independent evaluation of the projects conducted under this demonstration.

Demonstrations like the Multi-Payer Advanced Primary Care Practice allow CMS to test and validate innovative new models of health care delivery and to translate insights and lessons learned into future policy and program redesign. This demonstration is an example of the sort of programs that CMS will carry out under the Center for Medicare and Medicaid Innovation, which was authorized in the Affordable Care Act and will be in place no later than Jan. 1, 2011. The new center will allow CMS to significantly expand the portfolio of innovative demonstrations that will drive cost effectiveness and quality improvement in the health care system during the coming years.

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Henry Ford Study: Synthetic Peptide May Regenerate Brain Tissue in Stroke Victims

A synthetic version of a naturally occurring peptide promoted the creation of new blood vessels and repaired damaged nerve cells in lab animals, according to researchers at Henry Ford Hospital in Detroit.

“This successful experiment holds promise for treating clot-induced strokes in humans,” says study lead author Daniel C. Morris, M.D., senior staff physician in the Department of Emergency Medicine at Henry Ford Hospital. “Neurorestorative therapy is the next frontier in the treatment of stroke.”

He will present the findings June 3 at the Annual Meeting of the Society for Academic Emergency Medicine in Phoenix.

Dr. Morris explains that the researchers added the synthetic peptide Thymosin beta 4 to a group of drug treatments – including statins – used for neurorestorative therapy to activate repair mechanisms which mimic cellular changes that occur in the early stages of brain development.

This research follows an earlier study, reported by the same team in March, which found that Thymosin beta 4 improved neurological function after stroke in adult rats by increasing the formation of protective myelin around nerve fibers in brain cells.

These experiments conclude that the peptide repairs and regenerates stroke-injured brain tissue.

The results of the first study also were similar to other research using the peptide to regenerate damaged heart, corneal tissue and wound repair.

In the latest study, adult rats were dosed with Thymosin beta 4 one day after they were subjected to a blockage in the cerebral artery, then given four more doses, once every three days. Rats treated only with saline were used as a control group.

After eight weeks, the Thymosin beta 4 group showed significant overall improvement compared to the control group.

The researchers concluded that the peptide improved blood vessel density as well as promoted a certain type of immature brain cells called oligodendrocyte progenitor cells to differentiate into mature oligodendrocytes, which produces myelin to protect axons in nerve cells.

In addition to Dr. Morris, the Henry Ford research team included Michael Chopp, Ph.D.; Li Zhang, M.D.; and Zheng Gang Zhang.

Thymosin beta 4 is produced by RegeneRx Biopharmaceuticals.

The study was funded by the National Institutes of Health.

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