The pay for performance model also proposes to include a number of disincentives as part of the system. Examples of these would be not receiving payments for medical errors as well as cost increases. The goal of the pay for performance model of health care payments and rewards is to encourage an improvement in the quality of care provided as well as the efficiency of the overall health care system.

This system has been tested in a number of different health care systems including both large and small service providers. While these studies have shown some improvements within very specific circumstances, including an increase inefficiency, there has been no measurable decrease in cost. The reason for this is being linked to a higher amount of administrative tasks necessary to put the system into place. Other issues that are being seen with this model is how the quality of care is measured as well as the amount of autonomy and privacy between patients and physicians.

There are a number of different types of plans offered by Medicare Advantage. The four most common types include Special Needs Plans, Private Fee-for-Service plans, Preferred Provider Organization plans as well as Health Maintenance Organization plans. All of these plans differ slightly in the way their costs are structured as well as the amounts of out of pocket costs as well as monthly rates.

The private insurer will charge the consumer a set monthly premium and through Medicare Advantage, each month Medicare will pay a fixed amount of that monthly premium cost. While the amount that Medicare pays monthly is fixed, the individual insurance companies can vary in the amount of care costs including emergency and non-emergency care and out of pocket costs. Any plan provided by a private insurance company will have to adhere to the same services offered by Medicare parts A and B, however the amount of service covered does not need to be the same.

As with the majority of health care practices within the nation’s health care system, the goal of this type of management is to provide the patient with the highest quality of care while maximizing the cost savings. Case management focuses on a single patient rather than a large group of patients with similar health issues. The patient’s case is commonly managed by a single case manager who works with a number of other social workers in a number of agencies with the goal of coordinating knowledge and efforts in order to expand the necessary services that are offered to the patient. Through coordinated efforts case management works to create a care plan that is personal and specialized for each individual patient. Through evaluation followed by adjustment, this management technique is improved with each case.

There are a number of different goals that disease management hopes to achieve. There have been sources who have linked the practice to possibly reducing health care costs, however that goal is less focused on when it comes to this practice. The first and foremost goal is to minimize the negative side effects of the disease, as well as improve the patient’s overall quality of life. In many cases disease management communities or networks will focus on one or a couple of chronic diseases that affect a fairly large amount of the population. Some of the most common chronic diseases that utilize this health care practice include obesity, asthma, osteoporosis, coronary heart disease, hypertension, sleep apnea, chronic obstructive pulmonary disease, as well as a number of other common sicknesses.

The foreground for this type of health care organization originated with the study of how doctors and care givers within a hospital work together. Through this the realization was made that this group of health care providers worked as a network in order to provide more comprehensive care. The thought then became, how can we made a similar model to this work with physicians and care providers who work outside of a single establishment. From this thought process, the scope of accountable care organizations has begun to focus more on the application of the system when observing health care practices including specialty groups as well as IPAs, or independent practice associations. As with any typeof health care service it is likely that the applications of accountable care organizations will develop and evolve as it is discovered what parts of the system are effective and what parts are inhibiting.

“While other studies have looked at the effect of body weight on treatment outcome for estrogen receptor-positive breast cancer, no one has examined this variable in the HER2-positive subtype, which accounts for about one-third of all breast cancers,” says Dr. Crozier.

Researchers used data from the North Central Cancer Treatment Group N9831 study for their analysis. This phase III randomized clinical trial tested three different options for treatment of early stage HER2-positive breast cancer: chemotherapy alone (Arm A); chemotherapy followed by Herceptin for a year (Arm B); and chemotherapy plus Herceptin, followed by Herceptin for a year (Arm C).

In a review of data from 3,017 patients, researchers found that, considering all three treatment arms together, obese patients — those with a body mass index (BMI) of 30 or more — had worse outcomes than patients with a BMI less than 30, although these trends were not statistically significant.

Researchers then calculated disease-free survival for each study arm for normal weight, overweight and obese patients, and found that patients fared best in Arm C. In this arm, the difference between BMI and outcome was not statistically significant, Dr. Crozier says. Herceptin was powerful enough to provide an equal benefit in patients with vastly varying body weights, she says.

“We are continually searching for approaches that will help our patients have the best outcome possible after their diagnosis of breast cancer, and this study suggests that excess body weight may make a difference,” says senior investigator Edith Perez, M.D., director of Mayo Clinic’s breast program in Florida.

The study was funded by the National Institutes of Health, Genentech, Bayer, and the Breast Cancer Research Foundation.

The authors declare no conflicts of interest.

“This study adds to the observation that smoke-free workplace laws help reduce the chances of having a heart attack, but for the first time we report these laws also reduce the chances of sudden cardiac death,” says Richard Hurt, M.D., director of Mayo Clinic’s Nicotine Dependence Center. “The study shows that everyone, especially people with known coronary artery disease, should avoid contact with secondhand smoke. They should have no — literally no — exposure to secondhand smoke because it is too dangerous to their health.”

Dr. Hurt played an instrumental role in the passage of smoke-free ordinances in Olmsted County and the state of Minnesota. He says evidence from this new study will strengthen efforts by the Global Smoke-Free Worksite Challenge, a recently formed tobacco control advocacy collaboration that debuted at a Clinton Global Initiative event. The Challenge will encourage other countries and employers to expand the number of employees able to work in smoke-free environments.

“We are going to use this information to help us convince corporations — convince countries — that this is the right thing to do to protect the health of their workers and their citizens,” Dr. Hurt says.

The study draws data from the Rochester Epidemiology Project, a long-term, collaborative medical records project among health care providers in Olmsted County. The project makes Mayo Clinic one of the few places in the world where retrospective population-based studies are possible and allows researchers at Mayo Clinic to zero in on the frequency of certain conditions.

“This study underscores once more the importance of monitoring heart disease in communities in order to understand how to enhance cardiovascular health,” says Véronique Roger, M.D., director of Mayo Clinic’s Center for the Science of Health Care Delivery, who leads cardiovascular disease surveillance through the Rochester Epidemiology Project.

The population-based study showed that during the 18 months before Olmsted County’s first smoke-free law for restaurants was passed in 2002, the regional incidence of heart attack was 212.3 cases per 100,000 residents. In the 18 months following a comprehensive smoke-free ordinance in 2007, in which restaurants and workplaces became smoke-free, that rate dropped to 102.9 per 100,000 residents — a decrease of about 45 percent. Additionally, during these two time periods, the incidence of sudden cardiac death fell from 152.5 to 76.6 per 100,000 residents — a 50 percent reduction.

“Our findings provide support to the life-saving effect that smoke-free legislation can have among community members affected by these laws,” said co-author Jon Ebbert, M.D., associate director of Mayo Clinic’s Nicotine Dependence Center

Other Mayo study authors are Ivana Croghan, Ph.D., Darrell Schroeder, Susan Weston and Sheila M. McNallan.

The SMP program is operated by the Administration on Aging (AoA) in close partnership with CMS and the HHS Office of Inspector General. In June 2010, CMS announced funding for the SMP expansion initiative in conjunction with President Obama’s appearance at a senior center in Wheaton, Md., along with HHS Secretary Kathleen Sebelius. The 2011 grants will provide additional funds for SMPs to increase awareness among Medicare beneficiaries about how to prevent, detect, and report health care fraud. Increased funding levels for states identified with high-fraud areas will support additional targeted strategies for collaboration, media outreach and referrals. The Administration on Aging will continue to administer these grants in partnership with CMS.

“This demonstrates AoA’s and CMS’ shared commitment to educate beneficiaries so they can protect themselves and Medicare as a whole,” said Assistant Secretary for Aging Kathy Greenlee. “I thank the Centers for Medicare & Medicaid Services for their continued partnership in this effort to educate seniors about health care fraud.”

The SMP volunteers work in their communities to educate Medicare beneficiaries, family members, and caregivers about the importance of reviewing their Medicare notices, and Medicaid claims if dually-eligible, to identify errors and potentially fraudulent activity. Program volunteers also encourage seniors to make inquiries to the SMP Program when such issues are identified, so that the project may ensure appropriate resolution or referral.

Since 1997, HHS has funded Senior Medicare Patrol projects to recruit and train retired professionals and other senior volunteers about how to recognize and report instances or patterns of health care fraud. More than 4 million Medicare beneficiaries have been educated since the start of the program, through more than 1 million one-on-one counseling sessions with seniors or their caregivers. More than 25 million people have already participated in community outreach education events.

The Senior Medicare Patrol is just one way HHS is working to fight fraud and strengthen Medicare. In FY 2010, more than $4 billion was returned to the Medicare Hospital Insurance Trust Fund, the U.S. Department of the Treasury, and others as a result of enforcement activities targeting false claims and fraud perpetrated against government health care programs. The Affordable Care Act provides additional tools and resources to fight fraud in the health care system by providing an additional $350 million over the next ten years through the Health Care Fraud and Abuse Control Account. In addition, the Affordable Care Act toughens sentencing for criminal activity, enhances screenings and enrollment requirements, encourages increased sharing of data across federal and state governments, expands overpayment recovery efforts, and provides greater oversight of potential abuses.

Physicians traditionally check for gout by using a needle to draw fluid from affected joints and examining the fluid for uric acid crystals. Dual-energy CT scans were recently modified to detect the crystals, and the study found the scans “very accurate” in identifying patients with gout, says lead researcher Tim Bongartz, M.D., a rheumatologist at Mayo Clinic in Rochester, Minn.

“We wanted to really challenge the new method by including patients who were only a few days into their first flare of gout,” Dr. Bongartz says.

Dr. Bongartz notes that CT scans are significantly more expensive than the standard test for diagnosing gout. He also cautions that, while highly accurate overall, in one subgroup of patients studied — those with very acute gout — the CT scan failed to identify 30 percent of cases. The new tool is most helpful when joint fluid cannot be obtained or the fluid analysis comes back negative even when gout is strongly suspected, he says.

Siemens Medical Solutions provided software to be used on one of the systems involved in the study and provided partial salary support through an unrestricted research grant to the CT Innovation Center.

Researchers studied two groups of 1,155 adults each, all from the same community: one set with a new diagnosis of rheumatoid arthritis, the other without the condition. Based on gender and birth year, each person was paired with someone from the other group, and the medical records of each duo were examined over time for new fractures unrelated to cancer or severe trauma. In women and men with rheumatoid arthritis, new fractures were more likely than in their counterparts, regardless of their age when they were diagnosed with rheumatoid arthritis.

Women under 50 when diagnosed with rheumatoid arthritis were more likely than their counterparts without the condition to have their first new fracture even before age 50. While men with rheumatoid arthritis were also more vulnerable to fractures, that danger didn’t grow until they got older.

“Understanding what contributes to the risk for fractures for all with rheumatoid arthritis, including young women, would help us better prevent them,” says lead researcher Shreyasee Amin, M.D., a rheumatologist at Mayo Clinic in Rochester, Minn. Women under 50 with rheumatoid arthritis need to know that even though they are young, they need to take greater care to prevent fractures, she says.